For the Committee to note the appointment of Councillor Pauline Murphy as Chair, and Councillor Natalie Harrison as Vice-Chair for the municipal year 2023-34.

The Committee agreed to-

1.    Note the appointment of Councillor Pauline Murphy as Chair and Councillor Natalie Harrison as Vice-Chair for the municipal year 2023-24.

2.    Appoint Councillor Dr John Mahony as Vice-Chair for this particular meeting, due to the submission of apologies by Councillor Natalie Harrison.

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

There was one declaration made:

For the Committee to note the Terms of Reference of the Health and Adult Social Care Overview and Scrutiny Committee.

The Committee agreed to note the Terms of Reference for the Health and Adult Social Care Overview and Scrutiny Committee.

The Committee will be asked to confirm that the minutes of the meetings held on 08 February 2023 and 10 March 2023, are a correct record.

The Committee agreed the minutes of the meetings held on the 8 February 2023 and 10 March 2023 as a correct record.

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

There were no items of Chair’s Urgent Business.

To receive an update on the quarterly performance and finance status for Health and Social Care.

The Committee is invited to review the risk register as published for the Audit and Governance Committee in March 2023.

Councillor Mary Aspinall (Cabinet Member for Health and Adult Social Care) introduced the report and highlighted the following points:

a)     The report provided a comprehensive overview of some of the key performance and activity metrics that were used by the Council and its Partners, including the Integrated Care Board (ICB) and Livewell Southwest;

b)    The information within the report was used operationally and strategically by officers and senior managers across all organisations to ensure the best possible outcomes for people using the health and social care system.

Rob Sowden (Senior Performance Advisor), Helen Slater (Lead Accountancy Manager) and Gary Walbridge (Head of Adult Social Care and Retained Functions) delivered the report, and highlighted the following points:

c)     Referral demand for Livewell Southwest’s services had remained steady and staff had been working to reduce waiting lists, evidenced by a decline in waiting lists for adult social care support and adult social care occupational therapy;

d)    Nearly 90% of people referred into social care would not go onto receive long-term adult social care support, so it was important to have alternative long-term care in the community, supported by the Care for Plymouth model;

e)     The number of people in the community waiting for a domiciliary care package had reduced despite a general increase in demand;

f)      On average in 2022/23, 66% of people left the reablement service with no ongoing needs, which was the most desired outcome;

g)     There was a challenge in relation to long term admissions and placements into residential and nursing care in 22/23 with admissions of people aged 65 and over increasing by 57%. Work was being undertaken with partners to better understand the factors behind this;

h)    The number of people in receipt of a supported living package was increasing, but the waiting list remained low;

i)      The number of people in receipt of direct payments was increasing, which was positive as it allowed people to spend money on care they wanted to receive. Plymouth was expected to level the benchmarking averages by the end of the financial year 2023/24;

j)      Safeguarding outcomes were fed into the quarterly Plymouth Safeguarding Adults Board. There had been a drop in cases requiring a full investigation in 2022/23, which had been attributed to an in-service review with partners to ensure best quality of the investigation process;

k)     96.9% of people in 2022/23 who were subject to abuse and thus a safeguarding investigation, had seen their safeguarding personal outcomes achieved partially or fully;

l)      Section 42 of the Care Act related specifically to safeguarding and set out the responsibilities and duties of the Council. A Section 42 inquiry would occur when the concern was significant enough to be investigated to ensure the safety of the person in question;

m)   Complaint numbers were monitored on a monthly basis but had remained relatively static;

n)    The Adult Social Care survey had been completed in February/March 2023 and Plymouth had consistently outperformed its similar local authorities, as well as the national and regional averages;  ...  view the full minutes text for item 6.

Gary Walbridge (Head of Adult Social Care and Retained Functions) provided a verbal update on the position of the criteria for no right to reside, and highlighted that:

a)    No right to reside was a national criteria for measuring the number of people who were in a hospital bed, who no longer needed to be;

b)    Plymouth remained at 5%, meeting its target of 5%, with Devon and Cornwall at 5% and 10% respectively;

c)    The numbers had been relatively stable and Plymouth was the second best performing system in the South West.

Gary Walbridge (Head of Adult Social Care and Retained Functions) and Chris Morley (Interim Locality Director, NHS Devon) introduced the Better Care Fund Plan report and highlighted:

a)     The Better Care Fund (BCF) was the only mandatory policy to facilitate integration between health and social care, providing a framework for joint planning and commissioning;

b)    The BCF’s core objectives were to:

                         i.         Enable people to stay well, safe and independent at home for longer;

                       ii.         Provide the right care in the right place at the right time;

c)     The BCF also set out shared objectives which included:

                         i.         Improving discharges;

                       ii.         Reducing pressures on urgent and emergency care;

                      iii.         Supporting social care to achieve goals;

                      iv.         Supporting intermediate care, unpaid carers and housing adaptations;

d)    The plans were submitted to NHS England for initial approval, and would need to go to the Health and Wellbeing Board for approval by 31 October 2023;

e)     Investment had been made in community services to support individuals to stay at home for as long as was possible;

f)      The BCF allowed officers to evaluate systems that had been introduced on a short term basis to support issues such as discharges, and what potential long-term solutions could be implemented;

g)     The schemes that had been introduced would be rolled forward, but would be subject to an evaluation to consider delivery and impact;

h)    There were five key metrics, determined by national planning guidance that formed the basis of monitoring performance against the BCF plan:

                         i.         Avoidable Admissions;

                       ii.         Falls;

                      iii.         Discharge to Usual Place of Residence;

                      iv.         Residential Admissions;

                        v.         Reablement;

i)      In 2023/24, the Government would be providing £600 million to enable local areas to build additional adult social care and community-based reablement capacity and reduce delay discharges and improve outcomes for patients;

                         i.         The allocation for Plymouth was £3.341 million (£1.81 million to PCC and £1.528 million to NHS Devon Plymouth Locality) but it would be agreed jointly how best to utilise the funding to maximise the impact and support more people to stay at home;

j)      The Plymouth BCF 2022/23 investments totalled £37.8 million.

In response to questions it was reported that:

k)     A national tool had been released which enabled staff to analyse the number of people who were in hospital and the number of people who were being discharged each month, and to undertake analysis to make the service more effective;

l)      The short-term nature of previous investments had led to a complicated discharging system and ways of simplifying these and integrating these were being investigated;

m)   Services were reviewed to limit duplication and ensure the best use of resources;

n)    Affordable admissions related to wrap around care in the community to stop as many people from going into the emergency department and potentially being admitted to hospital, as well as working with individuals who are regular attenders of the emergency department.

The Committee agreed to note the report and the monitoring of progress.

Stuart Windsor (Future Hospitals Director, University Hospitals Plymouth NHS Trust), Nicki Collas (Future Hospitals Program Manager, University Hospitals Plymouth NHS Trust) and Amanda Nash (Head of Communications, University Hospitals Plymouth) introduced the Derriford Urgent and Emergency Care Centre item and highlighted the following points:

a)     In December 2022, the business case for Phase 1 was presented to the Joint Investment Committee and was approved. It had now also had approval from the Secretary of State;

b)    The full business case would be submitted in the months following the meeting;

c)     Derriford Hospital was a complex estate, sat in a complex system and so the team had wanted to ensure they were aware of the available opportunities and took an incremental approach to development with a long term plan for the estate as a whole;

d)    Phase One was to address the Urgent Emergency Care building which had received funding from the New Hospitals Programme;

e)     The second phase of work would focus ensuring there was the right capacity for work that needed to be done in the hospital environment whilst taking the opportunity to take services out of the hospital into the community where appropriate;

f)      The third phase would focus on Derriford’s role as a specialist service provider across the peninsula and the importance of ensuring there was the right capacity to deliver services at present and to cope with future changes in demand;

g)     The fourth phase would focus on women’s and maternity services being reconfigured to ensure the right services were in the right place with the right capacity;

h)    The fifth phase would link in closely with phase one and would focus on the creation of an integrated children’s hospital that allowed a flow from the emergency department to paediatric and other children’s’ services;

i)      The final phase would focus on maintenance within the hospital and ensuring the correct bed capacity;

j)      The phases could occur concurrently and would be broken down further to ensure maximisation of funding opportunities;

k)     Crowding was a significant and complex issue which had escalated quickly and formed the basis of the case for change for phase one of development;

l)      Within phase one of the scheme, the opportunity had been taken to remove one of the highest clinical risks around interventional theatre capacity for neurosurgery, by building additional conventional theatre capacity that could be used for both emergency cases and planned cases;

m)   A developer, Willmott Dixon, had been appointed and work was underway to finalise designs and the full business case;

n)    Enabling works were underway and £50 million had been secured from the new hospital programme to being works, which would include the re-routing of underground services and the building of a fracture clinic;

o)    The main contract works would commence in early 2024 and were due to take 2.5-3 years to be completed;

p)    A new walk-in entrance and separate ambulance entrance would be created on level 6;

q)    Level 7 had been designed to have patients  ...  view the full minutes text for item 9.

Stuart Windsor (Future Hospitals Director, University Hospitals Plymouth NHS Trust), Nicki Collas (Future Hospitals Program Manager, University Hospitals Plymouth NHS Trust) and Amanda Nash (Head of Communications, University Hospitals Plymouth) introduced the Community Diagnostics Centre Update and highlighted that:

a)    A report by Sir Mike Richards in 2020 had proposed the introduction of a series of diagnostics centres to address the diagnostic capacity issues across the country. The Government had launched a programme with plans to create a number of standardised diagnostic centres across the country;

b)    A diagnostics centre had already been established in Devon at the Nightingale Hospital. While the Plymouth diagnostic centre was originally intended as a branch/ spoke of this Devon hub, Plymouth’s unique challenges had inspired the development of a business case for a Plymouth hub in its own right;

c)    The bid had been successful and £25 million had been designated to create a community diagnostics centre in the city centre, close to some of the most deprived areas of the city;

d)    The centre would increase diagnostic capacity across the city, improve productivity and efficiency and reduce heath inequalities;

e)    It would include consultation rooms to increase efficiency alongside a variety of diagnostic tests, including those deemed to be a priority locally and the team were working in partnership with Plymouth City Council to develop the design;

f)     The centre would be built at Colin Campbell Court and a condition of the approval was to delivery temporary diagnostic capacity by the end of September 2023 via a mobile unit;

g)    The team were working closely with the strategic development team to ensure that any development there would complement future development;

h)    The site had excellent access by public transport and supported the trust’s aims to achieve net zero carbon emissions as access was not limited by car ownership;

i)     Services would include CT scanners, MRI scanners, X-ray rooms, ultrasound rooms and an audiology suite as well as the requirements for echocardiography, electrocardiogram, blood pressure monitoring, pacemaker checks and spirometry over 3,500 sqm;

j)     The project was expected to open by 1 April 2025 and would deliver the following additional annual capacity by the end of 2025/26:

                      i.        34,000 CT Scans;

                     ii.        9,000 MRI Scans

                    iii.        39,000 Ultrasound Tests

                    iv.        9,000 X-Ray’s

                     v.        2,000 Audiology assessments;

k)    A project board had been established with the Council, there were weekly working group meetings, and engagement would be carried out with patients and members of the public.

Councillor Mary Aspinall (Cabinet Member for Health and Adult Social Care) added;

l)     The project came under Councillor Mark Lowry’s (Cabinet Member for Finance) portfolio, but they would work closely together on this project;

m)  It would benefit some of the more deprived communities in Plymouth by bringing services closer to them, but the services would be available to all.

In response to questions it was reported that:

n)    A condition of the bid was to have the temporary mobile unit on site from September 2023, but there would  ...  view the full minutes text for item 10.

Ruth Harrell (Director of Public Health) introduced the agenda item and highlighted;

a)     A motion on notice on defibrillators in Council-owned Public Buildings (specifically the Council House) was raised at the 30 January 2023 meeting of the City Council and was subsequently referred to the Health and Adult Social Care Overview and Scrutiny Committee;

b)    The installation of defibrillators was not one organisations’ responsibility;

c)     A defibrillator could be used to give a jolt of energy to the heart which could restore its rhythm and needed to be delivered with CPR, but if used quickly could increase the chance of survival for people who suffer a cardiac arrest;

d)    Defibrillators were quick and easy to use and did not require training;

e)     The use of defibrillators was relatively low, with only around 30 cardiac arrests in Plymouth’s public spaces per year. It was impossible to know where one might be needed, but the British Heart Foundation had recommended placing them in areas with high footfall, and where the demographic was made up of people at a higher risk of cardiac arrest;

f)      The cost of a defibrillator was approximately £2,000, with relatively infrequent and low cost ongoing costs of checks as well as pad and battery replacements;

g)      Hospital Trusts across the country were building a database, called ‘The Circuit’, of the locations of defibrillators in order to direct people when they made a 999 emergency call;

h)    After looking at British Heart Foundation guidance and the location of Plymouth City Council buildings, it had been concluded that a number of the Council’s sites already had defibrillators, and where there wasn’t one, there was on in close proximity;

i)      Five areas were identified where action could be taken to increase the number of defibrillators, one of which included one in the proximity of the Council House and Guildhall, the Guildhall being the preferred location;

j)      Some defibrillators were only available at certain times of day, so one recommendation was to encourage the owners of those sites to make access to the defibrillators 24/7;

k)     Funding was sometimes made available to the voluntary and community sector for defibrillators, so it would be important to identify this and promote it to those in the city to increase the number of defibrillators across the city;

l)      ‘Restart a Heart Day’ was held in the middle of October each year which promoted defibrillators and CPR training and so it would be important to promote this.

Councillor Mrs Terri Beer, who submitted the motion on notice, added;

m)   Every minute was crucial when someone was suffering a heart episode and having a defibrillator nearby could save valuable minutes;

n)    The aim of the motion was to ensure all Council buildings, used by the public and by staff, had a defibrillator;

o)    A former councillor had recently experienced a heart attack at a community centre, and through the critical early use of a defibrillator, along with medically trained members of the public and CPR, had survived;  ...  view the full minutes text for item 11.

For the Committee to review the progress of Tracking Decisions.

Elliot Wearne-Gould (Democratic Advisor) presented an overview of the tracking decisions log, and highlighted that:

a)    Following the past three meeting of the H&ASC OSC, there were a significant volume of tracking decisions to be considered and actioned. While many of these had received replies, a meeting between the Chair and relevant officers would be convened to review the progress of actions, and agree further steps;

b)    Many tracking decisions had been updated since the publication of the agenda, and therefore more actions were completed than appeared before the Committee. These updates would be provided to the Committee;

The Committed agreed to note the tracking decisions document.

For the Committee to discuss item on the Work Programme.

The Committee agreed to add the following items to the Work Programme:

1.    Procurement of Domiciliary Care;

2.    Local Government and Social Care Ombudsman Recommendations;

3.    Updates on the progress of the build at Derriford Hospital as part of the New Hospitals Programme.