Meeting documents

To elect a Chairman of the Committee for the remainder of the year 2018/19.

Resolved:-

That Bill Pipe be elected as Chairman for the 2018/19 year.

Apologies for absence were received from Councillors David Jones and Tim Morris. Councillor Mike Lovell attended the meeting as a substitute for Councillor Tim Morris.

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

Cllr Alison Reed declared a general interest as an employee of the Dorset Healthcare NHS Foundation Trust.  She also declared that she was a registered patient at the Abbotsbury Road Surgery where she also facilitated service delivery in her role as a District Nurse.  She confirmed that she would take further advice from the Monitoring Officer should the closure of Abbotsbury Road Surgery be discussed due to her employment at this surgery.

Councillor Peter Shorland declared a general interest as a Governor of Yeovil Hospital.

Councillor Ray Bryan declared a general interest as a Governor of the Dorset Healthcare University NHS Foundation Trust.

Councillor Kevin Brookes declared a general interest as a Governor of Dorset County Hospital NHS Foundation Trust and he advised that his son was a patient at Abbotsbury Road Surgery, Weymouth.

Councillor Nick Ireland declared a general interest due to his wife's employment at Yeovil Hospital.

Councillor Bill Batty-Smith declared a general interest as a governor of the Dorset Healthcare University NHS Foundation Trust.

To confirm and sign the minutes of the meeting held on 15 June 2018.

The minutes of the meeting held on 15 June 2018 were confirmed and signed.

Public Speaking

There was one question received at the meeting in accordance with Standing Order 21(1).

There were 14 public statements received at the meeting in accordance with Standing Order 22(2).

Public Participation was conducted in relation to Item 7 - Report regarding the work of the Dorset Health Scrutiny Committee Task and Finish Group Re: Clinical Services Review and Item 10 - Glucose Monitoring Device for Individuals with Diabetes.

The question and statements are attached as an annexure to these minutes.

Councillor Nick Ireland raised the issue of censorship of part of a statement submitted by Mr Chris Bradey and asked for confirmation that this decision had been taken under paragraph 21(2)g of the Constitution.  He considered the majority of the statement to be factual and had been highlighted in the local press.

The Monitoring Officer confirmed that paragraph 21(2)g had been relied upon in this instance.  Questions and statements were published on the website in advance of the committee meeting and in the absence of a chairman prior to the meeting, he had not been happy for the Council to publish derogatory information concerning the former chairman on the website.  However, a ruling on whether it would be appropriate for this material to be read out could be made at the meeting by the Chairman. Following discussion with the Chairman he confirmed that it was the decision of the Chairman that the relevant section of Mr Bradey's comments should not be read aloud at the meeting.

Statements by Councillor Ray Nowak, Councillor Colin Huckle, Councillor Gary Suttle and Claudia Sorin in relation to Item 7 were read aloud by the Chairman.

Cllr Bill Trite addressed the Committee and asked the CCG to confirm whether in the area of Swanage and nearby villages, the number of people who would be put at risk of death as a result of longer travel times, would be the same, greater or lower than was presently the case.  He made reference to the comments of Councillor Gary Suttle, Leader of Purbeck District Council and the letter from Richard Drax, MP for South Dorset.

A statement by Councillor Suttle, Leader of Purbeck District Council,  read out by the Chairman, offered his sincere apologies for being unable to attend the Committee on behalf of Swanage and Purbeck residents.  He said that he would like to reassure residents of Purbeck and Swanage in particular that his views had not changed and that he had nothing to add to the evidence that he gave on behalf of residents at the evidence session of the Task & Finish Group.

Petitions

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

To consider a report by the NHS Dorset Clinical Commissioning Group (attached).

The Committee considered a report by the NHS Dorset Clinical Commissioning Group (CCG) that outlined the processes followed to determine the local NHS prescribing arrangements for the flash glucose monitor, Freestyle Libre®.

The report was introduced by the Head of Medicines Optimisation who outlined the timelines for the decisions that had been made since 2015.

She stated that an application for use in children had been made by Paediatric consultants at Poole General Hospital (PGH) and Dorset County Hospital (DCH) to the Dorset Medicines Advisory Group in September 2018 and a decision would be made that day.

Members highlighted the longwinded nature of the processes involved that would benefit up to 200 patients based on the current criteria. The necessary data collection to provide the evidence would not be onerous and they questioned why a trial was necessary when it was already available on prescription in Wales and Ireland.  It should not be a postcode lottery and access should not be restricted for Dorset residents.

The CCG Head of Medicines Optimisation explained the formulary and approvals processes used in Dorset.  She confirmed that an application for use by children had only recently been received and that this cohort had not been excluded.

Members felt that young people, in particular, would engage and benefit the most from using this device and it would help in setting out a lifestyle in which they could manage their condition at an early stage. 

Whilst appreciating the trials and processes, members wished to know how much longer it would take for residents to get access to the device when neighbouring counties had gone through a similar process and had reached a conclusion.  They noted that the process appeared to be longwinded in light of the trials that had already taken place in other counties and that Diabetes UK had estimated that there were approximately 4,469 people with Type 1 Diabetes living in Dorset.

Members were informed that the decision on adults had been made and that a system of education and specialist initiation was currently being put in place. A decision in relation to use of the device by children was imminent.

It was confirmed that this was not a trial, but a period of 6 months to assess whether the device worked for a limited number of individuals and submitting data to national data collections.  This was being overseen by the National Institute for Health and Care Excellence (NICE) who recognised that there was limited trial evidence, only 1 of which concerned children. The data would be available in February / March 2019 and a reassessment of whether it should be released into primary care would take place at that point. 

Members considered that attention to the timescale available to people would be critical in some instances, however, they were informed that there was no evidence to suggest that using the device would change long term outcomes, particularly if patients were already measuring blood glucose levels.

Despite these reassurances, members could not understand why  ...  view the full minutes text for item 37.

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

The Committee considered a report providing an update on the work of the Task & Finish Group - Clinical Services Review (CSR).

The Chairman of the Task & Finish Group presented the report and explained that the Group had spent much time learning and listening from the public and from the NHS commissioners and providers.  A great deal had been achieved from these meetings and he thanked those involved for their input.  He confirmed that, as a result of the two meetings, a clear explanation for some of the issues had been provided. 

The Dorset Clinical Commissioning Group (CCG) had listened and had answered the Group's questions that arose following the meeting with the public representatives.  This had ultimately led to the recommendation outlined in the report and it was important to keep talking and to trust the committee to work on a way forward to achieve what the public wanted.

In future it was anticipated by the CCG that ambulance times to the Royal Bournemouth Hospital (RBH) would be much quicker due to the major road improvements in that area and that this would assist in reducing ambulance journey times. The Group had also been promised that the Swanage ambulance station would remain open 24/7, fully manned with ambulances. There were also additional new ambulance vehicles in the pipeline for Dorset.

The Chairman of the Group emphasised that the NHS needed to improve and that this would come about by some of the changes proposed in the CSR.  The £147m funding for PGH and RBH would be essential elements in improving care for residents across the whole County.

The Group therefore recommended to continue to negotiate with the CCG to do what was right and to make the case on behalf of residents.

Following the introduction, the CCG Chief Officer read from a statement which is attached as an annexure to these minutes.  In summary, he highlighted the following points:-

·            All parties acknowledged the financial pressures and the unsustainability of the current system. 

·            Dedicated NHS staff were going above and beyond to provide services that were not sustainable.

·            The CSR plans had been backed by NHS organisations in Dorset and were underpinned by the Sustainability and Transformation Plan approved by local authority partners in Dorset.

·            Centres of excellence and care closer to home would improve patient care and was an evolutionary process that could not be implemented until such time safe services were in place. 

·            That the CSR plans had been subject to various governance process, including the Dorset Health Scrutiny and Joint Health Scrutiny Committees. 

·            That further work was ongoing with the South Western Ambulance Service NHS Foundation Trust (SWAST) in relation to ambulance travel times and that the focus of the CSR concerned getting a patient to the right place the first time and dedicated emergency care on one site with a 24/7consultant led service. 

·            33,000 patients currently attend A&E where there was no consultant on site.

·            That paramedics may spend a significant time providing medical assistance on  ...  view the full minutes text for item 38.

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

Resolved

That Kevin Brookes be appointed as the substantive member and that David Walsh be appointed as the reserve member to the Joint Health Scrutiny Committee on the NHS 111 Service provided by South Western Ambulance Service NHS Foundation Trust - future remit to include emergency transport provision.

The Deputy Director of Service Delivery, NHS Dorset Clinical Commissioning Group will provide a verbal update and answer any questions regarding progress with the implementation of a new Integrated Urgent Care Service.

This item was deferred for consideration at a future meeting.

To consider a report by the Head of Primary Care of the NHS Dorset Clinical Commissioning Group (attached).

This item was deferred for consideration at a future meeting.

To consider a report by the Chief Operating Officer of the Dorset County Hospital NHS Foundation Trust (attached).

Resolved

That the matter be delegated to the Committee Chairman and that consultation is requested on this matter.

To consider a report by the Chief Executive of the Dorset County Hospital NHS Foundation Trust (attached).

The Committee considered a briefing paper on progress following a decision by the NHS Dorset CCG to retain 24/7 Obstetric and inpatient paediatric services at DCH as part of an integrated service across Dorset in order to provide members with an overview of the progress being made in this area.

The Chief Executive of DCH advised that detailed work had commenced based upon the Maternity Transformation Plan attached to the report.  Sign off of elements of the plan was ongoing and there was not yet a public facing document.

During the first phase in April 2019 a business case for 24/7 obstetric care at RBH and DCH would be produced to show how much the service was likely to cost.  The second phase would look at an integrated approach for children's services for 0-25 year olds in conjunction with the local authority looking at health needs, education, housing as well as other influential determinants of health.  This phase had been delayed as the team had been busy working on a community paediatric model, and in addition, the Dorset County Council's Children's Social Care team had requested a year to do the groundwork due to work associated with an Ofsted inspection. 

Members asked about the status of the former proposal to work with Somerset CCG.  They were advised that the Somerset CCG had commenced its own CSR and that commissioners and providers in Dorset had been invited to attend some of their workstreams.  She confirmed that once a decision was made in Dorset, the door would remain open to Somerset to allow for the provision of sustainable services.

In response to a question, the Chief Executive confirmed that although not in competition with Yeovil to deliver the service, that Somerset CCG had published a case for change and were looking to develop a single service for Somerset, however, no further details were known at this stage in order to assess the implications for DCH.

The CCG Chief Officer stated that the CCG had not yet made a decision and had asked Yeovil and DCH to come back with proposals that would need to go through the correct processes including public consultation and the relevant health scrutiny committees.

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.

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

Liaison member updates from Bill Pipe (NHS Dorset Clinical Commissioning Group) and Nick Ireland (Dorset Healthcare University NHS Foundation Trust) would be circulated to members via e-mail.

To answer any questions received in writing by the Chief Executive by not later than 10.00am on 12 October 2018.

There were no questions submitted under Standing Order 20(2).           

The glossary had been provided for information.