Agenda and minutes

To receive any apologies for absence

An apology for absence was submitted from Alistair Neal.

Beth Rowland attended the meeting online.

To confirm the Minutes of the Meeting held on 7 November 2022.

The Minutes of the meeting of the Committee held on 7 November 2022 were confirmed as a correct record and signed by the Chair.

To receive any declarations of interest

Morag Malvern submitted a Personal Interest in Item 46 Adult Social Care Key Performance Indicators on the grounds that her son received Adult Social Care.

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 NHS Continuing Healthcare (CHC).

Sarah Webster, ICB Executive Place Director, Berkshire Wets, provided an update on Continuing Healthcare (CHC).  She focused on the Transformation Programme All Age NHS Continuing Healthcare which was taking place across BOB, local work in Berkshire West to address particular areas, and joint funding arrangements.

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

·       The ICB was formed in July 2022 through the merger of the three CCGs in the BOB area.  The ICB had wanted to quickly progress the transformation programme around CHC.

·       The aims of the Transformation Programme were as follows –

Ø  Ensure that assessments occurred at the right time and place, meeting all nationally mandated KPIs

Ø  Reduce variation in patient/carer experience of CHC assessments and eligibility across BOB in terms of the assessment process and

Ø  Establish appropriate ICB oversight of CHC and related services performance, developing locally appropriate and the application of the national eligibility criteria.

Ø  Standardise and enhance corporate support services for CHC and related services, improve service resilience and efficiency.

Ø  Review commissioning arrangements to drive economies of scale where appropriate whilst retaining local flexibility and responsiveness.

·       A CHC Transformation Board had been established which was overseen by the ICB Chief Nursing Officer.  It met monthly.  The Board had a broad representation across the ICB, including representatives from the five local authorities and patient representative organisations. 

·       There were three phases to the Transformation Programme –

Ø  Phase 1 - Comprehensive review of CHC service across BOB and seeing what variations existed and what operating model may be put in place.  This was underway (October – January 2023)

Ø  Phase 2 - Produce a strategic development plan for implementation of the recommendations from phase 1 ensuring high quality efficient, fair, and equitable AACC services across BOB ICS.  This was underway. (February - March 2023).

Ø  Phase 3 - Underpin the delivery of the Transformation Programme Plan using an inclusive and supportive approach, providing leadership and mentorship to the clinical and non-clinical teams responsible for service provision. (April – September 2023).

·       At present in Berkshire West the CHC team was an arm of the ICB.

·       Joint funding was where an individual may not meet the eligibility criteria for NHS Continuing Healthcare, but a contribution could made towards an element of their care in partnership with the Local Authority.

·       There were also specific actions for Berkshire West.  The LGA review across BOB in July 2022 had identified many areas for improvement particularly in Berkshire West.  The review had highlighted some inequity in access and potential inconsistencies across the three areas.

·       Members were informed that discussions between the Directors Adult Services in Berkshire West and the ICB (including the external Transformation Consultants), were ongoing about what could be done differently.

·       A local action plan was being developed with a focus on:

Ø  Reviewing the CHC standard operating procedures to align with best practice;

Ø  Agreeing a Disputes Policy with a target date by end of March 2023.  There was currently not a Policy  ...  view the full minutes text for item 43.

To receive an update on the Autism Strategy.

Wesley Hedger, Assistant Director; Adult Social Care Strategy, Commissioning and Performance, provided an update on the Autism Strategy.

·       The Council had a duty around the Autism Strategy to produce a commissioning plan. 

·       Covid and the pressures that this had caused, and the guidance issued by Central Government in 2021 around the Autism Strategy approach and desire to have an all age strategy, had changed the way the Council was approaching the development of the Strategy.

·       The Council was now moving towards the development of an Autism Strategy.

·       A permanent Commissioning Lead for Autism had been appointed in October 2022, and she was starting to develop the way forward.  There was an ambition to work with health to create a joint approach. 

·       A gap in the previous strategy was that it focused primarily on Adults Services, whereas the new strategy would cover all ages, across Children’s and Adult Services.  There was a commitment from these services to deliver this.

·       Timescales for delivery were highlighted.  Wesley Hedger indicated that the Strategy would be brought back to the Committee for further consideration.  It was intended that the draft would be produced in June and taken to Executive in September.

·       Members were asked about the current approach and were informed that it was very much working with the Voluntary Sector around the a joint offer and approach.  The Commissioning Lead for Autism had been appointed in consultation with the Voluntary Sector.  An Autism Alliance was being created to bring people together and would also support a delivery action plan.

·       Members questioned when the Committee could consider the draft Strategy and meet the new Commissioning Lead Autism.  Wesley Hedger indicated that it could be presented at the Committee’s July meeting, and that he would arrange a meeting with the Officer.

·       Members were pleased to note the all age approach that would be taken.

·       Members questioned what outcome the Strategy would have and the difference those with autism and their families may see.  Wesley Hedger responded that an action plan would be developed with the Autism Alliance.  The whole system commitment and desire for co-production was beneficial.  A Member went on to ask whether there were examples of best practices in terms of autism strategies that Wokingham could learn from.  Wesley Hedger emphasised a more consistent approach would be created.  There was currently a divide between children and adults’ provision.  The transition to adulthood was currently quite disjointed and the process would become smoother.

·       A Member commented that the Committee had had the Autism Strategy on its work programme for some time.  She questioned whether Members could have sight of the previous draft version produced in 2021, to ascertain direction of travel.  Wesley Hedger indicated that this version had not been completed and had not been signed off because it had not had an all age approach.  It had taken some time to get to the current position, for a number of reasons, such as resourcing.  During the pandemic many staff had been diverted to help  ...  view the full minutes text for item 44.

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

Alice Kunjappy-Clifton and Sarah Deason, Healthcare Wokingham Borough, presented the Healthwatch Wokingham Borough work programme.

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

·       Sarah Deason indicated that the work programme demonstrated the scope of the work that Healthwatch was undertaking.

·       Healthwatch had been working to bring more staff and members of the advisory group on board. 

·       Volunteers played a big part in Healthwatch’s work, helping to seek people’s views and undertake Enter and Views.  Enter and views were based on feedback received from the public.  It was noted that an Enter and View of a local organisation would be taking place in the near future, and the results reported back.

·       Healthwatch England had had a campaign regarding maternal mental health.  Healthwatch Wokingham Borough had followed this up to ascertain local experience.  The closing date for the survey was 27 January.

·       Work was taking place with Building Berkshire Together who were seeking views across Berkshire regarding the new build.  Healthwatch would assist with the engagement piece.

·       Healthwatch would jointly plan and present a session on self-neglect to the local voluntary sector with the West of Berkshire Safeguarding Adults Board VCS sub-group.

·       Another priority was specialist health support for people with learning disabilities.  Discussions had been held with local voluntary sector organisations and the NHS about access to support from professionals with a special interest and training in supporting people with learning disabilities.

·       Alice Kunjappy-Clifton went on to highlight a number of local priorities.

·       Alice Kunjappy-Clifton referred to concerns raised about the physical and mental health and wellbeing of asylum seekers living in local Home Office Contracted Accommodation.  Feedback had highlighted concerns about nutrition and isolation.  Healthwatch was working with Public Health to improve experiences.

·       With regards to GP access, Healthwatch was working with the Primary Care Networks to get messages about self-care and the new way of working out to the community.

·       Access to dental services continued to be an issue both locally and nationally.

·       Whilst experiences with maternity services had been flagged up at national level, Healthwatch had heard little on this matter locally.  It remained on the watch list.

·       Healthwatch England was shortly undertaking a campaign about the cost of living and the impact on access and physical and mental health.

·       Healthwatch Wokingham Borough would be part of the ICB review of CHC.

·       Support for carers to have time out to pursue interests outside caring, through provision of respite and other support services, was under review.

·       Mental health support for children and young people had also been identified as a priority.

·       Members were pleased to note that access to dental services remained on Healthwatch’s watchlist, and asked how they would escalate this.  Alice Kunjappy-Clifton indicated that they tried to offer support and signposting.  They had put a vulnerable person in touch with the Community Dental Service for instance.  They also provided feedback to Healthwatch England who were creating a national picture and talking to the Health Select Committee.

·       In response to a Member question, Alice  ...  view the full minutes text for item 45.

To receive the Adults Services Quarter 2 2022-23 Key Performance Indicators.

The Committee considered the Adult Social Care Key Performance Indicators.

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

·       There were seven Adult Social Care Key Performance Indicators, five of which were green, one was red, and one was amber.

·       AS 1 Percentage of safeguarding concerns, leading to an enquiry, completed within 2 working days, whilst red, was 54%, slightly improved on the previous quarter.  A triage process under which safeguarding concerns were triaged, had been put in place, and improvements were starting to be seen.  Performance in December had been 76%.  A significant improvement and a positive direction of travel was anticipated for Quarter 4.

·       AS 7 Percentage of CQC registered providers that are rated Good or Outstanding, was amber.  Wesley Hedger emphasised that numbers had a big impact on the indicator.  There were 26 older people care homes in the Borough and 52 care homes in total, so if the rating of one care home changed it could have a big impact.  The Council worked closely with the CQC on the care governance process to support the inspection regime.

·       A Member asked whether the Council had been aware of the circumstances behind the drop from green to amber for AS 7, and whether this had been rectified.  Wesley Hedger stated that the care governance process supported improvement in provision prior to an inspection.  Whilst there was pressure on the sector there was not the level of issues as there were in other parts of the country.

·       A Member questioned why Wokingham was below average for domiciliary care, and was informed that many inspections that took place during the pandemic were more light touch, and inspections were now more in depth.  There were pressures across the system such as the impact of the cost of living crisis.  Wesley Hedger indicated that he would look into the domiciliary care performance, and report back to Members. 

·       The Committee sought an update on Optalis.  Wesley Hedger emphasised positive working relations.  He informed Members that Loddon Court, a respite centre had recently transferred to Optalis.  A refurbishment of the building was due to begin shortly.  Members were updated on the contract management arrangements.  Performance had improved through the partnership with Optalis.

·       Workforce remained one of the major concerns for adult social care. 

·       A Member questioned if there should be a key performance indicator relating to autism. 

·       Members questioned whether figures could be provided in addition as percentages for AS 7 in future.

·       In response to a Member question regarding care home viability, Wesley Hedger stated that conversations were held with providers, occupancy levels were tracked using a national system.  The Council worked closely with providers on sustainability.

·       A Member noted that AS2 Social work assessments allocated to commence within 28 days of the request (counted at point of allocation), was at 100%, and questioned whether issues around recruitment and retention of social workers had now improved.  Wesley Hedger stated that it was still an issue.  However, there was a  ...  view the full minutes text for item 46.

To receive the forward programme for the remainder of the municipal year.

The Committee considered the forward programme.

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

·       Members requested a further update on Continuing Healthcare and progress made at the March meeting.

·       It was suggested that the Connected Care project be added to the Committee’s work programme.

·       Members sought an update on issues raised at the Overview and Scrutiny Management Committee regarding the Adult Social Care Key Performance Indicators.

·       Some Members stated that is was important to receive the Covid vaccine update and an update from South Central Ambulance in the near future.

·       The Chairman provided an update on the outcome of the first BOB Joint Health Overview and Scrutiny Committee meeting, which had taken place earlier that day.  It was agreed that the minutes of the meeting would be circulated once provided.

·       It was agreed that the items for the next meeting would be confirmed by the Committee via email.

RESOLVED:  That the forward programme be noted.