Agenda and draft minutes

To elect a Chairman for the Committee.

Decision

That Cllr Jill Haynes be elected as Chairman.

Decision

That Cllr Lisa Northover be appointed as Vice-Chairman.

Apologies for absence were received from Cllrs Ryan Holloway, Cheryl Johnson, Emma Parker and Roberto Roca.

To receive any declarations of interest.

Cllr Jon Orrell declared an interest as a practising GP in the NHS, holding a contract through Two Harbours Health Care in Weymouth.  He had a dispensation to enable him to take part in health scrutiny meetings.

Cllrs Nick Ireland and Chris Matthews declared interests as a Governor of Dorset Healthcare University NHS Foundation Trust.

Cllr L-J Evans declared an interest as a working GP and as a bank employee for Poole Hospital NHS Foundation Trust.

Cllr Andrew Kerby declared an interest as his partner was an assistant nurse with Dorset Healthcare University NHS Foundation Trust.  He had a dispensation to allow him to take part in health scrutiny meetings.

Cllr Hazel Allen declared an interest as an employee of Royal Bournemouth and Christchurch Hospitals NH Foundation Trust, with a Dorset-wide remit as a consultant nurse in liver disease.

To note the following term of reference:-

"To scrutinise the NHS response to COVID-19 across the Bournemouth, Christchurch and Poole and Dorset Councils' areas."

The Chairman read out the Committee's Term of Reference.

Noted

To receive a briefing from the Director of Public Health.

The Committee considered a report by the Director of Public Health and received a presentation on Public Health's response to the Covid-19 pandemic.

The presentation set out timelines for the pandemic: how Public Health had supported both local councils; the containment, delay, and lockdown phases; testing; the impact and easing of lockdown; mortality rates in Dorset in hospitals and care homes; and the latter phase of track and trace, and test and contain.

Covid-19 cases in Bournemouth, Christchurch and Poole (BCP) and Dorset areas remained low compared to the South West and the rest of England. It was not known what impact the increased number of visitors would have but officers would react quickly to any increased cases. The Local Authorities had received a test and trace grant which would be used to provide resources when there was evidence of an outbreak rather than carrying out testing of large numbers of people.  This was in line with Public Health England guidance.

The Local Outbreak Management Plans (LOMP) for both Councils had been published the previous day which would enable swift action to be taken should there be any local outbreaks.

Members asked questions and commented in relation to the app tested on the Isle of Wight, the test booking 119 telephone number, difficulties experienced with the on-line booking system, whether any lessons had been learned particularly with regard to dealing with any second peak, the need for local testing, tracking and isolation, particularly if there was a second peak, whether any hot spots had been identified for pro-active testing; and how an outbreak at a meat processing plant would be dealt with.

It was explained that:-

·         there were issues regarding personal date with the app tested on the Isle of Wight and it had been decided to establish a national telephone-based service which was now up and running.  It was not known whether the app would be progressed;

·         the 119 telephone number had been in place since 28 May 2020 and had been widely publicised through a national media campaign, on billboards at football matches, and TV advertisements.  It was the main route for booking a test and more publicity would be given to it via the publication of the LOMP and through other local communications;

·         lessons had been learned during the pandemic and continued to be identified.  With the introduction of the LOMP, Public Health now felt they had been given the tools to respond quickly to any outbreaks;

·         the Health Protection Board was working through a list of high-risk settings so that there was a clear understanding of what needed to be done quickly to address any outbreak;

·         extensive testing would not be carried out unless there was large outbreak;

·         the response to possible cases remained isolation, testing and reducing contact; and

·         Public Health had links to neighbouring councils who had their own LOMPs.  They worked alongside Environmental Health Officers with regard to communicable diseases and they had enforcement powers.  Some work on national powers which may be  ...  view the full minutes text for item 6.

To consider a briefing from the Chief Operating Officer, Dorset Clinical Commissioning Group.

The Committee considered a report and received a presentation by the Chief Officer, Dorset Clinical Commissioning Group (DCCG), on the NHS response to Covid-19. 

The Chief Officer paid tribute to the voluntary sector and public partners who had helped the NHS over recent months and to those who had lost loved ones to Covid-19, including NHS colleagues.

The presentation set out how all the agencies in Dorset had worked together to respond to the crisis; preparations for any surge and changes to services; operating requirements and measures taken; recruitment and redeployment of staff and associated resources; the financial response; concerns; mental health services impact; phase 2 to bring services back on line; and public engagement.

Such a collective effort across the NHS and all partners had never been seen before and there were lessons which could be learned from this.  The first phase was coming to an end and residents now had to live with Covid-19 on a daily basis.  With the easing of restrictions there was a real possibility of a second surge.

Members asked a number of questions including how the non-medical beds in hotels in Sherborne and Weymouth were funded, whether nightingale hospitals could have been used better to provide beds for those leaving hospital before returning to care homes, the NHS funding gap,  whether the system had enough resilience to deal with a surge in demand for services coinciding with a second peak, future support for community pharmacists and workforce issues.

In response it was explained that:-

·         Dorset Council would bill the DCCG for the hotels and the DCCG would then bill the national Covid-19 fund;

·         nightingale hospitals had been established for critical care which had not been needed and they had now been adapted for different uses;

·         costs for months 1-4 of the Covid crisis were being covered but it was not yet known what arrangements would be put in place for month 5 onwards;

·         Dorset's three acute hospitals were working together to ensure there were plans to address any second spike, but capacity was limited because of social distancing and infection control;

·         NHS services had become more innovative, with an increase in people taking advantage of the digital offer, and Trusts were working collaboratively with primary care to plan for any surges;

·         as many specialists had been unable to treat patients, hospital waiting lists had grown.  The most urgent cases were being prioritised by clinicians.  This was the same across the whole country;

·         work on wrap around care to deliver a safe service was underway and the voluntary sector had stepped up to support medication delivery.  There had been a shortage of some medication but this had been resolved.  The system was now better prepared for a second spike;

·         the workforce was paramount in delivering a safe and sustainable service.  If staff were off sick then this complicated the ability to run services or additional beds. Staff sickness was monitored, was reducing, and staff were returning to work.  Many staff had undertaken different  ...  view the full minutes text for item 7.

To consider a briefing from the Interim Executive Director for People - Adults, Dorset Council.

The Committee considered the Care Home Support Plans for Bournemouth, Christchurch and Poole (BCP) and Dorset Councils and received a joint presentation from the Director - Adult Social Care Commissioning, Bournemouth, Christchurch and Poole Council and the Head of Commissioning - Market Relationships, Major Contracts and over 65s, Dorset Council.

The joint presentation covered: the letter received from the Minister of State for Care detailing additional funding of £600m to support infection control and action to be taken by local authorities in response; joint work undertaken by BCP Council, Dorset Council, the Dorset Clinical Commissioning Group (DCCG), Public Health and provider representatives to provide a full view of support in place and future plans; the National Capacity Tracker (NCT) web application; financial support provided to care homes; feedback gained via the NCT; and an Infection Control Fund update for both Councils.  Particular attention was drawn to the joint working across organisations and providers in response to the pandemic.

Members were then given the opportunity to ask questions.  These related to: care homes charging self-funders extra on top of PPE costs; whether those receiving home care received help and support; and how the partnership working which had helped with discharges from hospital would continue;

In response members noted that:-

·         councils had no control over private organisations' charges although they had intervened in two situations with the result that the approach had been withdrawn.  Care homes would have to evidence how they were spending the additional funding and if this was not appropriate the support would stop;

·         there had been significant changes in the home care market with regard to complexity and increased demand.  People preferred to remain at home and working with providers gave an opportunity to promote Home First models with better outcomes for residents.  Advice had been given to care providers on how to reduce the risk of infection being transferred between visits and transport support provided;

·         DCCG had supported the roll out of infection control training to all care homes, home care providers, personal assistants etc.  This continued as the risk of Covid-19 remained;

·         joint working would continue.  There were common agreed principles for the Home First programme, which aimed to keep people in their own homes for as long as possible, with appropriate support, and help them to return home more quickly from hospital.

The Chairman thanked officers for their presentations, which provided some assurance for Councillors.  The pandemic had shown how the whole system could work together and this momentum should not be lost.

Noted

Members are asked to agree to delegate authority to officers, in consultation with the Chairmen of the Councils' respective health scrutiny committees, to progress a protocol for joint scrutiny of health issues across Bournemouth, Christchurch and Poole and Dorset Councils' areas.

The Chairman explained that a joint protocol was needed to enable scrutiny of common items across both Council areas.  This was agreed.

Decision

That officers from Bournemouth, Christchurch and Poole and Dorset Councils progress a joint scrutiny protocol after consultation with the Chairmen of the Bournemouth, Christchurch and Poole and Dorset Councils' health scrutiny committees.

To consider any items of business which the Chairman has had prior notification and considers to be urgent pursuant to section 100B (4) b) of the Local Government Act 1972. The reason for the urgency shall be recorded in the minutes.

There were no urgent items.

To move the exclusion of the press and the public for the following item in view of the likely disclosure of exempt information within the meaning of paragraph 3 of schedule 12 A to the Local Government Act 1972 (as amended).

The public and the press will be asked to leave the meeting whilst the item of business is considered.

There was no exempt business.

To receive questions or statements on the business of the Committee from town and parish councils and members of the public.

Please note that public speaking has been suspended during the Covid-19 crisis. Each question or statement is limited to no more than 450 words and must be electronically submitted to helen.whitby@dorsetcouncil.gov.uk by the deadline set out below. The question or statement will be read out by an officer of the Council and a response will be sent to the person submitting the question or statement following the meeting.

All questions/statements and the responses will be published in full within the minutes of the meeting.

The deadline for submission of the full text of a question or statement is 8.30am on Monday, 29 June 2020.

Please note that in view of the public's interest in this subject and because of their pertinence to the topic being scrutinised, multiple questions have been accepted from individuals for this meeting.

Questions from Claudia Sorin - Responses by Public Health

The World Health Organisation has told constituent countries repeatedly that testing, track and isolate is the key to proactive management of COVID 19. There are many concerns about the national programme, including long waits for results, results going missing, and results coming back void.  I understand that Dorset’s Public Health database showed in June that thousands of test results are still awaited, some from as long ago as February.

In some areas effective local test, track and isolate schemes have been set up, which use existing public health/GP structures – such as those for managing sexually transmitted diseases.  These local schemes have several advantages over the national scheme including:

·         councils had no control over private organisations' charges although they had intervened in two situations with the result that the approach had been withdrawn.  Care homes would have to evidence how they were spending the additional funding and if this was not appropriate the support would stop;

·         there had been significant changes in the home care market with regard to complexity and increased demand.  People preferred to remain at home and working with providers gave an opportunity to promote Home First models with better outcomes for residents.  Advice had been given to care providers on how to reduce the risk of infection being transferred between visits and transport support provided;

·         DCCG had supported the roll out of infection control training to all care homes, home care providers, personal assistants etc.  This continued as the risk of Covid-19 remained;

·         joint working would continue.  There were common agreed principles for the Home First programme, which aimed to keep people in their own homes for as long as possible, with appropriate support, and help them to return home more quickly from hospital.

Could the Joint Health Scrutiny Committee please advise:

1)    Considering the advantages of local testing and tracing schemes as outlined above, will Dorset Public Health consider setting up a local scheme in Dorset, over which they would have much greater control?

2)    How does Dorset plan to manage test, track and isolate?

3)    The Chair of the Health Select Committee commented last week that “We do not know where about two thirds of new infections are happening, so we cannot feed them into the test and trace process”. What are Dorset’s plans for finding asymptomatic carriers?

4)    How will those in insecure employment be supported to self-isolate?

5)    Given concerns about asymptomatic carriers, and the Chair of the Health Select Committee’s further comments last week that about one third of new infections are of people who have caught C19 in hospital, or in care homes:

-       are there plans for regular routine weekly testing of NHS and care staff, including those caring for people in supported living in the  community?

-  ...  view the full minutes text for item 12.