Agenda and draft minutes

To receive any apologies for absence from Board Members.

Apologies for absence were received from Graham Farrant, Chief Executive BCP Council, Judith Ramsden, Corporate Director, Children’s Services BCP Council and James Vaughan, Chief Constable, Dorset Police.

The Chairman welcomed Jenni Douglas-Todd, Chairman of the ICS for Dorset who was attending as an observer.

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

Julie Fielding attended as substitute from James Vaughan and Julian Radcliffe, Director of Inclusion and Family Services, BCP Council attended as a substitute for Judith Ramsden.

Board Members 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.

Councillor Kieron Wilson reported that he was currently working at the Royal Bournemouth Hospital.

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/ieListMeetings.aspx?CommitteeID=151&Info=1&bcr=1

The deadline for the submission of public questions is Thursday 28 May 2020

The deadline for the submission of a statement is 12.00 noon, Wednesday 3 June 2020.

The deadline for the submission of a petition is 12.00 noon, Wednesday 3 June 2020.

There were no public issues submitted for this meeting.

To confirm and sign as a correct record the minutes of the meeting held on 30 January 2020.

The Minutes of the meeting held on 30 January 2020 were confirmed as a correct record.

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

The Board noted the action sheet as presented.

The Chairman referred to the CAMHS Transformation Update and highlighted the request that a similar report be presented, as soon as possible to the BCP Council Children’s Overview and Scrutiny Committee.

The Board will receive a presentation on Covid 19 to include arrangements for recovery.

The Chairman reported that Covid 19 had led to deaths in the BCP local area and she acknowledged the loss and pain of everyone who had been personally affected and thanked all key workers across all Board partners including NHS staff, care sector staff, police, fire, Council and the voluntary sector who had supported the public through the period.

The Chairman introduced the item and called on Health and Wellbeing Board Partners to outline their response to the pandemic.

The Director of Public Health reported on the number of cases and deaths in the area.  He explained that the local outbreak was characterised by ongoing transmission in clusters associated with high risk settings such as hospitals and care homes – not widespread community transmission. The Board was advised of the Covid 19 command and control structure, how the local approach fed into the regional and national response to the pandemic and in particular the role of the Local Resilience Forum Strategic Co-ordinating Group.

The Vice-Chairman of the Board echoed the comments of the Chairman about the sad loss of life due to the pandemic and the fantastic work done by key workers across Dorset.  He highlighted the focus nationally in terms of the surge in demand for hospital carewhich was being foreseen for the NHS and the need to protect acute hospitals and create critical capacity.  The Board was informed that routine elective care had been stopped but was now beginning to restart.  The Vice- Chairman reported on the temporary building work which had been undertaken in acute settings to manage the flow around sites and keep social distancing in place as much as possible.  The Board was informed of the plans to create additional critical care capacity in Dorset.  The Vice-Chairman reported that outpatient appointments and training had been stopped during the pandemic period. Members were informed that Community Hospitals had played a part in discharging some patients to increase capacity.  The Vice-Chairman referred to ‘hot’ and ‘cold’ sites, the role of primary care GP sites which had all remained open and the support provided to care homes.  The Board was informed of the huge demand for PPE and the requirement to provide equipment for staff to undertake their day to day procedures with supplies being shared across Dorset where needed. The Vice-Chairman reported that PPE had not run out, but it had been ‘close to the wire’ due to demand.  He reported on the testing requirements and the increase in focus with the introduction of public testing and mobile sites across Dorset.  The Board was informed of the level of transformation including the use of technology which had provided the opportunity for staff to work remotely where appropriate, e-consultation and the huge take up of the 111 website.  The Board was informed of the NHS’ concerns relating to the dramatic drop in referrals to non Covid 19 related services such as cancer, children’s and cardiac and the focus to promote the message that the NHS was open  ...  view the full minutes text for item 43.

To receive an update in respect of the above.

The Director of Communities, BCP Council presented a report, a copy of which had been circulated to each Member and a copy of which appears as Appendix 'A' to these Minutes in the Minute Book which summarised the community response activity across Bournemouth, Christchurch and Poole in respect of Operation Shield, Together We Can and the Voluntary and Community Sector.

The Director outlined how Operation Shield worked and that telephone contact had been made with every shielding resident who was clinically vulnerable, or a welfare visit arranged if contact could not be made.  She explained that currently the Council was awaiting advice from the Government on the future arrangements for shielding residents and what support would be provided. 

The Board was informed of the development and operation of Together We Can with the dedicated helpline and volunteer hub.  The services responded to calls for assistance across multiple support areas, as well as making proactive calls to the Operation Shield cohort within the BCP area - assessing need and providing assistance by signposting, providing advice or directly deploying a volunteer to assist. A Board member referred to the hotline and the rapid and efficient response provided to patients that had been directed to the service and that he hoped such a system would continue to operate in the future. A Member asked that if there was any change to the current services provided that this would be communicated.

The Director reported that the future of food parcels was under review and the quality of the food was being feedback to the MHCLG.

Karen Loftus outlined the mobilising of volunteers across the BCP area.  She reported that it was volunteers’ week and arrangements had been made to cheer for volunteers this evening and encouraged everyone to take part to recognise all the work and support being undertaken by volunteers.

RESOLVED that the update provided be noted.

Voting – agreed

To receive an update in respect of the above.

The Corporate Director presented a report, a copy of which had been circulated to each Member and a copy of which appears as Appendix 'B' to these Minutes in the Minute Book which advised the Board that BCP Council Adult Social Care had implemented three easements to the Care Act (2014) under powers granted by the Coronavirus Act 2020.

The Director reported that the easements followed a comprehensive evaluation of service changes resulting from the Covid 19 pandemic undertaken by the Principal Social Worker.  The Coronavirus Act (March 2020) had created the ability for Councils to enact Easements to specific legal duties of the Care Act 2014 at four levels and the BCP Council Easements were at Level 2. The Board was informed that these easements had been introduced because Government recognised that the Covid 19 pandemic had placed unprecedented pressures on adult social care and that the full requirements of the Care Act 2014 may be difficult for Local Authorities to discharge.

RESOLVED that the Health and Wellbeing Board note three easements to the Care Act 2014 introduced by BCP Adult Social Care:

(a)  Assessments for people who are deaf are delayed in some cases because these can only be undertaken face-to-face with interpreters. Further work is in hand to explore whether technology may provide a solution which would allow this easement to be lifted.

(b)  Changes in the provision of Occupational Therapy prescribed adaptations and community equipment provisions in response to suppliers and builders operating a reduced or suspended service. There will be delays to some adaptations and equipment provision but, where appropriate, Occupational Therapy services will arrange interim solutions.

(c)  Day services have been closed in order to comply with social distancing measures.  Their function has been replaced by alternative provision within the community or client’s homes, including information, advice and welfare checks.

Voting – agreed

To receive an update in respect of the above.

The Head of Strategic Planning and Quality Assurance ASC Commissioning BCP Council presented a report, a copy of which had been circulated to each Member and a copy of which appears as Appendix 'C' to these Minutes in the Minute Book which provided an update on progress of the Better Care Fund (BCF) Plan for 2019/20 up until the end of February 2020, including information on the strategic themes and operational schemes and performance against the national BCF Metrics.

The Head of Strategic Planning and Quality Assurance reported on how service delivery had been adapted.  The report highlighted national targets which unfortunately were not being met.   The Board was informed that there had been a particularly difficult winter within hospital settings with an increase in adults going into care homes and with regard to delayed transfers of care winter funds were used to provide extra domiciliary care to aid discharge from hospital.

The report also set out budget issues, including the arrangements for extending existing BCF 75 agreements to include Covid 19 pooled expenditure as a national decision had been taken to provide free funding out of hospital for all patients requiring care and reablement on discharge from hospital.  This fund is being administered by CCGs and there is a national requirement to put in place a Section 75 agreement to govern this fund. It was proposed that authority be delegated to the Chair and Vice-Chairman to sign off the revised BCF 75 agreements.

The Head of Strategic Planning and Quality Assurance reported that a national programme of work was taking place led by NHS England to consider changes to the BCF from 2021 onwards. 

In response to a question from the Chairman the Head of Strategic Planning and Quality Assurance reported that there was national and local interest in the discharge to assess model whilst emphasising the need to understand the user experience and to take the opportunity to look at new models.

Sally Sandcraft, CCG reported that there has been a considerable amount of transformation with opportunities for learning and great partnership work in respect of new models of care and ways of working.  She acknowledged that there would be implications on how partners engaged with other sectors and used collective resources to enable that to happen.  Ms Sandcraft highlighted the need for complete packages of support in primary and community settings emphasising the work undertaken in providing wrap around support for care homes and moving forward with these achievements.

Jan Thurgood, Corporate Director endorsed the comments on the partnership working and the learning process from Covid 19.  She reported on the close working with the adult social care representatives of the sector and thanked the sector for the work undertaken by providers with statutory partners. She also highlighted the need to think about the shape of the ASC sector market going forward.

RESOLVED

(a)  That having considered the delivery of the plan and performance the report be noted.

(b)  That authority be delegated to the Chair and  ...  view the full minutes text for item 46.

To receive an update in respect of the above.

Jan Thurgood, Corporate Director presented a report, a copy of which had been circulated to each Member and a copy of which appears as Appendix 'D' to these Minutes in the Minute Book on the development of the coronavirus care home support plan.

The Corporate Director highlighted the impact across communities and in care homes of the sad loss of life due to Covid and in particular for the families and staff who have been affected. She wanted to recognise the tremendous contribution, effort and professionalism of all care staff and leaders and to thank them for all their work.

The Board was informed that the Government had announced on 14 May 2020 a national care home support package.  She explained this required Councils, NHS and care providers to work together to develop the Local Care Home Support Plan.  The Plan was designed to prevent the spread of Covid 19 into and within Care Homes and would cover issues such as PPE, accommodation available in care homes, how staff were used, clinical support given to care homes and testing available for residents and staff. The Corporate Director reported that a draft plan had been submitted regionally to NHS England and Local Government on 29 May 2020.  She explained that the plan would be published when a process of regional and national evaluation had been completedin the coming weeks. The Corporate Director reported on the provision of PPE and that all Care Homes were reporting that they had sufficient PPE which was a mark of the collective work undertaken across the Local Resilience Forum, the Council and the sector.  The Board was informed that the Government had made available resources through the infection control fund which would be passported to the Adult Social Care sector, 75% of the funding to care homes for infection control measures for staff with 25% allocated based on local discretion.

The Director of Public Health reported on national testing in care homes and the registration of care homes for testing kits.

Sally Sandcraft reported that in terms of the NHS there was a strong recognition of the need to support care homes.  She explained that the key strategy was how to identify those who were most vulnerable and to provide the necessary care they need. Ms Sandcraft reported on the acceleration of the work programme of enhancing support in care home.  She reported on the prescriptive nature of the NHS England advice which had proved challenging.  Sally reported that the LRF chair would now be provided with the clinical lead for each care home which fits alongside the proposal for a Primary care network to be aligned to each care home in the BCP area.

The Chairman referred to the nature of the tests which seemed to be very invasive and the frequency of testing in care homes.  The Director of Public Health commented and informed the Board that testing cannot be done in care homes without supporting them and understanding the context.  He explained  ...  view the full minutes text for item 47.

To receive an update in respect of the above.

The Board received a presentation from Julian Radciffe, Director Inclusion and Family Services, BCP Council on the SEND LGA Peer Review. 

The Director reported that the Council had invited this 4-day review which was held at the end of January 2020.  He explained that the team had been helpful and came with broad experience.  The Board was advised of the process of the review as detailed in the presentation which included self-evaluation, document and data review, review of EHCPs and interviews with all partners, focus groups and visits.  The Director outlined the areas of review.

He explained that there was a multi-agency approach in respect of the SEND provision.  The Board was referred to a series of recommendations from the LGA report and how they were themed.  The Director reported on some of themes which included that EHCPs were a real concern and there had been challenge on communication and engagement with all partners and in particular parents, carers, children and young people, co-production and the ability to develop new solutions, challenge on schools and whether they were sufficiently inclusive and joint commissioning work.  The Director reported on how the recommendations were being dealt with and the role of the Send Development Transformation Board.  He explained that the LGA recommendations had been included in the Send Development Plan and outlined the workstreams.  The Board was informed that there was a really strong sense of a local area partnership, a significant amount of work had been undertaken in respect of inclusion for those with complex SEND needs and to ensure that children had the best education experience, work was on going in respect of the process for EHCPs acknowledging there had been delays, significant progress was being made on the preparation of children and young people for adulthood including maintaining local arrangements,  the capacity of BCP schools had been extended to provide for children with complex needs, joint commissioning was moving with some pace and there was progress in engaging parents and carers on co-production.

Sally Sandcraft reported on the absolute commitment to continue to work with the Council and make faster progress and that the NHS recognises the need to grow capacity.  She reported that there was currently a recruitment exercise for an additional designated clinical officer which would help with the above activities. Ms Sandcraftreported on obvious links around the learning from care education treatment reviews, the development work and how we review the effectiveness of the behaviour pathway.

Councillor Moore thanked officers for all the hard work being put into improving SEND services and requested feedback to the Board and the Children’s Overview and Scrutiny Committee on the needs of Children and Young People and how they were being supported.

The Chairman asked that the LGA Peer Review team be thanked for the support and work in undertaking the Review.

RESOLVED that the presentation be received and noted and it be acknowledged that regular SEND update reports would be submitted to the Board.

Voting – agreed

To receive an update in respect of the development of the Forward Plan.

The Board considered the latest forward plan.

The Chairman reported that the meeting on 17 June 2020 would be cancelled and rescheduled.  She referred to the Local Outbreak Management Plan that was required and the need to arrange a meeting at short notice.  She also referred to the development session for the Local Plan and Housing Strategy and that the timing for the session was being considered.

RESOLVED that the Forward Plan be received and noted.

Voting – agreed

Local Outbreak Management Plan

The Director of Public Health reported on the national requirements for the development of a Local Outbreak Management Plan to be in place by the end of June.  He referred to the statutory responsibilities of Directors of Public Health and the 7 themes that would be reflected in the Plan.  The Board was informed that the final theme was around governance arrangements and the requirement for a public engagement board.  It was proposed that the Health and Wellbeing Board in each area would be used to carry out this function with the sign off of the plan in early July and some discussion on how the Board could function quickly as the public engagement board.  The Director of Public Health, in response to a question, commented on the need to consider the membership of the proposed board.

RESOLVED that the above approach and direction of travel be supported and arrangements be made for a meeting of the Board in early July 2020.

Voting – agreed

Note – in addition to the items contained within the agenda the Chairman agreed to the above item being included as a matter of urgency in order to comply with the deadlines to produce a Local Outbreak Management Plan.