Hampshire County Council Health and Adult Social Care Select Committee Meeting

Apologies were received from Councillor Diane Andrews.

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 5 July 2022 were agreed as a correct record and signed by the Chairman.

There were no deputations.

The Chairman noted the written update that Members had received on work with voluntary and community sector organisations since the Executive Member for Adult Services and Public Health Decision to on 16 June 2022 to cease grant funding.

Members were also reminded of the written update received from the Hampshire and Isle of Wight Integrated Care Board (ICB) regarding the Whitehill and Bordon Health Hub. The Chairman noted that the ICB would be attending the HASC meeting in January 2023 to present further information to the Committee.

The Chairman announced that Portsmouth Hospitals NHS Trust had received a Care Quality Commission (CQC) inspection which had taken place through April and May of this year and that the report was available online. The two areas which were inspected, namely the Medical Care and Urgent and Emergency Services in April and a ‘planned well-led inspection’ in May, were rated as ‘Good’ by the CQC.

Members were also reminded of the written briefing note from the Hampshire and Isle of Wight Integrated Care Board which had been circulated via email to HASC members setting out proposals for a GP surgery merger.

The Committee received a presentation from the Hampshire and Isle of Wight Integrated Care Board (representing Hampshire NHS providers) and the Director of Adults’ Health and Care (in respect of Hampshire social care provision) on service resilience, recruitment and resourcing across the health and social care sector.

The Director noted the Autumn Statement which had been published by the Treasury after the HASC papers had been circulated and noted the new information. The Committee noted that the Social Care Reforms (SCR) had been postponed for a two year period and that the funding identified to support SCR was to be made available to Local Authorities to support social care services. Furthermore, the social care Council Tax precept was able to be increased to 2%. Members also noted the Better Care Funding proposals and the allocations to the County Council.

Overall, both in health and social care, workforce resilience was a challenge. This was due to a complex range of factors, not least the competitive employment sector, intricacies of training and qualifications, potential industrial action and the impact this has on the perception of working in health and social care, growing demand for care, increasing cost of care and individuals with more complex support needs. The Committee heard how international recruitment had proven successful and noted how recruitment initiatives and innovative resourcing were seeking to engage and attract employees. Specific mention was made of current workforce shortages in mental health services and dentistry. Members were reassured that the continual focus amidst the shortages was to ensure the safety of services for users.

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

·         There was an onus on the Integrated Care Board to help the public to understand how health care works and how integrated services add value. Enabling public understanding and engagement could only bring about positive outcomes and potentially positive impacts on recruitment and retention of workforce.

·         The numbers of agency staff varied according to circumstances – for example, many services operate an internal ‘bank’ of staff who are called upon if there are short term absences in the first instance.

·         Apprenticeships and training whilst in post was an important focus.

·         NHS international recruitment was undertaken from ‘green list’ areas with a known oversupply of workforce.

·         The acronym ‘WTE’ on page 39 of the agenda pack stood for Whole Time Equivalent.

·         The high volume of administrative and clerical staff within the NHS was vital in terms of supporting clinical staff to focus upon clinical delivery.

·         The Adults’ Health and Care department were transforming Carer Support Services and it was anticipated that this would impact upon the uptake of day services. Two hundred older adults were currently attending social care day services.

There was a question which was not able to be asked due to time constraints and was submitted via email. The question and response is appended to these minutes.

RESOLVED:

That the Committee thanks presenters for delivering the comprehensive presentation, notes the information set out and the significant workforce pressures being faced across the sector.

a)     Recommendation to create a new community and mental health trust (Southern Health Foundation Trust and Solent NHS Trust)

Members had received a written briefing note from the Hampshire and Isle of Wight Integrated Care Board (HIOW ICB), Solent NHS Trust, Southern Health NHS Trust and also Sussex Partnership NHS Trust setting out their proposals to develop a new NHS community and mental health organisation for Hampshire and the Isle of Wight.

The Committee heard that the proposals were in the early stages, with a business case being developed, the project team appointed and community engagement having begun. Members heard that the proposed date for the creation of the new organisation was 1 April 2024.

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

·         Supporting people to remain well and to prevent health from declining to the point where more extensive care was required would be a key priority for the new Trust.

·         Work was and would be conducted to make NHS IT systems interact with each other in a more compatible way. This was particularly important in sharing information between partners and to prevent patients from having to explain their situation repeatedly to different healthcare professionals.

·         The consultation and community engagement proposals had not accounted for North East Hampshire. Members were concerned by this and wanted to ensure that the needs of the whole county were considered fairly. It was noted that the geographical complexities needed to be worked through as part of the process.

·         The outline business case for the new Trust was expected to be available in February/March 2023 with the more detailed, full business case available by October/November 2024.

Members were acutely aware of the rising demand for mental health services and commented on the significance of these proposals, changing the health infrastructure responsible for delivering these services. The Committee were concerned at some aspects of the presentation including the fact that consideration had not been given to incorporating the whole of the county.

Members discussed whether the proposals would constitute a substantial variation to health services. The general consensus was that the anticipated changes were significant enough to do so but it was agreed that a decision would be reached on this when the item next appeared on the HASC agenda (in March 2023) as more information would be available at that point.

RESOLVED:

i)             That the Committee note the progress made in developing the joint organisation.

ii)            That the Committee defer it’s decision on whether the proposals constitute a substantial variation to health services to the March 2023 HASC meeting when the item will be presented in further detail.

b)     Building Better Emergency Care (Portsmouth Hospitals NHS Trust)

The Committee considered the update report which set out the progress made thus far with the Building Better Emergency Care programme following the receipt of capital investment to build a new Emergency Department (ED).

Members heard that the full business case had been approved by NHS England and the funding had been released for the works to begin. Patients were expected to begin to use the new facilities, once built, by 12 November 2024.

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

·         A comprehensive improvement plan looking at pre-hospital planning, organisation, receiving critical care patients, acute flow, emergency care centre initiatives was continually being developed to help to make the new ED as efficient as possible. The Committee’s concerns regarding the operation and restrictions of the current ED were recognised and Members were assured that the issues would be addressed for the new build.

·         With the funding amount having been agreed in 2018, the construction sector had since seen significant pressures on costing due to inflation; this had been factored in and Members were assured that there was enough contingency to allow the build to progress.

RESOLVED:

iii)           That the Committee welcome the progress in the Building Better Emergency Care Programme and request a further update in Spring/Summer 2023 once construction has begun.

a)    Independent Review of Southern Health NHS Foundation Trust

The Committee received an update on the Trust’s action plan following the Stage 2 Independent Investigation and heard how improvements against specific actions had been implemented.

Members’ attention was drawn to the way in which the Trust were handling complaints and holding conversations internally with clinicians to ascertain an understanding of the situation which had lead to the complaint. Furthermore, the management of incidents had been overhauled entirely and was under close, regular scrutiny from clinicians and Board members. 

The Committee heard that the Trust were almost at the point of signing off the action plan with the Integrated Care Board and were hoping that this would be possible within the next month having recently submitted evidence.

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

·         Honest and open conversations and acceptance of liability were key factors that had been woven into the Trust’s culture. The Trust would keep challenging themselves to ensure that this continued.

·         In presenting the next update to the Committee, any changes would be highlighted bold within the report and some evidence based examples of the work conducted would be provided.

·         The process of the Independent Review and the tragic events which led to it had had an impact on staff over the years and a number of staff were still working through this at the current time with support.

RESOLVED:

i)     That the Committee welcomes the actions the Trust has taken to date in response to the recommendations made in the Independent Investigation Report.

ii)    That the Committee request that the Trust attend the March HASC meeting in 2023 to provide an update once the action plan has been signed off by the ICB.

b)    Care Quality Commission Inspection – Maternity Services (Hampshire Hospitals NHS Foundation Trust)

Members received an update from Hampshire Hospitals following their CQC inspection in November 2021 and actions against the improvement plan within Maternity Services.

It was noted that 41 actions were complete with 20 on track and 2 at risk of being overdue. Members were updated on e-learning completion rates, domestic abuse screening (which was possible to track via the Badger Notes app) and new standard operating procedures for equipment testing amongst other updates. The Trust’s ambition for community hubs was welcomed – these being a ‘one stop shop’ for antenatal and postnatal clinics, breastfeeding support and other services. Work on establishing the hubs was progressing.

RESOLVED:

i)     That the Committee note the work undertaken to respond to the action plan and request to be notified once all actions are complete.

c)    Care Quality Commission Inspection – Safeguarding (South Central Ambulance Service)

The Committee considered an update from SCAS following their CQC inspection in November 2021 and actions in regard to safeguarding improvements which had been identified as part of the inspection.

Members noted the work undertaken to the safeguarding IT system and safeguarding policies and close monitoring via internal reviews. The Committee were concerned at the slow rate of staff undertaking their safeguarding level 3 training. The Trust confirmed that there were challenges in balancing staff working on the frontline alongside attending training days but recognised the importance of the training and committed to improving the training rate. The Committee also sought reassurance from SCAS as to whether completion of safeguarding level 3 training was a requirement of professional re-registration for some of their workforce.

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

·         Community First Responders were required to undertake safeguarding level 2.

·         SCAS’s safeguarding duty began from the moment an ambulance was called and continued through to the moment the patient was discharged or transferred to another service.

·         Level 3 safeguarding training could be undertaken as part of a face-to-face session or remotely via e-learning.

RESOLVED:

i)     That the Committee note the work undertaken to date against the action plan and request a further update at the HASC meeting in March 2023.

d)    Dental Services Update – (NHS England/Hampshire and Isle of Wight Integrated Care Board)

The Committee received an update from the Hampshire and Isle of Wight Integrated Care Board (ICB) regarding the challenges in accessing dental services.

The national picture regarding shortages in NHS dentists, NHS dental nurses and the resultant challenges in accessing NHS dental services for patients was recognised. The ICB confirmed that they were linking with Hampshire MP’s to raise the issue of the national dentistry contract restrictions and also to look at proposals for developing dentist training in the South region. The Committee were supportive of the suggestion that, if no progress had been made come the March HASC meeting, the Chairman would write to local MP’s setting out the difficulties faced by Hampshire residents and lobbying for political support to amend the national contract.

The lack of incentives for dentists to work within the NHS was noted, including an additional year of training which was not required to enter into private practice.

There was a question which was not able to be asked due to time constraints and was submitted via email. The question and response is appended to these minutes.

RESOLVED:

i)     That the Committee recognises that access to dental services is an ongoing national issue and continue to monitor this from a Hampshire perspective via regular updates.

ii)    That the Committee request a further update at the HASC meeting in March 2023.

The Committee considered a report of the Director of Adults’ Health and Care

providing an annual update on the local authority statutory duty to safeguard

vulnerable adults.

RESOLVED:

That the Committee:

       i.        Notes the positive progress and strong performance of the Department to keep adults at risk safe from abuse and/or neglect, whilst acknowledging ongoing risks to fulfilling statutory safeguarding duties.

      ii.        Notes the commitment of a wide range of Adults’ Health and Care staff, and wider partner agencies, to delivering robust safeguarding arrangements in Hampshire.

     iii.        Notes the contribution of the Hampshire Safeguarding Adults Board (HSAB) to safeguarding strategy, assurance, and the development of policy across the four local authority areas of Hampshire, Portsmouth, Southampton, and the Isle of Wight.

    iv.        Receive a further update on adult safeguarding in 12 months’ time.

The Committee considered the forthcoming agenda items via the Work Programme.

RESOLVED:

That the Committee’s Work Programme be approved.