Agenda and draft minutes

Councillor Mandy Tromans (replaced by Councillor Tim Sinclair), Councillor Chris Mills, Councillor David Johnston (Stratford-upon-Avon District Council) and Councillor Margaret Bell (Portfolio Holder for Adult Social Care and Health).

Councillor Barker declared an interest in the item on South Warwickshire Community Beds Review as a member of Shipston Town Council. Councillor Holland declared an interest in the same item as the Council’s representative on the South Warwickshire NHS Foundation Trust (SWFT) Council of Governors. Councillor Rolfe advised that she had received a number of communications in relation that item.

The Chair welcomed everyone to the meeting, especially the presenters and new members of the Committee. Councillor Drew had provided literature and merchandise received from the Carers’ Trust which was available for members to take away after the meeting. She spoke on the work of the Carers’ Trust.

The Chair advised that she had received communications in relation to the item on the South Warwickshire Community Beds Review from a number of organisations and individuals. She would respond to all the correspondence in due course.

To receive the Minutes of the committee meetings held on 17 April and 14 May 2024.

The minutes of the Committee meetings held on 17 April and 14 May 2024 were approved as correct records and signed by the Chair.

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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.

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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.

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The Committee will receive an update from Coventry and Warwickshire Partnership NHS Trust (CWPT) about the transformation of community mental health services.

The Committee received a report and presentation from Eleanor Cappell, Alastair Penman and Richard Onyon of Coventry and Warwickshire NHS Partnership Trust (CWPT). The report confirmed the commitment to expanding services for people experiencing mental health illness. A revised approach would enable people to take an active role in their care planning and delivery, promoting greater choice and control over their own health and wellbeing. CWPT was committed to people not having to repeat their story or have multiple assessments. The report set out the approach to fostering a sense of safety and support, building trusting relationships with individuals, to promote recovery and a strengths-based approach.

The impact and benefits of this approach were reported, along with the aims to reduce health inequalities.  Key aspects were a multi-disciplinary approach, providing better access with greater geographical reach. There would be closer links with the community and localities, including partnership working with the voluntary and community sector (VCS). The aim was to be more responsive preventing people reaching a mental health crisis requiring their admission to hospital. The transformation had and would continue to deliver these positive impacts to reduce health inequalities, through specialist social work services, having a stronger presence in community teams, and moving to a strengths-based specialist assessment. As the transformation progressed with teams coming together, the focus would be on improving referral pathways, moving away from diagnosis-led services towards more ‘open door’ personalised support.

The report was for the Committee’s information but also sought support to the permanent closure of the pre-existing day services. The supporting presentation drew out the key messages including the rationale to close the day hospitals. Slides covered the following areas:

• Community mental health transformation - impact
• The National ‘ask’
• CWPT’s impact
• Adult social care offer
• The commitment
• What are the benefits?
• Key areas of focus for 2024/25
• Learning and what will change moving forward
• Day hospitals – The former Clinical Commissioning Group commissioned the Oakwood and Fennel Day Hospitals. The services were largely suspended in response to the Covid pandemic. The pandemic had accelerated the development of modernised mental health services.
• Recommendations for the permanent closure of the day hospitals, as they duplicated services now delivered via multi-disciplinary assessment, care planning and delivery of new therapeutic options within a place-based model.
• The benefits of the modernised service, which was more responsive, integrated, and individualised, with care closer to home and with the ambition to achieve better outcomes for patients.

In closing the presentation, Alastair Penman confirmed that currently people requiring inpatient care were being cared for locally. Richard Onyon emphasised the benefits of the community teams in providing constant and more responsive cover for the whole of Warwickshire, rather than requiring people to travel to specific centres like that located at Nuneaton. The new service was holistic and enabled better management of inpatient beds. It had removed the previous requirement for patients to be located at centres a considerable distance from their home. Eleanor Cappell reminded of the earlier presentation to the  ...  view the full minutes text for item 5.

To consider the annual feedback report for 2023/24.

Pete Sidgwick presented the annual customer feedback report for 2023/24 for Adult Social Care and Public Health services. The report summarised the compliments, complaints and comments received by these two services including learning and service improvement. Data, trends, and themes had been compared over the last three years.

The executive summary highlighted that a new customer feedback system was implemented on 15 January 2024, part way through the reporting period. Following a review in 2023/24, the Council’s customer complaints policy, including the updated children’s and adults social care statutory procedures, were approved by Cabinet on 15 February 2024.

At an organisational level, the overall feedback received had returned to pre-pandemic levels and in 2023/24 was at the lowest level in the last six years.  For Adult Social Care, the overall number of complaints had declined over the last three years and decreased from 189 in 2021/22 to 122 in 2023/24, a reduction of 35%. No Public Health service complaints were received in 2023/24.

The detail of the report included the following sections:

• Complaints Process.
• Analysis of customer feedback received during 2023/24, including a number of data graphics.

For Adult Social Care the data included:

• Initial feedback contact method
• Complaints data trend by month
• Complaint categories by subject
• Complaints per team
• Remedies
• Outcomes
• Timescale compliance
• Lessons learned and actions taken to improve services.

Members discussed the following points:

• The overall number of complaints was reducing, but compared to overall feedback, the percentage of complaints was rising. The reasons for this were explored, together with the endeavours to capture positive feedback from a variety of sources. Learning was taken from feedback where things hadn’t gone well and successes were celebrated. The councillor sought a balance to encourage positive feedback, so the report did not look worse than the actual position.
• Information was sought on the total number of customer interactions which the compliments and complaints were compared against. Around 12,000 people were supported each year. The councillor referred to the corresponding item at the Children and Young People OSC where 1.4% of interactions were related to complaints. This additional data had been requested by the directorate and could similarly be provided for this committee if helpful. It would provide context for future annual feedback reports.
• The decline in feedback levels was explored, it being questioned if anything further could be done to encourage feedback. It was considered that the ways people could provide feedback had been improved. The decline in feedback may indicate people were happy with the services provided, but similarly there may be a need to articulate the offer in a better way. If next year’s report showed a continuing decline in feedback levels, it may be necessary to rethink how the council engaged. Feedback was needed to understand the customer experience and to learn and adapt services accordingly.
• The number of cases closed during this period provided a positive indication.

It was agreed that the Committee notes the annual customer feedback report for 2023/24 for Adult Social Care and  ...  view the full minutes text for item 6.

For the Committee to consider and comment on the Quarter 1 Integrated Performance Report 2024/25.

Pete Sidgwick presented a summary of the Council’s performance at Quarter 1, which covered the period April to June 2024, against the strategic priorities and areas of focus set out in the Council Plan 2022-2027. The report provided a combined picture of the Council’s delivery, performance, finance and risk, enabling scrutiny and transparency for the organisation, partners, and the public.

The detail of the report and supporting appendices comprised:

•        Progress against the Council Delivery Plan (CDP)

•        Performance assessed against the Key Business Measures (KBMs) contained within the agreed Performance Management Framework (PMF)

•        Management of financial resources; and

•        Management of risk.

The Committee was able to monitor performance via a performance portal in the Power BI platform. A training session had taken place immediately prior to the Committee meeting on Power BI and the revised CDP and PMF.

Of the 61 activities listed in the CDP, nine were attributed to Adult Social Care and Health. The quarter one results showed a strong start to the year with 89% (8) of these being on track and 11% (1) at risk. Appendix one and subsequent sections of the report gave more information about progress. The 2024/25 PMF contained 67 KBMs. There were nine KBMs within the remit of this Committee, and eight were available for reporting this quarter, the remaining measure being due for reporting later in the year. The trend information was also positive.

The KBM ‘not on track’ concerned the percentage of people open to Adult Social Care with eligible needs, living in the community with support who were over the age of 65. The trend had been declining and the forecast position for the next reporting period was to remain stable. The overall position was positive, and context was provided of the challenges of the current operating environment.

Looking at finance, at the end of quarter one the services were forecasting a cumulative net service overspend of £15.105m, equivalent to 6.1% of the revenue budget. Saving targets were forecast to be underachieved by £0.422m or 6% of the current year’s target. The delivery of the planned capital programme remained on track.

In terms of risk, these were monitored at both the strategic and service level. For the Council overall, there were nine strategic risks, with three rated as ‘red’ or high level. This included one highlighted for this committee, on a mismatch between demand and resources. It was not distinct to this service area but was more directly related to it. At a service level there were 15 risks and no key risks highlighted which were ‘red’ (high risk).

The Council continued to operate in a challenging and rapidly changing environment, with the financial outlook in the short to medium-term impacting on the Council’s resources. Performance reporting would continue to track and highlight delivery and performance to inform prioritisation of activity and resources.

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

• Further information was sought on the indicator which was not on track, related  ...  view the full minutes text for item 7.

The Coventry and Warwickshire Integrated Care Board (C&W ICB) will provide an update to the Committee on the review of community bedded provision in South Warwickshire.

Laura Nelson, Chief Integration Officer for NHS Coventry and Warwickshire ICB provided an update, supported by Amy Danahay and Rose Uwins of the ICB. There had been previous engagement on the community hospital rehabilitation bed provision for South Warwickshire, dating back to February 2022.

Background was provided on the phased development aimed at modernising the Ellen Badger Hospital (EBH) in Shipston-on-Stour. The first phase comprised the construction of a new health and wellbeing hub, improved outpatient services, and expanded diagnostic capabilities. The sixteen in-patient beds were temporarily relocated. The inpatient area at EBH had been retained but due to changes in the building's footprint, the facility could now accommodate twelve beds. It did not comply with acute inpatient guidance and significant capital investment would be required to address a number of reported issues.

The report reminded of the review undertaken by South Warwickshire Foundation Trust (SWFT), and subsequent business case considered by the ICB in April 2023. The need for a wider review of rehabilitation services had been raised. The ICB had identified other areas to be addressed and had agreed to prioritise the rehabilitation beds in South Warwickshire.

The ICB recognised the legal and regulatory responsibilities associated with a service change. It considered that the potential changes flowing from the community bed review constituted a significant service change and consequently there was a need for further public involvement on the proposed options and their wider implications. Due to the time elapsed, the ICB needed assurance that all viable options for providing community rehabilitation beds, particularly in South Warwickshire, had been thoroughly explored, validated, and any critical new considerations identified. This reassessment, which included previous and new stakeholders, was conducted between June and August 2024. The options identified would serve as the foundation for any subsequent public consultation.

Progress was reported on the steps the ICB had taken in recent months, to assess if the clinical evidence supporting the options appraisal and subsequent Pre-Consultation Business Case (PCBC) were robust, to enable the ICB to proceed with a public consultation. Additional considerations were the submission of a system financial plan and a new estates infrastructure strategy and delivery plan. The following proposed options were confirmed as viable:

• Provide 35 community beds across three sites (EBH, Nicol Ward and Campion Ward) and continue to improve care at home (maximum of 12 beds at EBH).
• Continue to provide 35 community beds across two sites (Nicol Ward and Campion Ward) and continue to improve care at home.

With the ICB having completed all necessary steps, the Committee’s support was sought to move forward with the review through a formal consultation. It would involve the development of a PCBC and supporting documentation. Furthermore, it was proposed to shorten the consultation period from twelve to six weeks and the rationale for this was reported, thereby accelerating decision-making to March 2025 rather than May 2025.  The report included the proposed timeline. It acknowledged the potential implications from shortening the consultation period and how the ICB proposed to  ...  view the full minutes text for item 8.

The Committee will receive an update on NHS Dentistry from the Coventry and Warwickshire Integrated Care Board (ICB). This will respond to reported concerns over local services and the transfer of dentistry from NHS England to the ICB.

At 12.55 pm the Committee voted that the meeting should continue beyond three hours in duration.

The Committee received a briefing from Ali Cartwright, Chief Integration Officer and Tim Sacks, Director of Primary Care of the Coventry and Warwickshire Integrated Care Board (C&W ICB).

The update provided national context and background, including the transfer of dentistry, amongst other services to the ICB with effect from 1 April 2023. The report outlined the ICB’s roles in relation to dentistry. The six West Midlands ICBs had agreed to maintain the specialist dental (and pharmacy & optometry) commissioning team as a single team, hosted by the NHS England Office of the West Midlands to maintain the specialist knowledge and function.

In February 2024 the government published ‘Faster, Simpler and Fairer: our plan to recover and reform NHS dentistry’. This contained initiatives to improve oral health and access to dental care. It included plans to incentivise dental teams to provide NHS dental care and take on new patients. There were plans to increase the dental workforce and make it easier for practices to recruit new staff.

An overview was provided of dental services, which comprised primary care, community services and secondary care. A section was included on the national dental contract, implemented in 2006 and reviewed at a national level each year. The ICB had no ability to alter this overarching dental contract. It could commission additional services to address health inequalities. Dental providers were paid via a ‘unit of dental activity’ rate which fell into bands with the rates and example services detailed in the update. There was a recognised need to reform the dental contract.

Information was provided on dental services in Coventry and Warwickshire, with data on general dental services, orthodontic services and other services. A map showed the location of services across Coventry and Warwickshire.

The update included information on performance of providers. Services in C&W continued to perform well when benchmarked against other ICBs nationally. Key indicators of performance included the number of new patients registered with an NHS dentist and units of dental activity, compared to the data prior to the Covid pandemic. Coventry and Warwickshire was one of only two systems in England which had returned to pre-2019 levels for both new patient registrations and activity. Graphs were included to illustrate this.

Next, the update focussed on the dental services equity audit needs assessment. There were health inequalities across the ICB footprint. A report by the regional dental public health team had highlighted a number of these gaps, which would form the basis of a future local dental strategy. Data was provided in tables, highlighting:

• The prevalence of tooth decay in 5-year-olds in Warwickshire over the period 2008-2022, as compared to the West Midlands region and nationally. Whilst good overall, there were some areas with significantly higher tooth decay rates.
• The wards with comparatively poorest dental access across Warwickshire. Some areas of Stratford-upon-Avon were referenced.
• Rates of oral cancer and mortality in Warwickshire, compared to other  ...  view the full minutes text for item 9.

For the Committee to review and update its work programme.

The Committee reviewed its work programme. Councillor Drew had asked to address the members on the Menopause group in Kenilworth. Given the length of the meeting, this information would be circulated instead.