Apologies for absence were received from Councillors Tracey Drew, Judy Macdonald (North Warwickshire Borough Council), Jan Matecki, Penny-Anne O’Donnell, Kate Rolfe (replaced by Jerry Roodhouse), Pam Redford (Warwick District Council) and Shade Agboola (Director of Public Health). It was agreed to send the Committee’s best wishes to Councillor’s Drew and Rolfe, due to their ongoing illnesses.

Councillor Jerry Roodhouse declared an interest as a director of Healthwatch Warwickshire.

The Chair advised of a member development session on 6 October on the Council's Power BI system. She encouraged members to attend as this system was used to record progress with all developments and quarterly progress, as presented to the overview and scrutiny committees.

To receive the Minutes of the meeting held on 30 June 2021.

The Minutes of the meeting held on 30 June 2021 were accepted as a true record and signed by the Chair.

Notice had been received from a member of the public, which was subsequently deferred and would be presented to the November Committee meeting.

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.

The Committee will receive a joint presentation from Paula Mawson, WCC Strategy & Commissioning Manager for Health, Wellbeing & Self-care and Eleanor Cappell of the Coventry and Warwickshire Clinical Commissioning Group.

The Committee received a joint presentation from Paula Mawson, WCC Strategy & Commissioning Manager for Health, Wellbeing & Self-care and Eleanor Cappell of the Coventry and Warwickshire Partnership Trust. The presentation covered the following areas:

• The overall aims of the presentation:

•        To provide the committee with an overview of system-wide activity related to supporting mental health and wellbeing for adults in Warwickshire.

•        To highlight key health inequalities in mental health (MH).

•        To provide a focus update on the community MH transformation programme.

·       MH System – a graphic showing key areas of activity, including wider determinants, self-care, physical health, community assets, transformation, alternatives to crisis admission, inpatient services and community care. Reference to the range of mental wellbeing services provided in the community, with the work on Covid MH,  loneliness and isolation used as an example.

·       Health inequalities:

•        Headline findings related to socioeconomic impact and ethnicity on MH, together with wider determinants.

•        Examples of key activity to address health inequalities were provided.

·       Community MH transformation (CMHT) system update:

•        National vision and ambition – members were encouraged to view this YouTube explanatory video: The NHS Community Mental Health Transformation – YouTube

•        Local CMHT vision and ambition 

•        Community MH framework  

·       Expert by experiences – a quote from Claire Handy, a person with lived experience.

·       CMH redesign and core offer – examples of the initiatives undertaken.

·       Primary care integration with examples given of how this would take place.

·       Personality and complex trauma pathway – the vision and ambitions.

·       A graphic showing hopefulness and life skills, leading to enablement.

·       Rehabilitation.

·       Adult eating disorders – the vision and application.

·       Training provision.

·       Parity of esteem – serious mental illness (SMI) health checks – improving physical health of people with SMI.

·       Strategic coproduction: coproduction and community engagement

·       Voluntary and community sector – mental health alliance, working together and community MH coproduction

·       In summary:

•        There was a breadth of activity across the system to support people with mental ill-health, alongside activity to promote wellbeing and address determinants of poor MH and wellbeing to support prevention, early intervention and recovery.

•        Strong partnership working in place across the system (including with the VCS and experts by experience) to support transformation of services.

•        Good progress made to date on a longer journey of change.

Questions and comments were submitted, with responses provided as indicated:

• Several members found the presentation informative and useful.
• A discussion about the commissioning arrangements, the number of new practitioners involved in the service delivery model and the mechanisms being employed to ensure a complementary approach to service delivery, rather than working in silos. There was useful experience from earlier work, good partnership working, governance structures and funding of £23m over three years was in place.
• Reference to previous initiatives to support dementia patients, which had been discontinued. A key aspect was designing the offer around service recipients, for example who needed support at home rather than visiting specialists for specific appointments or group sessions. This point was heard  ...  view the full minutes text for item 5.

A report will be presented by Claire Taylor, WCC Commissioner (Maintaining and Promoting Independence).

A report was presented by Claire Taylor, the commissioner responsible for maintaining and promoting independence. This included a PowerPoint presentation which covered the following areas:

• Coventry and Warwickshire’s Living Well with Dementia Strategy, a joint, system-wide strategy across Coventry and Warwickshire (with a place-based focus in action plans). An outline of the work undertaken in drafting the new strategy.
• The vision and six key priority areas of: preventing well (reducing risk), diagnosing well, supporting well, living well, dying well and training well. The strategy had a ‘plan on a page’ approach for each of the six priority areas.
• A focus on key objectives; reviewing progress and additional objectives where required.
• A focus on what still needed to be achieved and how it would be measured.
• Reflection on progress to date.
• The equality impact assessment, to be reviewed throughout the lifetime of the strategy.
• Ensuring effective alignment with other strategies. 
• Current engagement with stakeholders over six weeks. Details provided of the mechanisms being employed and next steps to review and collate feedback, leading to the revised strategy being submitted for approvals and publication early in 2022.

It was reported that Coventry and Warwickshire’s Living Well with Dementia Strategy had been refreshed. A period of engagement commenced in early September 2021 and the strategy for the period 2022-2027 would be reviewed thereafter and published in early 2022. The report set out the close working with colleagues through the Health and Care Partnership Dementia Board. The draft strategy had been presented at various boards and approved by the County Council’s Portfolio Holder for Adult Social Care and Health. There were benefits of having a joint strategy for Coventry and Warwickshire, both for commissioning and service providers.

The strategy would be a system document across health and social care in Coventry and Warwickshire with a system partnership approach, fully supported by NHS colleagues and delivered in partnership with the voluntary and community sector. The report detailed the approach to producing the draft strategy, the wide engagement including stakeholders and how this strategy aligned to other local strategies, which focussed on carer wellbeing. Following the engagement, feedback would be collated, published and provided to stakeholders with the findings incorporated in the draft strategy where appropriate. The strategy would be presented to various boards and bodies including the Health and Wellbeing Board and the county council’s Cabinet for approval and would then be published on the Council’s website. 

The following points and observations were made:

• A question on the age profile of those with dementia as it seemed that more young people now had dementia. Key information would be provided in the strategy. An offer was made to provide up to date information regarding early onset dementia for the committee.
• Points about end-of-life care and ‘dying well’. There was praise for the services provided by the Admiral nurses. An area where the strategy could be strengthened concerned the end-of-life period and the dialogue with relatives. Some family members only became involved at the end-of-life but might  ...  view the full minutes text for item 6.

An overview of Domestic Abuse Services, the position and response in Warwickshire.

Emma Guest, WCC Domestic Abuse (DA) Commissioner and Harriet Birch from Refuge presented an overview of domestic abuse services, the position and response in Warwickshire. Partnership working was central to providing an effective response and characterised Warwickshire’s approach and its recognised good practice.

Harriet Birch spoke to the following sections of the report:

·                 What is DA?

·                 Warwickshire’s DA Service. This detailed the accommodation and resettlement support and DA community support services.

Emma Guest then presented the following sections:

·                 Demand, need and performance in Warwickshire.

·               Warwickshire’s partnership response to DA with an outline of the various groups involved:

·     Warwickshire’s Violence Against Women and Girls (VAWG) Board and Sub-Groups.

·     Emerging Trends.

·     DA Partnership Communications Group.

·     Multi Agency Risk Assessment Conference (MARAC) Steering Group.

·     Domestic Homicide Review Sub-Group.

·     Safe Accommodation Working Group.

·     DA Partnership Commissioning Group.

·     Harmful Practices Group.

·     Coventry and Warwickshire Sexual Violence Partnership Board.

·     Rape and Serious Sexual Offences Group.

·     COVID impact and response, together with performance during Covid restrictions.

·               The DA Act 2021, comprising the aims of the Act, specific new duties for all upper tier local authorities to provide “Safe Accommodation and Support”, the government funding provided and progress to date.

·               Delivering improvement activity underway and planned, with an outline of successful initiatives to date.

·               Future plans and priorities to be delivered over the next twelve months.

Through discussions with the government, the Local Government Association, the national DA Commissioners Office and other local authorities, the Council had been assured that it was making good progress to meet the new duties of the DA Act and to make improvements to the support offer for adult and child victim-survivors in Warwickshire.

An appendix to the report provided details of how domestic abuse could be reported and the support services available for anyone who was a victim of abuse or had concerns about family, friends or colleagues that were / or might be a victim of DA.

Questions and comments were submitted, with responses provided as indicated:

• A point about the volume of calls for police support related to domestic abuse issues often linked to drugs and/or alcohol.
• Reference to the refuge accommodation provision within the county. There were currently 24 units of accommodation and endeavours to increase this to provide another 36 units of accommodation. A member commented that current demand levels exceeded this and some people had to be located out of county in hotels or bed and breakfast accommodation, which could add additional risks.
• It may be several years before a victim decided to seek assistance.
• A concern was raised around domestic violence and abuse cases identified at school. School staff who were not sufficiently trained to intervene sought help from other agencies. The current arrangements were not adequate and there was a need for better support, education and communication. Whilst the new Act was welcomed, this was a significant issue which needed further investigation. The member offered to pursue this after the meeting, which was welcomed. An outline was given of the range of professionals involved and  ...  view the full minutes text for item 7.

To provide a summary of the comments, compliments, complaints and questions submitted in relation to Adult Social Care services. 

John Findlay introduced this item, to provide a summary of the comments, compliments, complaints and questions submitted in relation to Adult Social Care services.

The report set out the mechanisms available for customers to provide their feedback digitally, by telephone, face to face or by post.  Generally, over recent years the use of a digital self-account had increased and currently over 77% of responses were received this way.

There was a service level agreement (SLA) for timeliness of response to feedback classed as a question or a complaint. The report outlined how cases received by WCC were dealt with. During 2020/21, there were 593 cases assigned to teams which were within the remit of this report.  Of the cases assigned and processed during the period, just over 76% (77% of questions and 35.46% of complaints) were closed within the appropriate SLA.  The corporate SLA performance target for complaints was 70%. 

During 2020/21 there were 141 complaints closed by teams. Of those closed cases 50 (35.46%) achieved the SLA timeliness requirement. Most of the complaints raised focused on perceived issues with communication, financial issues and WCC service standards. Additionally, 20 complaints and enquiries relating to Adult Social Care were submitted to the Local Government and Social Care Ombudsman, with decisions made on 17 and a breakdown was provided of the findings. Of those findings, five were subject to full investigation, two of which were not upheld and three were upheld.

The report set out how the Council learned from the feedback it received, including a breakdown of learning for cases raised during this reporting period.

Questions and comments were submitted, with responses provided as indicated:

• A question about how services were learning and embedding changes. There were some IT system challenges and replacement of the complaints system, as part of a new customer relationship management system was being pursued actively. At the same time the cultural aspects would be looked at.
• Some people had difficulty in navigating telephone systems which routed them to the correct service and could need additional support.  During the Covid-19 pandemic an 0800 ‘hotline’ was established. There was a ‘digital first’ approach, but it was known that some customers were unable to access services through this means and other access routes were provided. Accessing services was the Council’s responsibility, not the service users.
• There was a need to communicate in plain English for those outside the organisation. Reference to the level of communication used by tabloid newspapers and it was questioned how the council presented its plans and strategies in a format for public consumption.
• It was requested that a further update be provided to the committee in due course.

Resolved

That the Overview and Scrutiny Committee considers and comments on the report as set out above.

The Council Plan Quarter 1 performance progress report for the period April 1st 2021 to June 30th 2021 was considered and approved by Cabinet on 9th September. This report provides a tailored update relevant to the remit of the Committee.

The Council Plan Quarter 1 performance progress report for the period 1 April to 30 June 2021 was considered and approved by Cabinet on 9 September. Pete Sidgwick presented a tailored update relevant to the remit of the Committee. It was reported that comprehensive performance information was available via the Power BI system.

The report focused on the Council Plan 2020 – 2025, giving strategic context and a performance commentary, including the Council’s two high level outcomes. These were assessed against 54 key business measures (KBM), of which twelve were within the remit of this committee. Current performance showed that one KBM was paused from reporting due to national suspension of inspection or examination regimes. Eight KBMs were on track and three were not. There were two areas of note, with a current performance narrative provided for each of these. Of the three areas not on track, none required escalation at this stage. Summary information was provided and the associated commentary and improvement activity for all reporting measures was available.  The impact of the Covid pandemic on these measures was noted.

A financial commentary was provided showing the position on the revenue budget, delivery of the savings plan and the capital programme.

A councillor commented on the worsening position in regard to suicides, which should remain a focus. Commissioners were aware of this and support was provided through a third-party organisation to affected individuals.

Resolved

That the Overview and Scrutiny Committee notes the progress of the delivery of the Council Plan 2020 - 2025 for the period.

To review the Committee’s work programme for 2021/22.

The Committee reviewed its work programme for 2021/22. The Chair advised members of an additional item that had been raised with West Midlands Ambulance Service (WMAS). This had resulted in the briefing note circulated ahead of the meeting and discussion at the full Council meeting the day before this committee. WMAS had offered to address members at the next committee meeting in November and the Chair had invited any member of Council to submit questions via herself. Members agreed to update the work programme accordingly. It was suggested that contact be made with Rugby Borough Council which was also considering this matter. A copy of the documents from that meeting could stimulate further questions.

A request to allocate a date for consideration of the Integrated Care System (ICS). A high-level briefing note had been requested from the clinical commissioning group and would be circulated as soon as it was received. Councillor Bell advised that an ICS workshop would take place on 18 October. This would look at how the system would fit together, including the relationship with the Health and Wellbeing Board. Nigel Minns added that the appointment of the ICS Chair was still to be confirmed and recruitment of the ICS chief executive was ongoing. A suggestion to extend an invitation for them to attend the committee, once both positions had been confirmed.

As part of the WMAS item, a request for data on the first responder service. All members would be invited to submit questions or lines of enquiry ahead of the meeting. These would be collated and submitted to WMAS, in order that a response could be provided.    

Councillor Bell thanked the committee for its consideration of the first three items on the agenda and she saw its input as essential in developing strategies at an early stage. The Chair noted the significance of these items, commenting on the weight of agenda and need balance agendas to ensure time in each meeting to scrutinise the topics in depth.

Resolved

That the Overview and Scrutiny Committee updates its work programme as shown above.