Agenda and draft minutes

Apologies for absence were received from Councillor Kate Rolfe, Councillor Kyle Evans (Nuneaton and Bedworth Borough Council) and Nigel Minns. Councillor Penny-Anne O’Donnell recorded apologies for her for late arrival.

None.

Members stood to observe a minute’s silence in memory of Her Majesty Queen Elizabeth. A welcome was extended to the recently elected County Councillor Ian Shenton who had joined the Committee.

To receive the Minutes of the committee meeting held on 22 June 2022.

The Minutes of the committee meeting held on 22 June 2022 were approved as a true record and signed by the Chair.

None.

Up to 30 minutes of the meeting is available for members of the Committee to put questions to the Portfolio Holder: Councillor Margaret Bell (Adult Social Care and Health) on any matters relevant to the remit of this Committee.

None.

Members of the Committee are invited to give notice of questions to NHS commissioners and service providers at least 10 working days before each meeting. A list of the questions and issues raised will be provided to members.

None.

For the Committee to consider and comment on the Quarter 1 organisational performance and progress against the Integrated Delivery Plan.

Becky Hale, Chief Commissioning Officer (Health and Care),

Warwickshire County Council and South Warwickshire Foundation Trust (SWFT) introduced this item and gave a presentation to pull out key messages. It summarised the Council’s performance at the end of the first quarter (April-June 2022) against the strategic priorities and areas of focus set out in the Council Plan 2022-2027. This report drew out relevant areas within the Committee’s remit from that presented to Cabinet on 8^th September. Sections of the report together with detailed supporting appendices focussed on:

• Performance against the Performance Management Framework
• Progress against the Integrated Delivery Plan
• Management of Finance
• Management of Risk

The report provided a combined picture of the Council’s delivery, performance, and risk. The overall performance remained strong, despite the current external environment. There were eleven key business measures (KBMs) within the remit of the Committee. Of these, nine were reportable at quarter 1, with seven of the KBMs assessed as being on track and two were not on track.

The report detailed notable performance in the broad area of ‘support people to live healthy, happy and independent lives’ area of focus. It set out expected trajectories for performance, for areas deemed more volatile than usual, as a result of the reported external factors.

There were some actions identified as ‘at risk’. These related to capital programmes and projects, linked to current inflation levels and supply chain challenges. One of the Council’s strategic risks related to adult social care and health directly (widening of social, health, and economic inequalities post pandemic). Two others related to inflation and the cost of living. The economy might impact on service provision and service demand. At the service level, two risks had been higher than target for three consecutive quarters, those being the risk of care market failure and the risk of an ongoing impact on Public Health resources from responding to Covid-19.

The presentation included slides on:

• Introduction
• Council Plan 2022-2027: Strategic Context and Performance Commentary
• Performance relating to this Committee
• Area of focus: Support people to live healthy, happy, and independent lives and work with partners to reduce health inequalities 
• Projection
• Integrated Delivery Plan
• Financial performance
• Management of risk

Questions and comments were invited with responses provided as indicated:

• A discussion about how officers monitored and responded to the performance data. An example was provided of smoking prevalence to show the improving trajectory, but also how the data enabled more targeted activity to address known concerns in specific localities. 
• Ensuring there were adequate care staff. It was questioned for rural areas whether the Council worked with parish councils to develop local initiatives targeted on an area. There was considerable work on community and domiciliary care around workforce retention, but officers were not aware of specific initiatives with parish councils, so would take this suggestion away for consideration.
• An area explored was the data on opiate, non-opiate and alcohol issues. It was agreed that more detail be provided via a briefing note on the substance types and  ...  view the full minutes text for item 5.

The Committee will receive a joint presentation on hospital discharge from health and the county council. This will include Discharge to Assess and Complex Discharge Pathways.

The Committee received a joint presentation from Laura Gibson of George Eliot Hospital (GEH), Helen Lancaster of the Coventry and Warwickshire Integrated Care Board (C&WICB), together with County Council officers, Zoe Mayhew and Denise Cross. This presentation on ‘Ambulance Turnaround, Winter Plan & Discharge Pathways’ included slides on:

• George Eliot Hospital NHS Trust. A slide showing data for this hospital trust including bed capacity, emergency department attendances, average data for admissions, discharges and ambulance visits.
• Ambulance Handover, showing the weekly numbers of transfers taking over one hour for the period March to August 2022.
• National Pathway Definitions. There are four pathways (0,1,2,3). This slide showed the proportion of people in each pathway and a definition of the respective discharge arrangements.
• Hospital Social Care and Reablement. This provided data for such things as referrals, increasing trends, reablement visits and the provision of equipment in the home.
• Social Care Domiciliary Care. This reported the data on referrals and increasing demands, domiciliary care pathways and typical waiting times for packages of care to begin.
• Length of stay - graphs showing hospital stays of over 21 days and the numbers of patients who did not meet criteria to reside in hospital.
• Pathway issues which identified contributors to delays.
• Joint actions, a slide which outlined some of the current initiatives being implemented.
• What does the future look like? A series of key outcomes to provide a process that was person-centred, strengths-based, and driven by choice, dignity and respect.
• Winter plan 2022/23.
• Core objectives and key actions for operational resilience
• New national board assurance framework key metrics.
• System wide planning aims. These sought to ensure there were no delays throughout the care pathway, maintaining services, ensuring sufficient bed capacity, admission prevention through use of alternate treatment services, timely discharge, partnership working and workforce wellbeing.

Debate took place on the following areas:

• Officers were thanked by several members for the presentation.
• The objectives were welcomed, with questions on the expected timeline for their completion and progress made to date. Some work was already underway, but a detailed timeline could not be provided. The challenges of the forthcoming winter period were not yet known, and some objectives may need to be reviewed, but the experience of partnership working over the last two years and moving care away from acute settings were key aspects raised.
• The system approach to addressing delayed discharges was welcomed. A point was made that all NHS services should have a focus on discharge, with specific reference to delays due medication provision.
• It was noted that private ambulance services were used, together with Warwickshire Fire and Rescue Service ‘hospital to home’ scheme. 
• Discussion about the collection of medical equipment that was no longer required, so that it could be reused by other people. Officers explained that the recycling of some smaller items was not feasible either for cost or infection control reasons. There were periodic campaigns where people could return equipment to designated sites and the service provider, Millbrook Healthcare could be contacted to collect  ...  view the full minutes text for item 6.

For the Committee to review and update its 2022-23 work programme.

The Committee discussed its work programme. The Chair confirmed that engagement was planned on the Integrated Care Partnership Strategy which would be considered at the November committee.

The Chair referred to the South Warwickshire Community Hospital Review. Member feedback had been requested about the future engagement requirements for this review. It was suggested that it be via the Portfolio Holder, Councillor Bell, who could then provide periodic updates to the Committee. A discussion ensued about this review and a wider bed review for the south of Warwickshire. A public meeting had taken place the previous evening. The Portfolio Holder was not aware of a wider bed review or that the community hospital beds formed part of it. Becky Hale clarified that there was work to assess the sufficiency of bed provision in care environments to support hospital discharge over the winter period. This was separate from the community hospital review. Councillor Bell provided further context on the status of the community hospitals. Patients recovering at these locations were not considered to be discharged from hospital in the same way as if they were placed in a care home. Councillor O’Donnell added that one of the community hospitals, Ellen Badger was currently closed. She spoke of the value of these facilities, the need for the committee to revisit this review and the strength of feeling at the public meeting. It was agreed to include an item on the next Committee agenda to revisit this issue. Councillor O’Donnell asked that the SWFT Chief Executive, Glen Burley be invited to the meeting to update members, which was agreed. If there was more information available ahead of the next committee it would be circulated to members.

Resolved

That the Committee notes the work programme as submitted, with the addition to the November meeting of the item on the Community Hospital Review.