Meeting documents

Apologies for absence were received from Councillor Ray Bryan, Councillor David Jones and Helen Coombes (Transformation Programme Lead for the Adult and Community Services Forward Together Programme).

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

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

Councillor Bill Batty-Smith 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.

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

To confirm and sign the minutes of the meeting held on 17 October 2018.

The minutes of the meeting held on 17 October 2018 were confirmed and signed.

Arising from the minutes, the Liaison Member for the South Western Ambulance Service NHS Foundation Trust advised that she had circulated an update to the Committee following the previous committee meeting.

Public Speaking

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

Two public statements were received at the meeting in accordance with Standing Order 21(2).  The statements are attached as an annexure to these minutes.

In response to a statement by Ms Debby Monkhouse, which was read aloud by the Chairman in her absence, it was confirmed that the Committee would write to the Secretary of State for Health and Social Care.  This letter would state that:-

·      the Committee was aware of the representation made to the Secretary of State by Bournemouth Borough Council in opposition to the Dorset Health Scrutiny Committee's referral;

·      the Dorset Health Scrutiny Committee had received a counter representation from Ms Monkhouse (which would be attached to the letter); and

·      it remained the Dorset Health Scrutiny Committee's position that the CCG's proposals would cause added risk to life and that the proposals for staffed community services were unproven, as detailed in its submission.

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 (attached).

The Committee considered a report by the Transformation Programme Lead for the Adult and Community Services Forward Together Programme following an Inquiry Day held on 13 July 2018.

Councillor David Walsh, who chaired the Inquiry Day, explained how the initial focus on Child and Adolescent Mental Health Services (CAMHS) had been widened to incorporate lower level support and mental wellbeing.  Invitations had been sent to around 80 organisations with 40 people attending on the day.  The event had begun with a compelling account by a young person regarding her experience of being unwell and needing the support of mental health services to recover.  This had been helpful in setting the context for the day which was structured around the 4 elements of the "Thrive Model" for mental health.

A presentation was given by the Senior Commissioning Manager (Mental Health) - NHS Dorset Clinical Commissioning Group (CCG) and the Assistant Director, Commissioning and Partnerships, Dorset County Council (DCC) that set the context and importance of the Thrive Model and the challenges ahead.  These were described as follows:-

1.    Getting advice: building and promoting resilience, self-help, advice and signposting for children going through temporary difficulties, and sitting below NHS mental health services.

The challenges were around the range of different offers across the county, services disappearing due to lack of funding leading to changes in service delivery; adequate confidence and skills in the workforce in dealing with mental health issues; capacity in other services, lack of understanding of CAMHS, recovery education model and whole school approaches to mental health, for example, physical activity to support wellbeing.

2.    Evidence based support: ie getting on the right pathway on diagnosis of a condition including CAMHS, social services and other different types of therapy.

The challenges in this area included workforce understanding of wider CAMHS services, inappropriate referrals, signposting to other services, developing the offer for children's emotional health and wellbeing within schools following the recent Government Green Paper.

3.   Getting more help in the community or in hospital.

Challenges were around children having treatment outside Dorset, a lack of tier 4 beds for acutely unwell young people (which was a national problem,) out of hours CAMHS services and supported housing and care packages at the time they were needed.

4.   Getting risk - more complex support

The challenges included increasing workforce skills particularly for self- harming, multi-agency risk plans with shared responsibility and accountability and joint commissioning between the CCG and other partners to refocus services around the Thrive Model.

The Committee was provided with an update on how activity across the County sat alongside the local transformation plan which had been refreshed in October 2018 and now described the Thrive Model in a much clearer way, including the challenges and opportunities.  The new care models would enable a more joined up approach to commissioning and providing adequate pathways.

The Thrive Model was the perfect conduit to shape further services so that NHS expertise was accessed much earlier as outlined in the recent government  ...  view the full minutes text for item 52.

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) setting out the approach that has been taken in Dorset.

Members were informed that the National Suicide Strategy had come into force in 2016. The umbrella pan-Dorset Plan covered the 6 key themes from the National Strategy with all organisations signed up to the Plan which included a commitment from Dorset HealthCare to achieve zero suicides within in-patient units.  Each organisation had its own governance and would develop its own plan to cover the areas that it could influence.  Overall governance would be via the CCG Integrated Community Care Service Programme Board and the local authority Health and Wellbeing Board.

An event on Monday 26 November 2018 relaunched the suicide prevention work and gathered views from attendees including the need to widen input from the community; the need to focus on families, carers, friends (who spot warning signs); the focus on making meaningful lives or helping to build better lives and the need for one aspirational suicide prevention plan for the whole County.

Next steps involved:-

·        quarterly meetings of the Steering Group - each organisation would attend with set agenda items and the theme for each meeting decided at the previous meeting;

·        a first meeting of the Steering Group in March 2019 would focus on lived experience and putting people as the central focus of the work;

·        support from the CCG to develop the wider partnership group to support the Plan and enable the reach across Dorset.

The Chairman asked whether the views expressed at Monday’s event would be taken forward in the development of the Strategy and it was confirmed that all of the views from the groups who attended had been noted and would not be discounted.  The Steering Group meeting in March would set the agenda for the whole year, with some suggestions becoming meeting themes. Suggestions had also been made to include community safety teams, the RNLI and coastguard in the Steering Group.

Councillor Ireland, who attended the event, considered this a very useful meeting with great enthusiasm and buy in by the parties who were there and a consensus of agreement on the areas where there were gaps in provision.  He felt it was important to understand that people presented through different routes such as housing and to include these as areas of focus to better identify those at risk.

A member commented that having a plan with a lot of stakeholders involved was different from delivering on the plan.  She drew attention to the difference in the approach taken if someone did not indicate that they were feeling suicidal despite the fact that they might feel suicidal on a different occasion.  There were also difficulties in getting back into the system once a patient had been discharged.  Questions were asked in relation to access to mental health services as a result of routine depression screening at GP surgeries and how suicide risk was picked up in children.

It was confirmed that  ...  view the full minutes text for item 53.

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

The Committee considered a report that included annual reports on behalf of the Committee and also that of Healthwatch Dorset.  The Committee's annual report represented a formal record of discussions during the past year that would be shared with the Health and Wellbeing Board.  It was usual practice to consider the work programme for 2019-20 at this stage, however, it had been felt necessary to postpone this discussion until after March 2019 when the new Dorset Council would come into being.

The Manager of Healthwatch Dorset informed the Committee of the following current areas of interest to Healthwatch:-

·    Transfers of Care and the "Home from Hospital" project:-

This project would follow the experiences of individual people on discharge from hospital, the aim being to track the ongoing support that needed to be met and offer the perspective of the person's journey rather than the care pathway.  Soon to be discharged people had already been recruited in Bournemouth with Dorset County Hospital and Poole Hospital to follow in the New Year.  Healthwatch had found that people were very keen to talk to them and visits would be offered to a person's home or by telephone.  It was hoped that this would provide a wider picture of whether the packages of care were in place as well as the enablers and barriers.

·    Access to primary care services for people in care homes

Access to NHS services was a right of every citizen and this did not change for a person living in a care home.  However, the reality was that there were greater problems in accessing services from a care home.  Starting with dental services, Healthwatch had been in touch with every care home in Dorset to ask about this.  The draft report had been sent to NHS England who commissioned dental services as well as local authorities, the Dorset Care Homes Association and Partners in Care.  Responses to the report were due by Christmas 2018 and would be published alongside the report in January 2019. 

·    Young people's emotional health and wellbeing

Although there was no separate project at the moment, Healthwatch was keeping a watching brief and actively wished to support carrying through the recommendations from the Inquiry Day. 

·    Involvement of local people in the shape of future health care services in Dorset, relating to changes to services resulting from the Clinical Services Review (CSR).

The primary interest of Healthwatch was in local people having accessible information about the proposals for change and opportunities for people to have their say and for their views to be incorporated into the decision making process.  Healthwatch had offered regular support to NHS organisations over the past 4 years in consulting with the public.  There was general support for the direction of travel behind the proposals and also significant anxiety of the potential effect of the changes in some parts of the County that had resulted in campaign groups.  Whilst making no judgement on the views expressed, Healthwatch applauded them for organising themselves and giving  ...  view the full minutes text for item 54.

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

The Committee considered a report by the Transformation Programme Lead for the Adult and Community Services Forward Together Programme that provided the forward plan for the last scheduled meeting of the current Health Scrutiny Committee prior to the inception of the new Dorset Council in April 2019.  A briefing on the health and housing item had been attached to the plan following a meeting between officers and Councillors Kevin Brookes and Tim Morris.

Resolved

1.    That the Forward Plan for the meeting to be held on 7 March 2019 outlined at Appendix 1 be noted; and

2.     That the approach for the scrutiny of Housing and Health in 2019 suggested at Appendix 2, Section 4.2 be agreed and considered at the meeting in June 2019.

Reason for Recommendation

To enable the Committee to fulfil its current duties to support the health and wellbeing of Dorset's citizens and to make best use of opportunities for scrutiny.

To consider a report by the Transformation Programme Lead for the Adult and Community Services Forward Together Programme.  This report includes the following items:-

·        Mental Health Rehabilitation Review

·        Review of Musculoskeletal Physiotherapy Services

The Committee considered a report containing briefings for information concerning

the following topics:-

·      Review of Mental Health Rehabilitation Services (NHS Dorset CCG)

·      Review of Musculoskeletal (MSK) Physiotherapy Services (NHS Dorset CCG)

A presentation was given on the mental health rehabilitation review that had been included in the report.  Members heard that needs analysis and view seeking had been undertaken and that options were currently being developed.  The CCG noted that the proposals should improve the bed offer and provide more opportunities for patients after services in the future. The Committee was asked for its view on whether the proposal would be viewed as an enhancement of existing services or whether public consultation would be necessary.

It was confirmed that public consultation would not be required, but that a further report should be submitted to the Committee in March 2019.

Resolved

1.    That a report is considered on the review of Mental Health Rehabilitation Services in March 2019; and

2.    That a report is considered on the review of MSK Physiotherapy Services in June 2019.

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

The following updates were provided by Liaison Members:-

Councillor Nick Ireland - Dorset Healthcare University NHS Foundation Trust

Councillor Ireland reported on the long Board meeting the previous day.  He reported that Ron Shields, the Trust's Chief Executive, had resigned and would leave his post at the end of March 2019.  There was much discussion about the closure of Portland Hospital and the lack of a new hub with mixed messages leading to confusion.  There continued to be staffing pressures and difficulties in recruitment.

Beryl Ezzard - South Western Ambulance Service NHS Foundation Trust

No meetings had been held.

Bill Pipe - NHS Dorset Clinical Commissioning Group

Funding for the Wareham hub would be in place in January 2019. A site had been secured by a land swap and some modular housing being built partly on the site that had been allocated could be easily moved.  There had been very little discussion on the CSR during the public part of the meeting.

Peter Shorland - Dorset County Hospital NHS Foundation Trust

A recent inspection had resulted in an upgrade from "requires improvement" to "good" in line with other hospitals in Dorset.

To answer any questions received in writing by the Chief Executive by not later than 10.00am on 26 November 2018.

There were not questions submitted under Standing Order 20(2)

The glossary had been provided for information.