Agenda and minutes

Apologies for absence were received from Councillors George Derx and Cynthia Ransome.

There were no declarations of interest made.

The minutes of the Health and Adult Social Care Overview and Scrutiny held on 15^th March 2017 was agreed as a true record.

[A period not exceeding 20 minutes for

Statements from up to 5 members of the public on

matters within the Panel’s remit, proposing action(s)

which may be considered or contribute towards the

future development of the Panel’s work programme].

Mr Doug Wright attended the meeting and made a statement about the Sustainable Transformation Plan, a document which explained what was happening with South Yorkshire and Bassetlaw in the future.  In respect of the structure of the organisation, reference was made to the top tier level which was a collaborative partnership board.  Mr Wright expressed his concern that the board undertook meetings which could not be attended by the public in order to listen to the discussions and also that the minutes were not yet available online therefore it was felt that decisions were being made in secret.

Mr Wright stated that the concept of Integrated Care Services was a principal that can’t be argued with, however, he raised concern about its financial aspect and how the funding was going to be found by 2021.  Mr Wright spoke about the rapid response function ran by the Doncaster CCG, which sounded excellent and working in practice.  Mr Wright stated that he felt that finance was key to this and was concerned that two systems couldn’t be run at once.  Comments were made that Tunstall Healthcare in Sheffield ran the operation at night unit with only has the one vehicle working across Sheffield.  He added that if this was true, funding needed to be set up to ensure that the right kind of social care was delivered.

It was explained that the purpose of the report was for the Doncaster’s Clinical Commissioning Group (CCG) to provide an opportunity to Panel Members to be consulted on regarding the closure of a Branch GP Surgery at Scawthorpe, Doncaster.

It was explained that there were currently three sites which formed the Ransome Practice in the North West Locality.  The main branch at the Health Centre in Bentley and another branch site at the Woodside Surgery at Woodlands.  The Practice had requested approval to close their branch site, The Clinic on Amersall Road at Scawthorpe.  It was reported that the Scawthorpe Clinic was the smallest surgery of the 3 and saw 22% of the practice population.  The Panel was informed that reasons for the closure included difficulty in recruiting GPs (the branch had only 2 partners now which had reduced from 4) and therefore spreading themselves thinly across the 3 sites.  It was explained that there were also issues with the building and that the Practice will have a reduction in PMS funding. Alongside these issues there was also an imposed premises rent increase of 400 per cent by NHS Property Services and a reduction in ability to increase revenue at the practice.

Healthwatch assured the Panel that the Practice has gone through a robust consultation process.  It was reported that the Practice Manager, a GP and representative from Healthwatch had attended all of the consultation meetings.  Also, that the Practice had developed a patient leaflet available in each of the branches, informing patients of the changes and the reasons why the branch was closing.  It was explained that there was a great deal of information that had been given to patients about the services operating through other practices and feedback had been received.  Members were informed that issues had included the concerns of the travel of elderly between practices.  It was outlined that once the consultation has ended further work would be done to consider the issues around the elderly, those housebound and how they will be addressed.

The Panel asked a range of questions and discussed the proposed closure in more detail.  The issues included the following: -

Concerns around the elderly and other patient groups – Members were concerned about travel to the other practices as two separate bus journeys would be required to travel from Scawsby to Bentley. Members were also advised that the practice had undertaken an Equality Impact Assessment and understood that nothing had arisen from that.

Vacancies on patient list at other Practices – It was explained that both the other two Practices had open lists and where lists were open, the branch would accept any patient within the area who wished to transfer. 

GP Recruitment – It was clarified that this issue was not just a problem within Doncaster but South Yorkshire wide.  Members were informed that within the General Practice Forward View document, there was a commitment to investing in other clinical groups, upskilling other members of staff to take  ...  view the full minutes text for item 40.

Members were presented with an update on the progress of Doncaster’s Strategic Health and Social Care Plans.  The presentation focused on three high level strategic plans; the South Yorkshire and Bassetlaw Sustainability and Transformation Plan, the Doncaster Place Plan and the council’s Adult Health & Wellbeing Transformation Programme.

It was explained in the presentation that the vision was that ‘people are able to look after their own health and wellbeing, but knows that support is always available from (us) and the community’.   Members were reminded of the several projects and their objectives that came under the Transformation Programme and included:

1.         Customer Journey

2.         Community Led Support

3.         Transforming Commissioning

4.         Digital and Technology

5.         Performance Management and Continuous Improvement

6.         Alternative Service Delivery Models

7.         Health and Social Care Integration

Members were informed that there had been a great deal of engagement and communication with the customer to ensure that they were aware of what those projects were.

There was a discussion around Runwood Homes and concern was raised around the issues when transferring of staff to future providers.   It was explained that there needed to be a mixed economy of providers to form an ecosystem of smaller providers such as DomCare that delivered a much wider voluntary and independent type of care.  Comments were made about how we financially enable people and in turn reduce isolation (reference was made to costs of using a befriending service).  It was explained that the purpose of the plan was about reaching people at a much earlier stage before issues escalated.  In terms of volunteering, Members were told that there was a great deal of people wanting to volunteer although there would need to be a support infrastructure in place. It was explained that there was a community led support model that would need to be developed.

It was explained that there was a great deal of work going on in terms of learning disabilities enabling those in long term hospital care to return to the home environment through supported living by the process becoming more person centred and achieving better outcomes.  It was added that there were a number of actions to be done that would improve the offer.  This included considering a joint strategy and that the Council was about to commission supported living

Performance - Members were told that results had improved and were still improving in the following areas:

•               Residential care places – reduced from a high of 1,606 in 15/16 to 1,370 (as at 30th June) and with admissions (over 65s with figs improving).

•               Admissions to residential care lowest since 2011.

•               Direct Payments had increased from 504 to 715 in the past 12 months – it was recognised that the Council had been poor performers in the past, however figures were now improving.

•               Governance was improving and on a positive trajectory reducing from around 80-90 down to around 20.

It was noted that such results demonstrated the best figures for 10 years.  In respect  ...  view the full minutes text for item 41.

It was explained to Members that this was a regular item on the workplan and set out to outline;

1.            What was happening to providers;

2.            The role of the Council;

3.            Recent government announcements around improved Better Care Fund (iBCF) with expectations against that.  It was explained that it was about improving the customer journey and IC work and flow in system where availability wasn’t there.

Members were provided with information around the Care Quality Commission (CQC) Inspection and Regulation of Adult Social Care.

The information summarised:

•               Key findings from the CQCs recently published report on the state and quality of domiciliary care services and provision of care in a registered Care Home for adults for the period 2014 to 2017.

•               Comparisons between the CQCs national key findings and the local data and intelligence in relation to the provision of adult social care in the Doncaster district.

•               Contract monitoring, engagement and other improvements activity undertaken by commissioning staff to support and drive up standards and quality.

•               Recently announced programme of Health and Social Care local system reviews to support those areas facing the greatest challenge to secure improvement.

Members questioned the Councils capacity to monitor contracts with providers, maintain standards and then prevent those standards from slipping.  Members were informed that the Council was undertaking its own review of commissioning and developing a Commissioning Strategy and Plan. Members were informed that the Doncaster provision was recognised as some of the best.

It was explained that the Council was presently looking for an interim Assistant Director, that two Heads of Service roles were still vacant and discussions were taking place with the NHS CCG regarding other vacant places.   

It was explained that nationally, the CCQ ratings and grading system had been abandoned four to five years ago and was then reintroduced 3 years ago.  It was added that the majority had since been inspected and that Doncaster had come out slightly higher than the national average.  Across Yorkshire and Humber, Doncaster had required less improvement than other local authorities.  Finally it was explained that Doncaster was average in terms of pay to providers and that its approach consisted of 1. A ‘pull-active’ approach, 2. Protected resource in contract management and 3. Establishing strong relationships with CQC inspectors and providers.

Clarification was provided in terms of ratings that although Doncaster did very well in respect of domiciliary care there were no outstanding services, however, they were no better than the England average. It was recognised that the aspiration was there to achieve outstanding but that CQC handed it out very rarely.

Members requested that a breakdown of this information be provided.

Members were informed that where homes may receive unfavourable reviews that the Council would work with them to construct an action plan to reach standard.  It was further explained that where homes had been closed, action would be needed, and that for the few that have been closed this had been handled successfully through  ...  view the full minutes text for item 42.

The Panel received a report updating Members on the Panels work plan for 2017/18.  A copy of the work plan was attached at Appendix A to the report taking account of issues considered at the Health and Adult Social Care Overview and Scrutiny workplanning meeting held on the 21st June, 2017.

Members were also presented with an update following meetings held of the Joint Regional Health Overview and Scrutiny Committees.

Resolved that the Panel note the Health and Adult Social Care Overview and Scrutiny Panel report.