Agenda and minutes

Please see note (a) at the end of the agenda.

Cllr Roger Wilson declared a personal interest as a Governor of the 2gether NHS Foundation Trust; and as a Trustee of the Gloucestershire Rural Community Council which hosts Healthwatch Gloucestershire.

Cllr Brian Oosthuysen declared a personal interest as a Governor of the Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT).

The minutes of the meeting held on Tuesday 15 November 2016 were agreed as a correct record and signed by the Chairman.

The committee to receive a presentation.

67.1     This item was particularly focused on crisis care. The committee was pleased to welcome representatives from the 2gether NHS Foundation Trust, the Gloucestershire Clinical Commissioning Group, the council and the Police to the meeting to engage with members on this important issue. The presentation included the national and local perspective on mental health. (For information - the presentation slides were uploaded to the council’s website and included in the minute book.)

67.2     The committee was reminded that there has been a real culture change in the way in which mental health services were commissioned and provided. The structure has changed from that of containment and sanctuary to one of hope and recovery; from a legacy of exclusion to one of an aspiration of and action to ensure inclusion.  The understanding of mental health illnesses has greatly improved with significant investment in learning from experience and developing knowledge. The committee viewed a short video about the Severn and Wye Recovery College, which was a good example of this change in approach. The Recovery College was established, by the 2gether NHS Foundation Trust and empowers people through peer support to become ‘students of their own recovery’, self-managing anxiety, depression and long term mental illness.

67.3     Members were informed that the Crisis Resolution and Home Treatment Teams (CRHTT) were currently being recommissioned to better meet the needs of people with high intensity needs. A pilot Crisis Café has been established in Gloucester City with Treasure Seekers.

67.4     It was explained that it was important to note that the crisis teams were not a blue light service. However the Mental Health Acute Response Service (MHARS) was co-located with the Police at Waterwells, and also worked closely with the Ambulance Service. The co-location of the MHARS has been in place for eight months and the Police representative informed the committee that this has been a huge step forward. Police Officers were benefitting from having direct access to health professionals for advice, and who also have access to health records and care plans which could inform the decisions that needed to be made when people were in crisis. It was further explained that the Police would be able to access the multi-agency care plans; this would help to inform on and better manage the risk elements in the case. In response to questions it was explained that there was a gradual cultural change with regard to risk management. Police Officers had been used to dealing singlehandedly with these situations and taking responsibility and were now learning that it was a positive change that they were now able to share the risk with colleagues.

67.5     The committee was informed about the implications for mental health with regard to the key changes in the Policing and Crime Bill. Members were pleased to note that on the enactment of the Bill it would be unlawful for Police cells to be used as a place of safety for young people. The committee also heard  ...  view the full minutes text for item 67.

The committee to receive a presentation.

68.1     The committee was pleased to welcome the End of Life Commissioning Manager to discuss and engage with members on this strategy. (For information – the presentation slides were uploaded to the council website and included in the minute book.)

68.2     Members agreed with the strategy’s aim ‘to make sure that the highest quality end of life care services are available to all who need it, irrespective of diagnosis, age, gender, ethnicity, religious belief, disability, sexual orientation, and social economic status’. The committee was pleased to note that a lot of work has gone into defining what was meant by palliative care, and to understand the main causes of death in this county; Gloucestershire was one of the few areas that has an up to date needs assessment in this regard. Members particularly welcomed the information that time had been taken to speak directly with families about their end of life experiences, both good and bad, and that these conversations had influenced and informed the development of the strategy.

68.3     It was noted that the strategy does not currently include children and young people but that this aspect would be debated at the next End of Life Board meeting with a view to expanding the strategy to cover under 18s in due course.

68.4     There was a shared concern that there seemed to be a disparity in the level of provision of palliative care across the county. This was acknowledged, and the committee was assured that the Gloucestershire Clinical Commissioning Group (GCCG) was already working with Gloucestershire Care Services NHS Trust (GCS) to improve access; and were also exploring what the palliative care model for the whole county should look like.

68.5     In response to a question members were informed that Gloucestershire was better than some areas in supporting people to die in their preferred place of death. The committee was also informed that there was a national debate as to the accuracy of the data around place of death and that NHS England was revisiting these metrics.

68.6     It was known that end of life provision for the homeless was poor and that the GCCG was looking at how it could implement the St Mungo’s guidelines (www.mungos.org/endoflifecare). There was also more work to do to reach and talk to the seldom heard groups.

69.1     The committee noted that the concerns relating to the 62 day cancer target, and Improving Access to Psychological Therapies (IAPT) remained and that the GCCG continued to work through the associated action plans to address these issues.

69.2     It was questioned whether the expected (national) funding for mental health had reached Gloucestershire. It was explained that mental health funding was being channelled through the Sustainability and Transformation Plan and there has been significant investment for 2017/18.

69.3     Concerns remained with regard to ambulance response times, in particular that the presentation of the Ambulance Response Programme data did not make it easy to identify whether response times were improving. This issue would be looked at in greater detail at the committee’s meeting in March 2017 when the ambulance service were due to report.

69.4     Members were disappointed that there seemed to be no improvement in the performance against targets for the non-emergency patient transport service delivered by Arriva Transport Solutions Ltd (ATSL). There was a frank exchange of views with the GCCG, and although the GCCG did make it clear that it was applying all the contractor clauses in this contract, members felt that it should be looking at stronger measures. This matter will be looked at in more detail at the committee’s meeting in March 2017.

69.5     The committee was concerned to note that there has been deterioration in performance in relation to delayed transfers of care (DTOC). This was a complex area and the GCCG was working with all providers in the county to improve this position.

69.6     In response to questions the committee was informed that the GCCG had received interest from a provider to deliver the Out of Hours Service (OOHS) on a short term contract basis from 1 April 2017 when the SWASFT contract ended. The GCCG was developing a new NHS111 contract and it was possible that OOHS would be part of this contract. The committee would be kept up to date with progress on this matter.

69.7     Members were concerned that operations had been delayed due to the lack of available beds in the acute hospitals. The committee was informed that whilst this was regrettable this was directly related to winter pressures.

70.1     The committee noted that the performance picture had not changed significantly since receipt of the quarter one report. The committee was disappointed to note that although the council was a high performer with regard to personal budgets it has still not been able to translate that into people electing to receive direct payments, despite the work that has been undertaken to promote this option.

70.2     In response to a question it was explained that the savings that had been made through the Building Better Lives Programme related to developing better models of support, eg. promoting independence utilising Forwards Gloucestershire. This was not about reducing staff resource.

70.3     It was questioned what coverage the new drug and alcohol service had in the Cotswolds area. It was agreed that this information would be sent to members of the committee.

ACTION:        Sarah Scott

The committee noted the report.

As part of the scrutiny of the budget process the committee is to receive a presentation on  the proposals for Adult Social Care and Public Health.

72.1     The Deputy Director Adult Social Care tabled the detail of the draft Medium Term Financial Strategy (MTFS) relating to Adult Social Care and Public Health. He confirmed that since the publication of the draft MTFS the Council has now been notified that it would receive a further £2.5m for the Adult Social Care Support Grant for 2017/18. This was a ‘one –off’ amount and was ring-fenced, aimed at starting the transition to the increase in the Better Care Fund from 2018/19.

72.2     The committee discussed how this funding might be best utilised. Members noted the cost reductions in the adult mental health services budget as well as reductions in the budget for services for people with a learning disability. One member suggested that the additional funding could be used in these areas. Discussions would need to be had with the Gloucestershire Clinical Commissioning Group and other partners as to the appropriate use of this funding.    

72.3     With regards to Learning Disabilities, members were made aware of the positive work that had been carried out in terms of helping individuals into employment and increasing independence. Members commented on performance concerns relating to a reduction in the number of assessments being carried out and queried this decrease in performance levels against intended reductions in budget. It was important to note that the cost reductions in the budget did not relate to a reduction in staffing levels for social worker teams, but were through the changing approach brought about by the Building Better Lives Programme.

The committee noted the report.

The committee noted the report.

The committee noted the report.