To receive any declarations of interest from Committee members in relation to items on this agenda.

There was one declaration of interest:

The Committee will be asked to confirm if the minutes of 16 November 2022 are a correct version, for the record.

The Committee agreed the public and private minutes of the meeting held on 16 November 2022 as a correct record.

To receive any reports on business which, in the opinion of the Chair, should be brought forward for urgent consideration.

The Chair, Councillor Mary Aspinall, welcomed Councillors Hulme, McLay, and Noble to the Committee, following changes agreed at City Council on 30 January 2023.

Alan Knott (Policy and Intelligence Advisor) outlined the Health & Adult Social Care Policy Brief to the Committee.

The Committee agreed to-

1.    Request a copy of the ‘Delivery plan for recovering urgent and emergency care services’ which had been discussed within the report;

2.    Note the report.

Ross Jago (Head of Oversight, Governance & Risk) delivered the Health & Adult Social Care Risk Monitoring Report to the Committee, and highlighted the following points-

a)     There had been a reduction in the overall number of risks on the Strategic Risk Register;

b)    The risks relevant to the Committee had remained relatively static;

In response to question from the Committee, it was reported that-

c)     Rates of Covid-19 had been steadily increasing, both nationally and locally, following their earlier decline. On 23 January 2023, University Hospitals Plymouth (UHP) had approximately 23 Covid positive patients however, todays figure was approximately 80;

d)    While UHP had to regulate visitor numbers to wards during peak times, there were currently no restrictions against visiting Covid patients;

The Committee agreed to note the report.

David Harper (SWAST) delivered an update on the South and West Devon County Ambulance Service to the Committee, and highlighted the following points-

a)    In July, SWAST saw an increase in ambulance activity, peaking at over 400 incidents per day. Since then, ambulance activity had reduced much closer to expected levels, with 2022-2023 data demonstrating close to pre-pandemic trends;

b)    There had been a particular increase in December 2022, with incidents rising to approximately 380 per day, placing significant pressure on the system. This had likely been due to a combination of Covid, Flu, and Strep-A infections;

c)    Even during peak activity, SWAST had been successful in limiting the number of patients conveyed to ED, to around 34% of all patients seen. This had been achieved through placing emphasis on clinical hubs and a ‘see and treat’ strategy, and had thus prevented excess pressure on ED and hospital services;

d)    Through January 2023, the ambulance service had seen a large reduction in demand, likely due to the reduction in Covid and Flu cases, combined with media coverage of NHS pressures, as well as industrial actions;

e)    SWAST had seen a large increase in frontline vehicle service hours. In 2019-2020, approximately 37,000 vehicle hours had been used, however this was now approximately 48,000 hours. While SWAST was funded for 5,400 hours per week, performance data showed they were often providing more;

f)     There was a noticeable correlation between hospital handover delays, and ambulance repose times. There had been a significant improvement in ambulance response times since the reduction in demand, and handover delays;

In response to questions from the Committee, it was reported that-

g)    When an ambulance arrived at the hospital forecourt, hospital staff then assumed responsibility for that patient. However, there was a collaborative responsibility between the ambulance crew and hospital staff while the patient remained waiting in the ambulance;

h)    A new system of rapid assessment and triage had been established, where every patient arriving at ED by ambulance was triaged in the hospital face to face within 30 minutes, before ongoing treatment was organised;

i)     There had recently been a power outage to the sever network at Derriford Hospital, which had compromised the hospitals ability to use the IT network to order clinical services. This had caused significant disruption, and taken considerable time to recover;

j)      There had been a significant increase in ambulance crew on-scene times, with crews trying to manage patients at home, without the need to convey patients to ED;

The Committee praised the hard work and dedication of ambulance crews, and agreed to note the report.

Jo Turl (NHS Devon) delivered a presentation to the Committee on the ‘111 and Out of Hours GP service’, and highlighted the following points-

a)    The 111 and Out of Hours GP service had recently changed to a new provider, PPG. While the winter period had been very challenging and hard to predict or prepare for, there had been strong collaboration across the services, and signs  ...  view the full minutes text for item 43.

Anna Coles (Strategic Director for People), Moriah Priestley (Interim Head of Commissioning), and James Stannard (Care Home Business Improvement Partner) delivered the ‘Fair Cost of Care and Market Sustainability Plans’ update to the Committee, and highlighted the following points-

a)     As part of the Adult Social Care Reform agenda, all local authorities had been required to engage with their local care providers to complete a ‘Fair Cost of Care exercise’. This engagement work had begun during summer 2022, to better understand the cost of delivering care throughout older-persons care homes and the home care market. Local authorities had been required to publish their final findings by 01 February 2023, and develop market sustainability plans to identify gaps in current care provision, and future options to strengthen resilience;

b)    Plymouth had previously identified gaps in home care provision across the city, particularly for complex dementia care, resulting in delays to domiciliary services and hospital discharges. This sometimes required outsourcing care to other local authorities, which was recognised as having potentially detrimental impacts for patients and their families. From April 2023, Plymouth City Council was looking to uplift home care contracts by 10%, and care home contracts by 8%;

c)     Responses from providers had been low (around 30%) and it had therefore been difficult to draw conclusive trends and outcomes from the engagement work however, it was recognised that:

                                               i.     The care home market had gone through a challenging period recently, and key gaps in provision had been identified;

                                              ii.     Home care providers were stretched a little too thin across the city;

                                             iii.     A ‘zoned’ approach to care was being explored for the city, which would bring care providers and clients closer, thus seeking to address these gaps;

                                             iv.     Other local authorities had experienced similar market trends and care provision challenges.

d)    Significant additional efforts had been undertaken to boost engagement with the care providers, including extending deadlines, personalised sessions, and 1:1 calls. It was recognised that many care providers struggled with a lack of capacity to engage in this exercise, thus leading to a lower rate of return than anticipated. These trends had also been experienced by other local authorities;

e)     Having now concluded, there was not sufficient information to use the ‘Fair Cost of Care’ exercise as it was initially intended, resulting in the need to engage in fee negotiations with individual care providers. Plymouth was therefore now engaging with the market to set its fee rates for 2023/34;

In response to questions from the Committee, it was reported that-

f)      The documentation and assessment process for the ‘Fair Cost of Care’ exercise followed a standardised methodology, set nationally, thus PCC had little ability to amend or simplify the process;

g)     Fee rate negotiations took place annually, examining cost pressures across the market and available resources. The ‘Fair Cost of Care’ exercise was the first national exercise to understand the cost of care across the adult social care market;

h)    PCC regularly engaged with care homes regarding vacancy levels, staffing  ...  view the full minutes text for item 44.

For the Committee to discuss the Motion on Notice, ‘Defibrillators’, referred to the Health and Adult Social Care Overview and Scrutiny Committee by City Council on 30 January 2023.

Ruth Harrell (Director of Public Health), Anna Coles (Strategic Director for People), and Elliot Wearne-Gould (Democratic Advisor) outlined the ‘Motion on notice- Defibrillators’ to the Committee, and highlighted the following points-

a)    A Motion on Notice from City Council, 27 February 2023, had been referred to the Health and Adult Social Care Overview and Scrutiny Committee for consideration. The motion stated: Not all our public buildings have defibrillator and it’s essential that there is this valuable piece of equipment on site here in the Council House and other Council owned buildings across the City;

b)    Defibrillators were not needed often, but when they were, could save lives. There were approximately 140 cardiac arrests in Plymouth per year, with the majority (3/4) occurring at home. Due to a lack of clear guidance, it was difficult to know the best location to install defibrillators however, it was widely recognised that rapid intervention with a defibrillator increased the chances for patients’ recovery. As a result, it was important to consider placing them in areas of high footfall, as well as considering age/ social groups of particular vulnerability, and the financial implications of instillation, training, and ongoing maintenance.

In response to questions from the Committee, it was reported that-

c)    The majority of modern defibrillators were automated, and therefore provided step by step instructions to the user on how to prepare the patient, position pads, administer CPR, and automatically monitored cardiac rhythm, only allowing a shock to be delivered if appropriate. Defibrillator training was also now a common component of first aid courses.

1.    The Committee agreed to request a report covering the health and financial implications of the instillation of defibrillators across Council buildings, so that options could be considered at the next meeting of this Committee.

For the Committee to review the progress of Tracking Decisions.

The Committee agreed to note that there were 2 tracking decisions in progress, with the remainder marked completed.

For the Committee to discuss items to add to the work programme.

The Committee agreed to:

1.     Bring a report on ‘Defibrillators’ to the next Committee meeting in June 2023;

2.    Recommend that the Work Programme be amended to group future items into targeted session for the next municipal year.