Agenda and minutes

To receive any apologies for absence

Apologies for absence were submitted from Alistair Neal and Shahid Younis.

Rachelle Shepherd-Dubey attended the meeting online.

To confirm the Minutes of the Meeting held on 5 July 2023.

The Minutes of the meeting of the Committee held on 5 July 2023 were confirmed as a correct record and signed by the Chair.

To receive any declarations of interest

There were no declarations of interest.

To answer any public questions

A period of 30 minutes will be allowed for members of the public to ask questions submitted under notice.

The Council welcomes questions from members of the public about the work of this committee.

Subject to meeting certain timescales, questions can relate to general issues concerned with the work of the Committee or an item which is on the Agenda for this meeting.  For full details of the procedure for submitting questions please contact the Democratic Services Section on the numbers given below or go to www.wokingham.gov.uk/publicquestions

There were no public questions.

To answer any member questions

There were no Member questions.

To receive an update on dental services in Wokingham Borough.

The Committee received an update on dental services in Wokingham Borough.

During the discussion of this item, the following points were made:

·       Hugh O’Keeffe commented that patients attending over a two year period had fallen dramatically over the pandemic.  Improvements were being seen but had attendance levels had started to plateau since early 2023.

·       Members were provided with information regarding commissioned activity in January and June 2023.  In April the Beanoak surgery had handed back its NHS contract of around 10,000 units of activity.  It was one of approximately 15 practices that had handed back its contract since 2021.  Temporary activity had been put in place to cover this, and practices in Woodley and Bracknell were providing cover currently.  A plan for recommissioning this activity on a permanent basis, from April 2024, was being developed.

·       With regards to delivery of activity, practices had to deliver a certain percentage of activity that had been commissioned in order to retain a level of funding.  Performance had dropped significantly during the pandemic, and then improved in 2021-22.  Forecasted activity had been exceeded by the end of the year.  During 2022/23 the overall activity delivered in BOB was 80.34% of that commissioned.  Berkshire West and Wokingham had performed slightly better.

·       Those who had not attended a dentist for some time often had more complex dental needs and required lengthier treatments.

·       Many access challenges remained, particularly for those who had not visited a dental surgery for some time.  Often these were from vulnerable groups.  Much of the recovery of access had related to practices recalling patients who had previously attended.

·       It was noted that a third of the queries with the NHS England contact centre regarding dental practices, between January and December 2022, had come from the Earley area. 

·       The Committee was updated on action being taken to improve access.

·       Changes had been made to the national contracts.  These were designed to improve dentist remuneration in terms of more complex treatments, expand capacity by allowing practices to deliver more contracted activity, and to provide more information for patients.  Further changes to the contract were anticipated over the next few months.

·       Some practices had provided additional access sessions.  Take up in BOB had been quite low. 

·       Members were reminded of Flexible Commissioning.  The pilot would run June 2023 to March 2024.  Under this up to 10% of contracts could be flexed and activity targets converted to additional access sessions.  It was hoped that this would help to support more vulnerable groups.  30 practices had signed up in BOB (2 in Wokingham) and it was planned for 3,000 sessions to be delivered (148 in Wokingham).  Between June and August 2023 18 sessions had been held in Wokingham and 62 patients seen.

·       There had been investment in the referral services to try to recover the pre pandemic position and progress was being made.

·       A Member commented that several practices had left the NHS and questioned if these practices were asked their reasons for leaving and what might make  ...  view the full minutes text for item 27.

To receive a presentation on the ASC Specialist Accommodation Project.

The Committee received a presentation on the ASC Specialist Accommodation Project.

During the discussion of this item, the following points were made:

·       Wesley Hedger outlined how the programme had come to be.  Reflecting on the Learning Disability Community Wokingham Borough Council’s Learning Disability Strategy 2019, and how the Council could support people to live independently as possible in the community, it was considered that the number of adults with learning disabilities, supported in Wokingham, was higher than many other parts of the country.  As the local population increased the number of those with learning disabilities needing support was also likely to increase.  In addition, a number of people had been living in accommodation which was now considered to be unsuitable. 

·       A strategic aim was to maximise independence and the opportunity for people to stay in their own home through a strength based approach to care and support.

·       Aims of the programme included –

Ø  Reducing residential care placements, especially for those with learning disabilities;

Ø  Providing support within the local Borough where possible and developing provision including alternatives to traditional residential care, through greater use of supported accommodation, shared lives etc;

Ø  A greater use of technology to increase efficiency and improve outcomes throughout;

Ø  Increasing partnerships with care providers and neighbouring authorities to address unmet needs, especially around complex disabilities and challenging behaviours.

·       There had been various sources of funding including WBC Capital Programme bid, NHS funding, Homes England Grant, S106 developer contributions, Housing Revenue Account and utilising borrowing through Loddon Homes.

·       Optalis and Specialist Mental Health and complex needs providers had been involved in the care commissioning process.

·       Whilst the programme had been led by Adult Social Care, it involved and brought together a number of different Council departments, such as Property Services.

·       Phase 1 of the project had been delivered and 36 people had now been accommodated.  The percentage of people living in their own home was steadily increasing. 

·       The Committee viewed a video regarding the ASC Specialist Accommodation Project.

·       The Council had been successful in getting a LGA Housing Advisor Programme grant which would help with understanding what was needed next for the project.  Phase 2 was due to begin.  One of the most difficult elements was the matching of people with accommodation.

·       The Council had won a Municipal Journal Award for Best Practice for the programme.

·       A Member asked how Adult Services worked with Children’s Services to identify those who would be transitioning between the services, to help them become more independent.  Wesley Hedger stated that there was a Transition Team which began engaging at age 16.

·       A Member queried whether consideration was being given to the allocation of new build properties given the level of development within the Borough, and was informed that the programme helped to move away from registered provision.  The programme had enabled close working between Adult Services and Property Services, enabling conversations around developer contributions in schemes identified.

·       In response to a question about lessons learnt from Phase 1, Wesley  ...  view the full minutes text for item 28.

To receive a presentation on Home Care.

Wesley Hedger provided a presentation about Home Care (Domiciliary Care).

During the discussion of this item, the following points were made:

·       Domiciliary care services provided regulated activity of ‘personal care’ for people living in their own homes.  The needs of service users varied greatly but care packages were targeted to individual circumstances.

·       Domiciliary care services were regulated by the Care Quality Commission.

·       Service users were usually aged 65+.  They would be visited at various times of the day, or in some cases care would be provided over the full 24 hours.

·       Support could include help with washing, bathing, cleaning themselves, and toileting.

·       The Council had a duty to maintain the market and to ensure that care provided was safe and affordable and that there was sufficient choice in the local area. 

·       The market was a mixture of local authority commissioned domiciliary care and self-funders.  Wokingham’s market also included neighbouring local authorities and some providers who were registered in those areas but provided services to Wokingham residents. 

·       Capacity in 50 providers registered for domiciliary care was monitored through the NHS capacity tracker.

·       Care was delivered to 2,100 people, not all of whom lived in the Borough. 

·       Approximately 7,100 hours of care were commissioned per week.

·       Members were informed that there were 507 clients who were funded by WBC and approximately £7million was spent per annum.

·       A Care and Support Framework was used to commission care.  This was an initial 5 year arrangement – an initial 3 year arrangement until 31 October 2024 with an option to extend for a further 2 year period.  The Council commissioned off framework if required.

·       The rates paid by the Council for care had been supported by an independent cost of care exercise which had included provider input.

·       The Council sought to minimise the use of 15 minute calls.

·       As the local population grew the number of people requiring care was likely to increase and be required for longer periods.

·       There were in the region of 619 self-funders in the Borough, however, self-funders were not required to inform the Council that they were paying for their own care.

·       A high number of providers in and around the Borough worked exclusively with the self-funders market.

·       How quality was ensured included –

Ø  Competitive process to join the Care and Support Framework;

Ø  Finance checks, insurance checks, health and safety, safeguarding and a demonstration of an ability to deliver the services;

Ø  Current CQC ratings;

Ø  Advice, support and monitoring provided by the Quality Assurance team;

Ø  Contract managing visits undertaken by Commissioning.

·       Provider failure was monitored and over the last 24 months only 3 providers had exited the market and ceased trading for a number of reasons.

·       Additional support available to home care providers was highlighted.

·       Members questioned whether workforce shortage was an issue.  Wesley Hedger indicated that recruitment, rates of pay and funding available were issues across the whole sector.  However, there was not a struggle to find care.

·       In response to a question about complaints,  ...  view the full minutes text for item 29.

To receive an update on the work of Healthwatch Wokingham Borough.

The Committee received an update on the work of Healthwatch Wokingham Borough.

During the discussion of this item, the following points were made:

·       Members were informed that the Enter and View Report for Wokingham Medical Centre had been published and would be discussed at a future meeting. 

·       In April Healthwatch had asked the public what three health and social care priorities they would like Healthwatch to look at.  Access to GP appointments had been identified as an area of concern and focus groups would be undertaken in September to November, around patients’ experiences of booking GP appointments.  New ways of working would also be shared at these workshops as many people were unclear about new ways of working.  Vulnerable groups would also be asked about their experiences.  A report would hopefully be brought to the Committee in March.

·       Healthwatch was still looking at dentistry.  Information about the experiences of pregnant women and people with learning disabilities had been sought.  Alice Kunjappy-Clifton indicated that she had had conversations with Hugh O’Keeffe as to how the experience for these cohorts could be improved.

·       Last year NHS England had published a report around maternal mental health which indicated that 1 in 4 women were not receiving mental health checks at their surgeries during their 6 weeks post-natal checks.  GPs would be asked to look at this service again.  It was noted that 18% of women who committed suicide were in the first year of childbirth.

·       The BOB Healthwatches would be supporting the All Age Transformation Continuing Healthcare Programme.

·       Members were informed that communities were becoming more ethnically diverse and that some people were struggling with information standards.  Healthwatch would be looking at information for those whose first language was not English, and also for those who were deaf.

·       Alice Kunjappy-Clifton referred to work relating to asylum seekers’ experiences.

·       Many were struggling with the cost of living of crisis.  People had raised difficulties in travelling to appointments because of transport costs, and also the cost of prescriptions.

·       A Member questioned why some GP surgeries were not offering Covid booster vaccinations.  Alice Kunjappy-Clifton indicated that people could use the national booking service to locate the nearest appointments.

RESOLVED:  That the update from Healthwatch Wokingham Borough be noted and Alice Kunjappy-Clifton thanked for her presentation.

To receive the Adult Services Key Performance Indicators.

The Committee received the Adult Services Key Performance Indicators Q1.

During the discussion of this item, the following points were made:

·       It was noted performance against AS9 a and b ‘Annual measure: Increase in healthy life expectancy at age 65 (males/females)’ had worsened for females.  Ingrid Slade explained that whilst there had been a decrease this was not an area of concern, and Wokingham was not out of step with other local authorities.  The focus was now more around disease free years and increased quality of life.

·       Performance against AS1 ‘Social work assessments allocated to commence within 28 days of the requests (counted at point of allocation)’ had improved for August.  A redesign of the pathway and how allocations were undertaken under this using more specialised teams, had been completed in the last few months.  It was anticipated that performance against AS1 would improve in the next quarter.

·       Whilst performance against AS4 ‘New permanent admissions to residential or nursing care homes (65+) (ASCOF Measure 2A2)’ had reduced, performance was still better than other neighbouring local authorities, and reflected increased volume and complexity of cases.  A Member questioned whether this increased complexity and volume meant that performance against this indicator was likely to remain red.  Wesley Hedger indicated that the increase in referrals was high, but that the redesign of the pathway, moving away from a more generalised approach, would enable the signposting to more appropriate specialist teams, and help ensure that referrals were made quicker. 

·       A Member commented that performance against AS1 ‘Social work assessments allocated to commence within 28 days of the requests (counted at point of allocation)’ was often red.  They questioned the reason for this.  Wesley Hedger stated that as people approached the 28 day period a risk assessment was carried out through a risk matrix, and if a risk was identified, people were signposted appropriately.  Adult social care as a whole remained under pressure, and that retention and recruitment remained a challenge.  The Council had a Workforce Strategy in place.  He agreed to provide a more detailed written response.

·       With regards to AS10 ‘Annual measure: Percentage of adults classified as overweight or obese’, Ingrid Slade commented that performance was similar to national trends and also a post pandemic trend.  There was a lack of physical activity generally across the pandemic.  Public Health was working with Sports and Leisure to deal with the effects of this in a strategic way.  Whilst there was a lot of initiatives available, they were not currently well joined up.  Further consideration needed to be given to developing an offer for those who were obese or overweight, which was broader than that, that had been previously available.

RESOLVED:  That the Adult Services Key Performance Indicators be noted.

To consider the forward programme for the remainder of the muncipal year.

The Committee considered the forward programme for the remainder of the municipal year.

During the discussion of this item the following points were made:

·       The Committee requested that a more detailed update be provided on home care, linked to the Market Provision Statement.

·       The Chair indicated that he had met with the Woosehill GP Surgery PPG.  It had been suggested that a business case would be required around an additional GP Surgery to cover Wokingham.

·       A Member suggested that the currently unscheduled items on GP access and communicating different ways of working be scheduled as two separate items.  Councillor Hare indicated that Healthwatch was undertaking work around these areas and could update as their work progressed.

·       A Member asked about GP provision for the Arborfield area.  Councillor Hare agreed to follow up on this.

·       It was agreed that maternal mental health be scheduled for the first meeting of the 2024 municipal year, and that this include training for midwives around mental health.

RESOLVED:  That the forward programme be noted.