Agenda and minutes

Adults and Health Select Committee - Wednesday, 4 December 2019 10.30 am

Venue: Ashcombe Suite, County Hall, Kingston upon Thames, Surrey KT1 2DN. View directions

Contact: Ben Cullimore, Scrutiny Officer 

Items
No. Item

17.

APOLOGIES FOR ABSENCE AND SUBSTITUTIONS

    To receive any apologies for absence and substitutions.

    Minutes:

    Apologies were received from Bill Chapman and Cameron McIntosh.

    Bernie Muir would act as Chairman in Dr Chapman’s absence.

     

18.

MINUTES OF THE PREVIOUS MEETING: 10 OCTOBER 2019 pdf icon PDF 97 KB

    To agree the minutes of the meeting of the Adults and Health Select Committee held on 10 October 2019 as a true and accurate record of proceedings.

    Minutes:

    The minutes were agreed as a true record of the meeting.

19.

DECLARATIONS OF INTEREST

    All Members present are required to declare, at this point in the meeting or as soon as possible thereafter:

          I.        Any disclosable pecuniary interests and / or

        II.        Other interests arising under the Code of Conduct in respect of any item(s) of business being considered at this meeting

     

    NOTES:

    ·         Members are reminded that they must not participate in any item where they have a disclosable pecuniary interest

    ·         As well as an interest of the Member, this includes any interest, of which the Member is aware, that relates to the Member’s spouse or civil partner (or any person with whom the Member is living as a spouse or civil partner)

    ·         Members with a significant personal interest may participate in the discussion and vote on that matter unless that interest could be reasonably regarded as prejudicial

    Minutes:

    None received.

20.

QUESTIONS AND PETITIONS

    To receive any questions or petitions.

    Notes:

    1.    The deadline for Member’s questions is 12.00pm four working days before the meeting (28 November 2019).

     

    2.    The deadline for public questions is seven days before the meeting(27 November 2019).

     

    3.    The deadline for petitions was 14 days before the meeting, and no petitions have been received.

    Minutes:

    None received.

21.

CABINET MEMBER UPDATE pdf icon PDF 320 KB

    Purpose of the report: To share details of the Cabinet Member’s priority areas of work, including any strategy and policy developments, and provide an overview of the budget position and performance of services within the portfolio.

    Minutes:

    Witnesses:

    Sinead Mooney, Cabinet Member for Adults and Public Health

    Liz Uliasz, Deputy Director, Adult Social Care

    Kate Scribbins, Chief Executive, Healthwatch Surrey

    Nick Markwick, Co-Chair, Surrey Coalition of Disabled People

     

    Key points raised during the discussion:

     

    1. The Cabinet Member updated the Select Committee with regard to the Surrey Public Health Peer Challenge, mentioned in item 15 of the report. At the Peer Challenge meeting in November 2019, agreed-on recommendations included:
      1. To review and simplify the governance of the system;
      2. To ensure that Surrey County Council was clear about the expectations of the Public Health team;
      3. To ensure that the Public Health team accepted change and was clear about how they were delivering against the priorities set out for them.

    The action plan would detail how these recommendations would be implemented, and the recommendations would be closely monitored.

    1. The Chairman pointed out that care commitments were over budget and queried why there had been an overspend and what was being done to balance the budget. The Cabinet Member explained that mitigation measures were in place to ensure the budget was balanced, including a staffing underspend of £1.4 million, partly because of difficulties around recruitment; the level of inflation; managing providers’ expectations; an underspend of around £1.5 million on ASC internal transformation; and £1.8 million of funding carried forward from the 18/19 budget. Underspends would be offset against an increase in spending on care packages.
    2. A Member expressed concern about managing providers’ expectations, as many care providers were already struggling financially. The Cabinet Member replied that a report would be coming forward with details of an uplift in funding for the upcoming year. The importance of working closely with providers was emphasised, as were improvements in communications in the past year. The Deputy Director of Adult Social Care added that the commissioning function had been strengthened and restructured, and that providers’ requests for increases in spending were dealt with on a case-by-case basis.
    3. A Member asked for clarification on why there had been an underspend on transformation, despite the relatively high level of transformation that had been happening. The Deputy Director for ASC responded that the underspend was partly due to incomplete recruitment.
    4. A Member queried whether the Council was working with district and borough councils to ensure that there were homes available countywide for people who needed care, with no neglected areas, and whether existing homes were being adapted or new facilities built. Cabinet had recently signed off three sites for the development of homes, with a focus on residents within those catchment areas. In addition, there were many private developments going through the planning process. The Council worked with districts and boroughs to develop residents’ own homes so that residents could live independently there.
    5. The Select Committee queried stock levels of the flu jab. The Cabinet Member stated these had increased and would be available until February 2020.
    6. The Co-Chair of the Surrey Coalition of Disabled People questioned the efficacy of direct payments, due to frequent delays, and asked  ...  view the full minutes text for item 21.

22.

ADULT SOCIAL CARE TRANSFORMATION UPDATE pdf icon PDF 2 MB

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    Purpose of the report: To receive an update on the progress of the Adult Social Care transformation programmes. The report sets out a summary of achievements in the last month and the Q2 performance against the Directorate’s key performance indicators. It also includes a number of case studies which illustrate the changes underway.

    Minutes:

    Witnesses:

    Sinead Mooney, Cabinet Member for Adults and Public Health

    Liz Uliasz, Deputy Director, Adult Social Care

    Kate Scribbins, Chief Executive, Healthwatch Surrey

    Nick Markwick, Co-Chair, Surrey Coalition of Disabled People

     

    Key points raised during the discussion:

    1. The Deputy Director of ASC introduced key points from the report. Mental health and learning disabilities, reablement for these groups and housing across social care were being considered.
    2. Members were reminded that Surrey Heartlands was going through a mental health transformation, and the Select Committee itself was continuing to hold the Mental Health Task Group. A Member encouraged the Council to work with the third sector (charities and voluntary and community groups) and improve GPs’ relationship with the third sector.
    3. A Member  asked what the balance was of the spend of the care package budget between older people and people with learning disabilities. The Deputy Director for ASC informed members that she would obtain this information.
    4. A Member noted that the council planned to create 90 care units a year in the next few years, in contrast to only seven units over the last 14 years, and questioned whether there was the structure and authority in place to realise this successfully. The Cabinet Member responded that an officer who would work on property and housing in ASC was being recruited, and the Select Committee would be kept updated on this. An extra care brief had been designed and procurement was being examined.
    5. A Member referred to the strategic commissioning approach, whereby privately-run care services might be taken back under control of the Council. He questioned whether it could be guaranteed that the Council could run the services cheaper than the current owners. The Deputy Director of ASC reiterated that this approach was needed and emphasised the development of positive relationships with the market.
    6. A Member asked if there was a target number of social care package reviews to deliver. The Deputy Director for ASC responded that the target was not numerical, but rather based on outcomes for individuals. There was variation between different teams and how many reviews they completed; reasons for this included a lack of staff and higher demand in some teams.
    7. A member observed that the RAG (red, amber, green) method of rating data could be too focused on financial measures rather than outcomes for individuals. The Deputy Director of ASC informed members that she would meet with Simon White, the Executive Director of Public Health and Heartlands, and the Chairman of the Adults and Health Select Committee with regard to this issue.
    8. A Member observed that the conversational approach of an occupational therapist (OT) could be helpful when reviewing patients and asked if there were enough OTs to implement this approach. The Deputy Director for ASC stated that more OTs were needed to apply this approach more widely and a better offer should be made to OTs to make it an attractive job. Also, social workers in general were expected to have a more conversational approach.
    9. A Member expressed  ...  view the full minutes text for item 22.

23.

SOUTH EAST COAST AMBULANCE SERVICE UPDATE pdf icon PDF 2 MB

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    Purpose of the report: This report updates the committee on the South East Coast Ambulance Service, with special focus on changes since the last report of 8 March, especially in the areas of performance, the recent Care Quality Commission (CQC) report, executive leadership development and other strategic operational updates, or local performance and development initiatives of interest for Surrey.

    Minutes:

    Witnesses:

    Ryan Bird, ePCR Operations Manager, SECAmb

    Peter Carvalho, Senior Contracts Manager (Ambulance Contracts & IUC), Surrey Heartlands

    Bethan Eaton Haskins, Executive Director of Quality & Nursing, SECAmb

    Kate Scribbins, Chief Executive, Healthwatch Surrey

    Nick Markwick, Co-Chair, Surrey Coalition of Disabled People

     

    Key points raised during the discussion:

    1. The Executive Director of Quality and Nursing gave a summary of the report, including the following points.
      1. The report looked at performance, executive development and future plans. Despite advances having been made, the service still required radical improvement. SECAmb examined its own performance from a quality perspective, not a financial perspective.
      2. The incoming HR director of SECAmb could be announced as Ali Mohammed. Details of new executive leadership, including the new Chief Executive, were covered in the report.
      3. SECAmb’s top priority was sustaining and improving response times.
      4. SECAmb received an outstanding rating in the caring category, which was a good morale boost for staff. They also received an outstanding rating in the well-led category.
      5. For category 1 and 2 calls (the most urgent), the service was close to or exceeding targets. However, SECAmb remained challenged with regard to category 3 and 4 calls, due to the lower priority level.
      6. There were struggles in recruiting paramedics, which might worsen when paramedics started working in primary care, as this would make the job offer less attractive to some.
      7. Hospital handover delays were also an area of concern. There needed to be system-wide change to tackle this.
      8. Ofsted found two out of the three areas inspected in the clinical education department less than satisfactory. Members were assured that education programmes were still being run, but were no longer allowed to be called apprenticeships. An independent review of this had been commissioned.
      9. Whatever the outcome of Brexit, mutual aid had been agreed upon in order to mitigate potential negative impacts.
    2. A Member asked for more information on performance issues in rural populations. The Executive Director explained that there was a strategy to ensure that essential framework remained in place in rural areas. The ePCR Operations Manager added that rural areas were mainly where category 3 and 4 delays were seen. The Senior Contracts Manager (Ambulance Contracts & IUC) remarked that collaborative work was being done with regard to system resilience and accessing local care pathways that could not currently be accessed.
    3. A Member requested clarification regarding SECAmb’s acquisition of the NHS 111 contract. The Executive Director answered that the commissioning for the 111 and 999 services were separate, and that currently SECAmb ran the 999 contract but until now had not run the 111 service. Qualified healthcare professionals would handle 111 calls where necessary.
    4. Members emphasised the importance of SECAmb staff having special training regarding mental health and learning disabilities. For example, explaining the situation to patients with autism was essential for alleviating anxieties that could be more likely for autistic patients. The Executive Director explained that there were mental health clinicians in the assessment centres and this had had a significant impact on improving outcomes. Members suggested that  ...  view the full minutes text for item 23.

24.

RECOMMENDATIONS TRACKER AND FORWARD WORK PROGRAMME pdf icon PDF 96 KB

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    Purpose of the report: For the Select Committee to review the attached recommendations tracker and forward work programme, making suggestions for additions or amendments as appropriate.

    Additional documents:

    Minutes:

    Key points raised during the discussion:

    1. The Select Committee acknowledged that most of the recommendations had been completed.
    2. Members were reminded that the meeting originally scheduled for 6 February 2020 had been moved to 22 January 2020.
    3. The Select Committee was informed that an update on the Winter Pressures Follow-Up report would be possible at the meeting of 14 July 2020 (later than spring, which had originally been suggested, since the ‘winter period’ lasted officially until April for the officers involved).
    4. Members were reminded of upcoming business meetings, including the mental health briefing on Friday 6 December 2019, and the Performance Dashboard Working Group meeting on 11 December 2019.

25.

DATE OF THE NEXT MEETING

    The next meeting of the Adults and Health Select Committee will be held on 22 January 2020 in the Ashcombe Suite, County Hall.

    Minutes:

    The next meeting of the Adults and Health Select Committee would be held on 22 January 2020 in Council Chamber, County Hall at 10:30.