Meeting documents

An apology was received from Alison Reed (Weymouth and Portland Borough Council).

There were no declarations by members of disclosable pecuniary interests under the Code of Conduct.

To confirm and sign the minutes of the meeting held on 6 September 2016.

The minutes of the meeting held on 6 September 2016 were confirmed and signed.

Public Speaking

There were no public questions received at the meeting in accordance with Standing Order 21(1).

Mr Williams (Chairman of the Hughes Unit Group Supporters), addressed the Committee in relation to specific points arising from the Care Quality Commission report. He raised concerns over RIO, the record keeping software used by Dorset County Hospital, and suggested that the system was not fit for purpose.

Petitions

There were no petitions received at the meeting in accordance with the County Council’s Petition Scheme.

To consider a report by Nick Johnson, Director of Strategy and Business Development, Dorset County Hospital NHS Foundation Trust.

The Committee received a presentation by the Director of Strategy and Business Development, Dorset County Hospital NHS Foundation Trust, which outlined Dorset County Hospital’s (DCH) organisational strategy.

The Strategy had been developed to take account of and align to the Dorset Clinical Services Review and the Dorset Sustainability and Transformation Plan. It was focussed around delivering the right outcomes for patients so that safe and high quality healthcare would continue to be provided as close to communities as possible. The purpose was to deliver compassionate, safe and effective healthcare.

Members raised concerns over the lack of information in the report. It was recognised that whilst the overall aims of the strategy were sensible, the Committee would need to receive specific details in order to properly scrutinise it, in particular information around travel contingencies for elderly patients in the more rural parts of the County. It was noted that the report did not contain any detail around the changes that would be made or how they would impact on the day to day service delivery. It was agreed that once the specific detail had been developed, a report would be presented to the Committee so that they may scrutinise the proposed plan.

Noted.

To consider a report by Sian Summers, Service Specialist, Specialised Commissioning – NHS England South.

The Committee considered a report by Service Specialist, Specialised Commissioning – NHS England South. The report outlined the aims of the new arrangements for Neonatal Services. It was noted that the changes outlined in the report were not a consequence of criticism of the current services. However, it was felt that the changes were required to ensure safe and sustainable delivery of those services in the future.

The report highlighted the current Neonatal Services’ arrangements and outlined the background and evidence supporting the change in the level of neonatal provision at Dorset County Hospital and described the proposed options for the Neonatal service re-designation. It was noted that there were not sufficient staffing resources available to sustain the current model of service delivery.

Members were concerned that if services at Dorchester were staffed and run by midwives, the new arrangements could potentially mean any babies born at Poole Hospital would then have to remain there until they were ready to go home which would cause issues for families residing at some distance from Poole. It was clarified that there was no intention for the Dorchester unit to be midwife run and that it would continue to be staffed by neonatal nurses and covered by on call paediatric staff and consultants.

Members were also concerned about the availability of ambulances to transfer patients to Poole and the potential risks of delivery en-route.  Reassurance was given that these matters had been considered and plans to mitigate risk put in place.

The Clinical Director confirmed that he would be happy to meet with the Kingfisher Ward campaign group and Members of the Committee, should they wish.

Noted.

To consider a report by Caroline Hamblett, Chief Executive, Weldmar Hospicecare Trust.

The Committee considered a report by the Chief Executive of Weldmar Hospicecare Trust which highlighted the quality accounts for 2015/16. It was produced as a statutory requirement as Weldmar received funds from the NHS and also helped the users of the services and other stakeholders to see how they worked to improve the services provided.

The Committee received a presentation that highlighted the work that Weldmar did and the services they provided. The Chief Executive informed the Committee that the majority of feedback about their services was positive and complimentary. However it was noted that negative feedback was rarely given as families of patients did not wish to appear ungrateful. To ensure that any and all required improvements could be made, Wedlmar were working closely with families and patients to implement improvements wherever possible.

The Committee formally congratulated Weldmar on receiving an outstanding rating from the Care Quality Commission (CQC). It was noted that it was rare to receive such a positive rating and it was a remarkable achievement that Weldmar had managed to do so.

Members raised concerns over available finances and how Weldmar could sustain services if donations and funding streams started to reduce. The Chief Executive confirmed that income had always been unreliable and Weldmar were always looking at different ways to deliver more cost effective and sustainable services.

Noted.

To consider a report by Sally O’Donnell, Dorset Healthcare University Foundation Trust.

The Committee Considered a report by Dorset Healthcare University Foundation Trust which provided an update on progress with the Quality Improvement Plans for Dorset Healthcare addressing the findings for the sixteen core services from the CQC comprehensive inspection as well as the re-inspection of seven core services in March 2016.

The Committee raised concerns over negative feedback received in regards to the current record keeping systems being used. It was clarified that the systems now in place were much better than the previous ones and clinicians found them easier to work with than any other software available. Issues had occurred in the way in which different staff used the system, but a more consistent approach was now being implemented.

Some councillors raised concerns with the criticism of Mental Health Services and in particular that they had not seen any improvement to services for several years despite concerns being raised on numerous occasions. It was clarified that interim changes had now been made to the Senior Leadership Team and all Mental Health Services had been bought back under single leadership in an effort to try and apply a consistent approach for all services.

Noted.

To consider a report by the Interim Director for Adult and Community Services.

The Committee considered a report by the Interim Director for Adult and Community Services which provided an update on the Joint Health Scrutiny Committee - Clinical Services Review following the last meeting of the Committee held in October.

Further meetings of the Joint Health Scrutiny Committee would need to be established towards the end of the CCG’s formal 12 week public consultation period, to formulate a response from the Committee and to review the process after the consultation had ended. In order that stakeholders’ views could be considered prior to the formulation of a response to the consultation, it was suggested that an Inquiry Day be arranged depending on the CCG timescales.

Some councillors suggested that a Task and Finish Group be established to look at the matter in further detail. The Chairman agreed to consider establishing a group at a later date, depending on the outcome of the inquiry day.

Resolved

1.         That members agree to the setting up of an Inquiry Day to coincide with the public consultation to be launched by the CCG.

To consider a report by Paul Rennie, NHS Dorset Clinical Commissioning Group.

The Committee considered a report by NHS Dorset Clinical Commissioning Group which outlined NHS Continuing Healthcare, what is was and the patients who required these packages of care. The report highlighted budget information in addition to statistics relating to service users.

A steering group had been established to look at various different ways of improving care packages in a more cost effective and patient friendly way. The actions from the last meeting of the steering group were included in the report.

Members queried the reduction in the number of individuals receiving Continuing Healthcare funding and the appeals process.  Concern was also expressed regarding delays in the process and the impact this has on families.  It was noted that there has been an increase in people with very high cost packages and that work is being undertaken to look at the care market and cost of placements.

Noted.

To consider a report by the Interim Director for Adult and Community Services (attached).  This report includes the following items:-

·         Quality Account update: Dorset County Hospital

·         Dorset Health Scrutiny Committee Forward Plan

·         Director of Public Health Annual Report 2016

The Committee considered a report by the Interim Director for Adult and Community Services which contained Dorset County Hospital’s Quality Account Update, Dorset Health Scrutiny Committee’s Forward Plan and the Director of Public Health’s Annual Report 2016.

Noted.

On 6 September 2016 Dorset Health Scrutiny Committee received a report by NHS Dorset Clinical Commissioning Group regarding changes to General Practice Commissioning and Locality Working.  The report outlined the changes to commissioning arrangements and the pressures on services and noted that a Primary Care Commissioning Strategy was being developed and would be presented to the Primary Care Commissioning Committee (PCCC) in October 2016.  Members agreed that they would like to receive a further report re the Strategy at their meeting in March 2017. 

However, the publication of the Draft Primary Care Commissioning Strategy in October 2016 has raised concerns as to the nature and scale of changes being suggested within ‘blueprints’ for each Locality, in addition to concerns about the degree to which such changes have been subject to consultation and engagement.  The Dorset Health Scrutiny Committee have therefore invited the Clinical Commissioning Group to send a representative to their meeting on 14 November 2016 to respond to questions.  As these concerns did not come to the attention of the Committee until 10 November it was not possible to include a formal report in the published agenda papers within the required timescales.  It is therefore necessary to add it as a matter of urgency.

To provide context and further information, the Draft Strategy is available to view via the following link;

http://www.dorsetccg.nhs.uk/aboutus/primary-care-strategy.htm

The NHS Dorset Clinical Commissioning Group have also circulated the following statement;

We want to be absolutely clear that we have no plans to close any practices and any claims that we do are inaccurate. We are in fact actively working across Dorset to support practices where they are facing the greatest pressures.

Primary Care faces a number of challenges in the future, and if we continue as we are doing, our workforce and finances could soon become overstretched.

The draft Primary Care Commissioning Strategy and Plan considers how services could be delivered differently to ensure they are safe and sustainable for the future; for example consolidation of sites or back office functions. This draft version of the strategy which is on our website has been circulated to key stakeholders to gain their views.

Our ongoing strategy is to work with local groups of practices to help shape the way in which we will deliver services to meet future population needs. This includes looking at how we would support new models of care.

It is up to individual GP surgeries to decide whether to merge or not as they are independent contractors, we cannot force any change.

We have been listening to the pressures that General Practice faces and it is clear that practices will have to work together and explore new ways of working and looking at transforming the way care is delivered if we want to ensure that services are sustainable in the future.

The Committee considered an urgent item that related to Dorset Clinical Commissioning Group's Draft Primary Care Commissioning Strategy and Plan.

On 6 September 2016 Dorset Health Scrutiny Committee received a report by NHS Dorset Clinical Commissioning Group regarding changes to General Practice Commissioning and Locality Working. The report outlined the changes to commissioning arrangements and the pressures on services and noted that a Primary Care Commissioning Strategy was being developed and would be presented to the Primary Care Commissioning Committee (PCCC) in October 2016. Members agreed that they would like to receive a further report regarding the Strategy at their meeting in March 2017. However, the publication of the Draft Primary Care Commissioning Strategy in October 2016 had raised concerns as to the nature and scale of changes being suggested within ‘blueprints’ for each Locality, in addition to concerns about the degree to which such changes had been subject to consultation and public engagement.

The CCG clarified that what had been published on the website was a draft and not a final proposal. It was made clear that no decisions had been made and no changes had yet been implemented. The draft was currently being debated by General Practitioners and the ‘blueprints’ in the draft were based on national standards. The draft document had been published for discussion and not decisions.

Resolved

That the Committee, considering the draft Primary Care Commissioning  Strategy:-

1.         Evaluates the proposed changes as a major change and thus subject to intervention by the Dorset Health Scrutiny Committee.

2.         Makes the CCG aware of the Committee’s deep regret and displeasure that the CCG did not itself so identify the matter as such and bring it fully to DHSC at an earlier stage.

3.         Believes that the proposed changes could have a devastating effect on rural communities and in areas with a high concentration of elderly people and therefore require further and intensive scrutiny, and to provide for discussion at this meeting a plan for appropriate consultation with the public as required by the Section 242 (18) of the National Health Service Act 2006.

4.         Requires therefore that the CCG provide a formal report and send a representative(s) to a special meeting of the Committee to be held within one calendar month of today’s date.

5.         Requires that the CCG take no irreversible decisions in this matter until after the special meeting.

No questions were asked by members under standing order 20(2).