Agenda and draft minutes

Health and Adult Social Care Overview and Scrutiny Committee - Monday, 29th November, 2021 6.00 pm

Venue: Committee Suite, Civic Centre, Poole BH15 2RU. View directions

Contact: Joseph Tyler  Email: joseph.tyler@bcpcouncil.gov.uk or Email: democratic.services@bcpcouncil.gov.uk

Media

Items
No. Item

164.

Apologies

To receive any apologies for absence from Councillors.

Minutes:

Apologies were received from Cllr K Wilson.

165.

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 C Rigby substituted for Cllr K Wilson.

 

NOTE: Cllrs A Jones, S Phillips and R Rocca joined the meeting remotely via Microsoft Teams. They were all informed of the relevant legislation that meant they would be prevented from voting on any motions that may occur during the course of the meeting.

166.

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:

The Vice-Chair declared, for transparency, that she was an employee of the

University Hospitals Dorset Foundation Trust.

 

Cllr C Johnson declared, for transparency, that she was an employee of the

University Hospitals Dorset Foundation Trust.

 

Cllr C Matthews declared, for transparency, that he was a governor of the

University Dorset Hospitals Trust and that, in relation to item 7 the BCP Carers Strategy, that his wife worked for the Alzheimer’s Society.

167.

Confirmation of Minutes pdf icon PDF 248 KB

To confirm the minutes of the meeting held on 27 September 2021.

Minutes:

The minutes of the meeting held on 27 September 2021 were approved as a correct and accurate record.

168.

Public Issues

To receive any public questions, statements or petitions submitted in accordance with the Constitution. Further information on the requirements for submitting these is available to view at the following link:-

 

https://democracy.bcpcouncil.gov.uk/documents/s2305/Public%20Items%20-%20Meeting%20Procedure%20Rules.pdf 

 

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.

169.

Action Sheet pdf icon PDF 216 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.

170.

BCP Carers Strategy pdf icon PDF 141 KB

Additional documents:

Minutes:

The Director of Adult Social Services (DASS) and the Commissioning Manager: Prevention and Wellbeing introduced and presented the report. The main points were as follows:

 

·       The Adult Social Care (ACS) service were in the process of reviewing the Pan-Dorset strategic vision across the county, with the relevant partners.

·       This process and vision was to reflect the challenges that carer’s face in BCP, for example 11% of all carers are unpaid.

·       The process had included workshops, surveys, meetings with the BCP Carer Reference Group and the Pan-Dorset steering group. Along with the Carer’s Rights Day, held in Kinson, that was attended by three BCP Councillors.

·       The new Carers Strategy survey had been written up and completed and was now ready to be sent out.

·       The Committee were recommended to request an update on the progress of this at a future meeting.

 

The Committee asked several questions following the report. Answers were provided by the Director of Adult Social Services and the Commissioning Manager: Prevention and Wellbeing:

 

·       The Committee heard that it was difficult to identify every unpaid carer in the BCP area, because many do not consider themselves to be an unpaid carer. This was something that the ASC service were working on with their Pan-Dorset and strategic partners to address in order to better reach and inform the unpaid carers in BCP.

·       Members were informed that the ASC service would be asking carers for their feedback on terminology relating to care, including the use of the term ‘unpaid carer’ itself.

·       The Committee heard, following a question on self-directed funding for carers in BCP, that the ASC service provide a lot of different ways of supporting carers, but this must be a key focus area of the strategy. It was heard that the ASC service commission a lot of services on behalf of carers, for example the ‘sitting service’, whereas some authorities pass a direct payment to the individual to purchase this themselves. BCP carers had told the ASC service that they like the Council to commission this service for them. This would lower the amount of people that receive self-directed support.

·       Members were told that BCP as a conurbation contains a large cohort of what is considered ‘elderly’ carers. In comparison to Dorset, BCP has a different client base, in some ways due to the contrast of the urban / rural areas. The Committee heard that BCP do commission some joint areas alongside Dorset, however this strategy would allow for a focus on BCP residents.

·       A member asked about the 22% dissatisfaction rate in regard to support that carer’s had received from local GPs. The Committee heard that it the specific reasons for this were unknown, but it was a signal that the ASC should work more closely with GPs. This was particularly important because a lot of people and carers use their GP as a first port of call. Members were told that if an individual registers as a carer that it will make services available for  ...  view the full minutes text for item 170.

171.

Dementia Services Review pdf icon PDF 738 KB

To receive an update on progress following the Dementia Services Review.

Additional documents:

Minutes:

The Head of Service (Mental Health & Learning Disabilities) Dorset CCG introduced and presented the report. The main points were as follows:

 

·       The Dementia Services Review was implementation from 1 April 2021, however faced great challenge throughout the pandemic.

·       There was a changing diagnostic model with increased capacity that was central to the memory assessment service. This required the introduction of a multi skilled approach that would involve advance care and nurse practitioners. Less complex cases would also go through this process with medical psychiatrist input as well.

·       In the post-diagnostic area, a diagnostic coordinator role had been commissioned. This role was embedded into the primary care service and would specifically follow people from diagnoses to their end of life, monitoring their changing levels of need.

·       Throughout the process there had been ‘memory road shows’ provided.

·       Referrals to the service had plateaued in recent months. This would be monitored going forward.

·       A main aim for the BCP area was to hit the national diagnostic rate of 67% of primary care registers.

·       As part of the covid recovery, the service had been given temporary funding and through this the service was trying to recruit additional employees to catch up on the backlog of referrals. There were challenges in recruiting, but the service now had a full-time medical officer that could provide up to 50 slots a week. It was hoped that this would reduce waiting times.

·       Overall evaluation of the entire model would take place after it had been implemented and working for some time. The key metrics of waiting times, diagnostic rates and the experiences of carers and service users would all be factored into the evaluation. This information should be available at the beginning of the next financial year.

 

The Committee asked several questions following the report. Answers were provided by the Head of Service (Mental Health & Learning Disabilities) Dorset CCG:

·       The committee heard that the service would not see student nurses providing diagnoses as this was a skilled activity, however students could observe assessments as these were undertaken by advance care nurses/practitioners and psychiatrists.

·       Members were informed that the average waiting time for a diagnosis was 16 weeks. This was identified as a prime challenge and the aim was to get this down to 6 weeks with the new full-time medic in place. Interim measures for those waiting for a diagnosis are memory roadshows and carers workshops with dementia coordinators working in primary care. This amount of advice and guidance was to keep communication channels up for people whilst they are waiting for a diagnosis.

·       On the issue of referrals from GPs, members heard that there was now better connectivity between the memory assessment service and the primary care network and GPs.

·       Members heard that within the community dementia service, emphasis was on early intervention in order to prevent people ending up in crisis and potentially hospital admission. The Dementia Coordinator, with support of the intensive support team, works with families to manage positive behaviour and any changes to  ...  view the full minutes text for item 171.

172.

Home First Implementation Review pdf icon PDF 299 KB

For the Committee to receive an update on the outcomes of and learning from the implementation of the full Home First approach across the Dorset Integrated Care System.

Minutes:

The Director of Operations for Adult Social Care introduced and presented the report. The main points were as follows:

 

·       This was the second update on the new Home First model, following its implementation in January 2021.

·       The Home First model stemmed from the government guidance published in March 2020 on hospital discharge service requirements.

·       The programme would assist in the discharge of hospital patients at the earliest opportunity. This would enable to freeing up of hospital capacity and streamline the discharge process, utilising the right staff at the right time and place when necessary.

·       During 2021, the funding continued to be made available to those with enhanced need or new need of care. This funding stream was anticipated to remain up until March 2022. BCP Council continued to provide a dedicated workforce to implement the programme. The multidisciplinary team worked on a 7-day service that enabled people to take best pathway, bespoke to their needs.

·       The service is aware that their systems were struggling, as was common to the national picture, to get people safely discharged from hospital while maintaining the flow in hospitals. The system struggles periodically at times for those people who do not need further hospital bed respite.

·       The challenges and key actions facing the service were: capacity, beds, nursing home beds, more domiciliary rapid response care, communications strategy.

·       The financial impacts were primarily contained within the enhanced need of care for those discharged. The people leaving hospital on average receive 28 hours a week care, this would then be reassessed and on average reduces to 19.5 hours a week. Community cases are usually 14 hours on average. There was generally a greater need and level for care on those being discharged from hospital at present.

 

The Committee asked several questions following the report. Answers were provided by the Director of Operations for Adult Social Care:

 

·       Members acknowledged the brilliant equipment provision service, in particular the speed and level of equipment that was provided to people.

·       The Committee were informed that the service hoped for other family members to be involved in the discharge process discussions, if appropriate. This would enable to service to gather information from the assistance support network that was already there and then factor that into any care provision. Service provision at the point of discharge should be temporary until a long-term plan can be assessed. Members heard that a rapid response from our service if the individual’s plan was not up to scratch would be in place.

·       On the issue of ‘Pathways’, it was clarified that Pathway 2 was for those who would be discharged into a recovery bed, this could be due to a fracture for example, where the individual would receive rehabilitation. Pathway 3 was for very high, complex needs likely for those individuals who would remain in residential care and have longer-term needs. Members were told that these were nationally set definitions.

·       On the issue of performance figures, namely the 250/300 individuals waiting for discharge from hospital, the  ...  view the full minutes text for item 172.

173.

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 Tourism and Active Health and the Director for Public Health Dorset presented the item. The main points were as follows:

 

·       Covid infection rates remained high in BCP but the curve had plateaued over the start of the Winter period.

·       Current rates saw 592 cases per 100,000 of the BCP population in the week leading up to 21 November 2021. This compared to the South West rate of 523 per 100,000 and the English national rate of 428.5 per 100,000.

·       Infection rates remained highest in the younger age groups. Primarily in school-aged children and the parental age group.

·       Hospitalisation rates were rising but remained significantly lower than where they would be without vaccinations. There were currently 97 hospitalisations in BCP relating to Covid.

·       Case rates in BCP were akin to that of the figures in July 2021.

·       Demand for the booster programme was very high and the offer had recently been expanded to over 40s.

·       170,000 booster doses had been delivered across BCP, with around 25,000 taking place per week. This rate saw 45% of eligible population vaccinated.

·       Walk-in clinic slots were being offered to meet the high demand.

·       People could try booking their booster via the national booking service or by waiting to be called by the GP.

·       Trusted Voices and Vaccine ambassadors were continuing to work with communities to deliver impartial information about the vaccination campaign in an attempt to increase the take up rate.

·       Local Outbreak Management Plans were in place and the importance of testing, tracing and isolation were of the utmost importance.

·       EpiCell were producing the near-term forecasts for hospital admission rates over the Winter period. 24 hours, 7 day a week consultant advice was also being made available during the Winter.

·       The outbreaks within care homes were slowly increasing, with 36 open situations in BCP.

·       The #LetsTalkWinter campaign had been created in order to promote wellness and protection against illness/Covid. The key aims included boosting immunity by way of vaccinations, hygiene such as frequent hand washing, obtaining prescriptions in good time, helping and supporting friends and relatives in the community.

·       Supporting schools to stay open, providing targeted assisted lateral flow testing in public locations, extending the local contact tracing partnership until March 2022 and using the Trusted Voices approach and the Let’s Talk Winter campaign to improve communications were all highlighted as key issues and actions for the Winter period.

 

The Committee asked several questions following the report. Answers were provided by the Director of Public Health Dorset and the Portfolio Holder for Tourism and Active Health:

·       The Committee were informed that there was now a ‘pharmacy collect scheme’ in place for people to pick up lateral flow test kits from their local pharmacy or chemist. The scheme required people to obtain a QR code from the national website before collecting a test kit, this was to allow information gathering on the number of kits being requested.

·       Members were told that the Community Testing Program provides assisted testing to those groups  ...  view the full minutes text for item 173.

174.

Forward Plan pdf icon PDF 257 KB

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

Minutes:

Members considered the Committee’s Forward Plan. The main comments and suggestions were as followed:

 

·       The Chair referred members to the recent Budget Café presentation and encouraged them to seek information on this if they had not attended the session. The session provided detailed information on the ASC budget and a breakdown of what the service spends this on.

·       The Chair requested that the All-Age Autism project be added to the Forward Plan for a future date.

·       The Chair referred to the Hospital Infrastructure Plan Update item and requested that an update on this come to Committee shortly.

·       The Committee agreed for responses to the Front Door Service satisfaction survey to be circulated for members’ information.

 

RESOLVED that the Committee agreed the Forward Plan.

Voting: Unanimous.