Meeting documents

Apologies for absence were received from Stephen Lugg, Peter Oggelsby, Alison Reed and Tim Morris.

 David Jones declared a general interest as a governor of Poole Hospital NHS Hospital Trust. As this was not a disclosable pecuniary interest he remained in the meeting and took part in the debate.

Bill Batty-Smith declared a general interest as his granddaughter was employed at Dorset County Hospital. As this was not a disclosable pecuniary interest he remained in the meeting and took part in the debate.

Ray Bryan declared a general interest as a Governor of the Dorset Healthcare University NHS FoundationTrust. As this was not a disclosable pecuniary interest he remained in the meeting and took part in the debate. 

To confirm and sign the minutes of the meeting held on 13 November 2017 and 20 December 2017.

The minutes of the meeting held on 20 December 2017 were confirmed and signed.

It was noted that the minutes of the meeting on 13 November 2017 had been circulated with the agenda in error and had been confirmed and signed at the meeting on 20 December 2017.

Arising from the minutes of the meetings held on 13 November and 20 December 2017, Councillor Beryl Ezzard commented that the minutes had not provided a clear explanation of the reasons why there had been a reversal of the decision to refer the proposals contained in the Clinical Services Review to the Secretary of State for Health.

The Chairman explained that the criteria for a referral to the Secretary of State for Health had not been met and that dialogue continued with the Dorset Clinical Commissioning Group (CCG) and therefore any referral at that stage would have been premature.

Public Speaking

Two public questions and one public statement were received at the meeting in accordance with Standing Order 21(1) and 21(2).  All public participation at the meeting related to minute 6 in respect of the Clinical Services Review (CSR). The questions, answers and statement are attached as an annexure to these minutes.

Cllr Jon Orrell, County Councillor for Weymouth Town, addressed the Committee, stating that it was his view that Local Government Reorganisation had been organised into two distinct areas in order to protect the interests of Dorset outside of the Bournemouth and Poole conurbation and in the same way, the Dorset Clinical Commissioning Group could not be relied upon to look after the interests of the whole of Dorset due to its geography. He stated in Weymouth & Portland, the 4 most deprived areas of Dorset including Underhill, Westham, Melcombe Regis and Littlemoor would lose the most beds under the CSR proposals.  He referred to a review by the National Audit Office which had concluded that the loss of NHS beds would create a shift of people into social care and subsequently burden local authority finances. Effective scrutiny arrangements would be necessary in future to ensure that the County Council received an adequate proportion of the health and social care funding in order to look after people at home. 

Petitions

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

To consider a report by the Transformation Programme Lead for the Adult and Community Services Forward Together Programme.

The Committee considered a report concerning appointments to committees and other bodies following the resignation of a member of the Committee.

Resolved

That the following appointments be agreed:-

• Joint Health Scrutiny Committee on the NHS Dorset Clinical Commissioning Group Clinical Services Review - Nick Ireland (David Jones - Reserve Member)
• Joint Health Scrutiny Committee on the NHS 111 Service provided by South Western Ambulance Service NHS Foundation Trust - Beryl Ezzard
• Liaison Member for South Western Ambulance Service NHS Foundation Service NHS Trust - Beryl Ezzard
• Lead Member for Dorset Health Scrutiny Committee for Child and Adolescent Mental Health Services - Bill Pipe

Reason for Decisions

To support the County Council's aim to help Dorset's citizens to remain safe, healthy and independent.

To consider a report by the Transformation Programme Lead for the Adult and Community Services Forward Together Programme.

The Committee considered a report that updated members on the discussions and resolutions relating to the decision by the Dorset Health Scrutiny Committee to refer the Clinical Commissioning Group's (CCG) proposals for changes to service provision to the Secretary of State for Health. 

The report was introduced by the Health Partnerships Officer who explained that, although the Joint Health Scrutiny Committee (JHSC) did not support a referral to the Secretary of State for Health, it had agreed that further scrutiny of the capacity and performance of the ambulance service was necessary.  This would be undertaken by another Joint Committee already established to look at the NHS 111 service and a meeting would be convened in due course.

Councillor Nick Ireland stated that there was a public perception that the Dorset Health Scrutiny Committee (DHSC) was not fulfilling its duties and that changes to the Clinical Services Review proposals had taken place as a result of campaigning rather than the direct involvement of the Committee.  He noted that the retention of maternity services at Dorset County Hospital were as a result of withdrawal from discussions by the Somerset CCG. He considered that the residents in Purbeck would be disadvantaged with worse travel times in 9 out of 10 cases. Furthermore, these timings did not take account of waiting times in the ambulance on arrival at Dorset County Hospital.  He proposed that there was a reversal of the decision made by the Committee on 20 December 2017 and that the proposals in the Clinical Services Review (CSR) were referred to the Secretary of the State for Health.

Responding to the proposal, the Chairman stated that evidence and justification would be required in order to make the referral and that there was no evidence to suggest that communication had broken down with the CCG.

Members debated the proposal with some of the view that there had been insufficient engagement with the CCG and a lack of evidence that the proposed changes would result in better health services for Dorset residents.  They also noted that the proposals outlined in the CSR had recently been accepted for a Judicial Review.  It was suggested that a working group could consider any further evidence and assess whether the criteria for a referral to the Secretary of State had been met.

Legal advice was sought on this point and the Solicitor confirmed the requirement to establish whether the threshold for a referral had been met in the first instance. 

Some members considered that a referral could be made based on criteria in relation to the adequacy of the consultation and the proposals not being in the interests of the health service in the area, however, they accepted the need to consider further whether the evidence met this threshold before proceeding with a referral.

The Health Partnerships Officer informed the Committee that there had been engagement with the CCG for a period of two years prior to the formal consultation period.  The Joint Health Scrutiny Committee (JHSC) had submitted  ...  view the full minutes text for item 6.

To consider a report by the Deputy Director - Urgent and Emergency Care, NHS Dorset Clinical Commissioning Group.

The Committee considered a report by the NHS Dorset Clinical Commissioning Group (CCG) and received a presentation by the Transformation Delivery Manager on the Dorset Integrated Urgent Care proposals.

Members asked whether the plan included greater utilisation of assets for extended periods during the day or night rather than the existing reliance on staff availability.  They were informed that this was being considered as part of a project in relation to the urgent treatment centres and providing a consistent offer that included access to diagnostic testing.  This project also sought to address the challenges of having staff in the right place to operate the specialist equipment.

Members also heard that it was hoped to introduce online GP consultations by December 2018 in conjunction with the 111 service, subject to the outcome of a procurement process. The expected timeframe for the call handler to refer users to an appropriate provider would be dependent on the clinical input by the Clinical Assessment Service (CAS) with the aim being to provide a seamless service. There remained challenges to be overcome concerning demand and capacity, that could be partly mitigated by GPs being able to answer calls when needed.

The Executive Director of Healthwatch stated that the proposals outlined new models of care that represented a significant variation of service that would require further scrutiny.  The consultation had been very limited and inadequate and the Equalities Impact Assessment had also fallen short of what an appropriate assessment should be and should therefore be subject to further scrutiny.

The Committee was advised that this was a nationally mandated service and that a communications plan was in place to clearly articulate the arrangements once the contract was awarded.

Members asked about the urgent element of improving access given the noticeable loss of GP services and were advised that this concerned extending the hours of primary care from 6.00pm to 8.30pm Monday to Friday and to have a consistent offer irrespective of where people lived.

The greater use of technology to monitor health at home was also questioned and members were informed that technologies including Skype were continuously being considered in the context of its safe usage.

Resolved

That a further report outlining the concerns of Healthwatch in relation to the Integrated Urgent Care Service proposals is considered by the Committee at its meeting in June or September 2018.

Reason for Decision

To support the County Council's aim to help Dorset's citizens to remain safe, healthy and independent.

To consider a report by the Commissioning Manager, Partnerships (attached).

The Committee considered a report presented by the Commissioning Manager for Partnerships, Dorset County Council Adult and Community Services, concerning a member led inquiry day into mental health in Dorset on 13 December 2017.  The key issues arising from group sessions held on the day had been described in the report and included:-

• consistency - differences in level/scope of services
• accessibility - the need to look at accessibility of services the lower end of the mental health spectrum.
• the continuing negative profile of mental health
• the lack of person-centred recovery support

The intention would be to integrate the findings of the inquiry day into the business as usual work of the operational and commissioning teams with an additional recommendation to create a joint commissioning group with the CCG and integrate with the mental health acute care pathway.  This work had received a high level of support from local authority partners.

New models of care that met the needs of the community and ensured the correct levels of support were currently being investigated.  The existing model of shared accommodation was inefficient and no longer considered to be appropriate.  The Council was therefore working with local authority partners to provide alternative solutions that allowed people to live independently in their own homes. 

Members noted that 50% of candidates in the youth parliament had campaigned on mental health issues and that help for young people at an early stage would be beneficial for their adult lives over the longer term. 

The current response by dementia services was also being reviewed, particularly early onset dementia, as well as early intervention for carers facing mental health issues due to their role. The admiral nurse model would also be considered as part of this review. 

Noted

To consider a report by the Transformation Programme Lead for the Adult and Community Services Forward Together Programme.

The Committee considered a report concerning a review of Child and Adolescent Mental Health Services (CAMHS) including the scoping document for a proposed Inquiry Day on Monday 21 May 2018.  The scope of the Inquiry Day would now include wider, lower level support, as well as the more intensive CAMHS provision.

An initial planning meeting for the Inquiry Day had taken place, with a further meeting scheduled on 4 April 2018.  Planning for the event was ongoing and some initial invitations had been sent with a good response from those who had been contacted.  Healthwatch was part of the planning group for this event.

Noted

To consider a report by the Transformation Programme Lead for the Adult and Community Services Forward Together Programme.

The Committee noted its work programme and the following additional item:-

• Accountable Care Systems - 15 June 2018, Dorset County Hospital to be invited to this meeting
• Referral to Secretary of State for Health - Report of Task & Finish Group -    15 June 2018 or earlier if practicable
• Urgent Integrated Care Service - date to be advised
• The Dementia Services Review (a briefing in June to be followed by a full report in September).

To consider a report by the Transformation Programme Lead for the Adult

and Community Services Forward Together Programme.  This report includes the following items:-

·        NHS Dorset Clinical Commissioning Group: Assisted Conception Policy

·        NHS England: Modernising Radiotherapy Services in England

The Committee considered a report containing briefings for information concerning the NHS Dorset Clinical Commissioning Group: Assisted Conception Policy and NHS England: Modernising Radiotherapy Services in England.

Noted

To consider any updates from the liaison member for the following;

·         Dorset County Hospital NHS Foundation Trust.

·         Dorset Healthcare University NHS Foundation Trust

·         NHS Dorset Clinical Commissioning Group

·         South Western Ambulance Service NHS Foundation Trust

Councillor Shorland advised that the next meeting of the Dorset County Hospital NHS Foundation Trust would take place in April 2018.

Councillor Nick Ireland updated members on changes in personnel in the Dorset Healthcare University NHS Foundation Trust.

The Health Partnerships Officer advised that she would contact the South Western Ambulance Service NHS Foundation Trust with details of the new liaison member.

To answer any questions received in writing by the Chief Executive by not later than 10.00am on 5 March 2018.

A question was submitted by Councillor Nick Ireland under Standing Order 20 (2) that was considered under minute 4 and is attached in the annexure to these minutes.