Hampshire County Council Health and Adult Social Care Select Committee Meeting

Apologies were received from Councillors Garton, Harvey, Irish, Craig, Harrison and Meenaghan.

Deputy members who attended were Councillors Ford, Groves, Hiscock and Hayre.

Members were mindful that where they believed they had a Disclosable Pecuniary Interest in any matter considered at the meeting they must declare that interest at the time of the relevant debate and, having regard to the circumstances described in Part 3, Paragraph 1.5 of the County Council's Members' Code of Conduct, leave the meeting while the matter was discussed, save for exercising any right to speak in accordance with Paragraph 1.6 of the Code. Furthermore Members were mindful that where they believed they had a Non-Pecuniary interest in a matter being considered at the meeting they considered whether such interest should be declared, and having regard to Part 5, Paragraph 2 of the Code, considered whether it was appropriate to leave the meeting whilst the matter was discussed, save for exercising any right to speak in accordance with the Code.

The minutes of the previous meeting held on 31 July 2023 were agreed as a correct record and signed by the Chairman.

The Committee did not receive any deputations.

The Chairman announced that, following the Notice of Motion passed at County Council in July, he had worked with his local MP to highlight the issue of underage vaping and to campaign for a ban on vape products. The Chairman noted recent press coverage surrounding a ban on single use vapes and how the County Council would welcome such a ban for a number of reasons.

The Chairman drew Members’ attention to the Joint Health Overview and Scrutiny meetings which had been organised for 20 September and 31 October 2023 to hear progress on the new hospital programme for Hampshire.

Members were updated on the publication of the Adult Social Care Intervention Framework which had been published on 8 August providing councils with information on the Department for Health and Social Care’s approach to enhanced monitoring, support and statutory intervention in adult social care. The Chairman noted that the online link to the Framework would be circulated to HASC Members post meeting.

The Chairman noted the national news surrounding Martha’s Rule following the death of teenager Martha Mills and ensuring that hospital patients were aware of their rights for a second opinion.

The Chairman also noted the recent press coverage regarding female clinicians working in healthcare experiencing harassment in the workplace and expressed his concern at the reports which had been emerging.

Members were updated on the progress of the HASC Care Proposals Task and Finish Group following the first meeting in August. The Public Consultation had started on 4 September 2023 and would run for ten weeks, ending on 12 November 2023. The Committee noted that the Task and Finish Group intended to meet throughout the autumn with a final meeting in early December to review the consultation outcomes.    

a)    Planning for Winter (Hampshire and Isle of Wight Integrated Care Board)

The Committee received the report of the Hampshire and Isle of Wight Integrated Care Board (the ICB) setting out measures being taken to prepare for winter pressures and highlighting a change to the way in which patients were discharged from hospital.

The changes to the hospital discharge process were set out in detail within the report and the ICB had estimated that the changes had the potential to increase the number of people waiting in hospital for discharge 35%. The Committee were concerned at this high percentage. The ICB advised that there were several activities ongoing and planned which would minimise hospital admissions and mitigate against the planned changes.

In response to Members’ questions, it was confirmed that:

·         With reference to the increase of attendees to Emergency Departments (page 16 of the report detailed a 6% increase), there was a combination of contributing factors – a higher complexity of cases and a saturated health service across all areas under higher demand.

·         Anticipated industrial action by clinicians throughout the winter period had been incorporated into planning with urgent care prioritised.

·         The 35% figure quoted by the ICB, the increase in patients waiting for discharge from hospital, equated to roughly 260 discharges per month.

·         The ICB were hoping to be able to access the recently announced £200 million NHS resilience funding released by the Government to help support throughout the winter period and were working with NHS England to confirm the amount of funding available to them.

·         The changes to the hospital discharge policy were under continual assessment with an ICB Discharge Board meeting fortnightly, assessing against key performance indicators and that the ICB would be happy to bring the data back to a future HASC meeting to share with Members.

The Committee were concerned about the reduction in services especially given the oncome of the winter period and the range of pressures that this would present. Members agreed that, given the level of concern, the ICB should be invited back to HASC in November to present an update on the implementation of the changes.

RESOLVED:

That the Committee monitor the proposed changes to hospital discharges closely and request an update on the implementation of these changes at the November 2023 HASC meeting.

The Committee received the report of both the Hampshire and Isle of Wight ICB and Frimley ICB with an update on access to dentistry services and community pharmacy provision.

Members had received regular updates on challenges in accessing dental care across Hampshire which was reflective of the national picture and also linked to difficulties with the national dental contract. It was noted that there were few incentives for dentists to work for the NHS with many choosing to enter into private practice.

In response to Members’ questions, it was confirmed that:

·         Monitoring of dental activity delivered against the contracts awarded was conducted throughout the year and funds were reclaimed if the contracted activity hadn’t been undertaken.

·         The national dentistry contract had been somewhat modified in late 2022 although feedback from NHS dentists showed that it was still not fit for purpose. Both ICB’s were awaiting additional reform to take place.

·         The ICB’s had explored amending individual dental contracts where possible, offering temporary units of dental activity to areas with particular challenges and additional procurement. It was confirmed that the ICB’s were aiming to look at flexible commissioning alternatives within the current framework wherever possible.

RESOLVED:

That the Committee continue to monitor the performance of dentistry provision across the Hampshire administrative area and request a further update from both ICB’s at the May 2024 HASC meeting.

a)    Care Quality Commission (CQC) Inspection – Mental Health Inpatient Units (Southern Health NHS Foundation Trust)

The Committee received a report from Southern Health NHS Foundation Trust (Southern Health) following a recent CQC Inspection on their mental health inpatient units which had returned a rating of ‘requires improvement’.

The high number of vacancies within the key nursing workforce were identified and Southern Health agreed that looking to recruit more apprentices and linking with Universities could help in addressing this issue. Members were grateful for sight of the action plan and noted that the majority of actions had already been completed.

RESOLVED:

That the Committee note the progress made against the action plan.

b)    Pressures facing Ford Ward, Fordingbridge Hospital (Southern Health NHS Foundation Trust)

The Committee received a report from Southern Health NHS Foundation Trust (Southern Health) setting out proposals to temporarily pause admissions to Ford Ward at Fordingbridge Hospital.

Members noted that Ford Ward was a recovery and rehabilitation ward comprising 15 beds although it had been running at a capacity of 8 beds

since March 2023 due to staffing challenges. Southern Health confirmed that, at the time of the pause to admissions on 21 August 2023, six patients remained on the ward and that, since this date, all patients had now returned home having finished their rehabilitation.

The Committee sought reassurance from Southern Health that they had no plans to permanently close Ford Ward and this reassurance was given. Southern Health noted that they were undertaking an options assessment and would notify the HASC once this had concluded and any proposals had been drafted.

RESOLVED:

That the Committee request to be kept informed of any changes to Ford Ward and any implications that arise going forward.

The Committee considered the report of the Director of Adults’ Health and Care and Director of Corporate Operations setting out savings proposals for Adult Social Care and Public Health as part of the Savings Programme to 2025 (SP25) ahead of consideration by the Executive Lead Member for Adult Social Care and Public Health.

Members noted the financial context from a County Council perspective and the reduction in core funding that had been experienced over several years since 2010. Members were reminded of previous savings and transformation programmes including T2021 and SP23 and noted the forecast budget gap for the two years to 2025/26 of £132million.

The Committee noted the financial context from a Directorate perspective and the influencing factors and pressures across the entire health and social care landscape. The specific SP25 proposals for the Directorate were covered, totalling £49.7million, along with a summary of existing budget breakdown by service area.

Members agreed that the context of the report was disheartening but acknowledged that the reduction in funding to the County Council presented a difficult set of circumstances. Members noted that the Council would continue to lobby Government to seek a fairer funding formula and legislative change where possible.

In response to Members’ questions, it was confirmed that:

·         Directorates were working collectively, applying similar approaches and collaborating wherever possible.

·         The Public Health budget was not included as part of SP25 as it was funded by a ring-fenced grant set at a national level.

·         The contribution of the voluntary sector was invaluable and that the County Council would continue to support the important work conducted by these organisations.

Members requested a recorded vote. The results of the vote are detailed below:

For: 10

Councillors Burgess, Bryant, Hayre, North, Jackman, Branson, Curnow-Ford, Briggs, Withers and Ford.

Against: 4

Councillors Taylor, Dowden, Hiscock and Groves.

Abstain: 2

Councillors Joy and Tree.

RESOLVED:

That the Health and Adult Social Care Select Committee support the

recommendations being proposed to the Executive Lead Member for Adult

Social Care and Public Health in paragraph 2 of the attached report.

RESOLVED:

That the Health and Adult Social Care Select Committee discuss and agree

potential items for the work programme that can be prioritised and allocated by the Chairman of the Health and Adult Social Care Select Committee in

consultation with the Director of Adults’ Health and Care.