Members will be asked to make any declarations of interest in respect of items on this agenda.

There were three declarations of interest in accordance with the Code of Conduct:

The Committee will be asked to note the appointment of Councillor Pauline Murphy as Chair, and Councillor Kathy Watkin as Vice Chair for the Municipal Year 2024/25.

The Panel agreed to note the appointment of Councillor Murphy as Chair, and Councillor Watkin as Vice-Chair for the Municipal Year 2024/25.

The Committee will be asked to note the Health and Wellbeing Scrutiny Panel’s responsibilities.

The Panel noted the ‘Health and Wellbeing Scrutiny Panel’s’ responsibilities, as set out in the Constitution.

The Committee will be asked to confirm if the minutes of 20 February 2024 are a correct version, for the record.

The Panel agreed the minutes of 20 February 2024 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 Murphy, welcomed new members to the Panel for this Municipal Year.

Stephen Beet (Head of ASC and Retained Functions) and Emma Crowther (Service Director for Integrated Commissioning) delivered the Quarterly Performance Report for H&ASC and discussed:

a)    Livewell Southwest Referral Service (LRSS) ‘front door’ waiting lists had reduced;

b)    Care Act Assessment waiting times and sizes had also reduced, and a new IT system had been adopted;

c)    The number of ‘Care Act Reviews’ conducted per month had increased, with 61.4% of people receiving an annual review;

d)    The process for reporting ‘Adult Safeguarding’ matters had been changed, resulting in higher quality referrals and a reduced investigation response time;

e)    Numbers of people receiving ‘Direct Payments’ for care in Plymouth was above the national average at 25.5%, allowing people greater choice and control;

f)     The quality and resilience of commissioned care providers remained stable, and strong oversight was in place. Waiting times for ‘Domiciliary Care’ remained low however, the number of people in ‘Nursing Care’ remained high. Exploratory work was being undertaken to understand the causes and possible solutions;

g)    ‘No Criteria to Reside’ figures remained low for Plymouth however there were sustained pressures in Cornwall.

In response to questions, the Panel discussed:

h)    Increased capacity amongst Domiciliary Care providers;

i)     Safeguarding waiting lists, complexity, and investigation times;

j)     Adult Mental Health service demand, waiting lists and delays;

k)    Staff sickness, absences and the use of temporary cover.

The Panel agreed to:

1.    Note the report;

2.    Request further clarity regarding the number of Adult Mental Health referrals and assessment delays;

3.    Request further details regarding staff sickness and absences.

Helen Slater (Lead Accountancy Manager) delivered the Quarterly Finance Update for H&ASC and discussed:

l)     The Adult Social Care (ASC) budget was the largest revenue budget within the Council, at £103 million for 2024/25;

m)  Month Two forecast reporting showed savings on the majority of packages: Domiciliary Care £139,000, Supported Living £105,000, Residential Long-stays £400,000 Direct Payments £40,000;

n)    There was a pressure of circa £1million at Month Two, largely due to overspend within Nursing Care. Following analysis, it had been identified that this was due to the number of clients exceeding expected levels;

o)    There were also pressures relating to ‘client income’, which was not performing as forecast. Budget containment activity was ongoing between partners to re-evaluate package rates and client numbers to mitigate risks;

p)    Overall, a ‘nil variance’ was reported for the ASC budget at Month Two as it was expected that this £1 million pressure would be resolved in year.

In response to questions, the Panel discussed:

q)    A ‘Deep Dive’ would be conducted to explore the budget variance;

r)    The current financial position was an early year indication, and would be subject to changes.

The Panel agreed to note the report.

Ross Jago (Head of Oversight and Governance) delivered the Quarterly Risk Report for H&ASC and discussed:

s)     Risks regarding the Adult Social Care Workforce had reduced but would continue to be monitored to track long-term market sustainability;

t)     Risks around Adult Social  ...  view the full minutes text for item 51.

Liz Davenport (SRO: PASP, NHS Devon), Jenny Turner (Programme Director: PASP, NHS Devon) and Paul McArdle (University Hospitals Plymouth) delivered the Peninsula Acute Sustainability Programme (PASP): Developing the Draft Case for Change, and discussed:

a)    The ambition of the PASP was to develop sustainable care for local people and deliver high quality equitable services;

b)    It was important that care was delivered in the most appropriate setting for each individual and that care was accessible for all;

c)    Engagement had been undertaken with patients and staff over several years, and feedback had centred around:

i.      Long waiting times for access to services;

ii.     Complex processes to gain access to services;

iii.    A need to ensure equity of access to services, particularly for deprived groups and rural areas;

iv.    A need to ensure services were ‘joined-up’ and integrated;

v.     The lack of an electronic patient record, and need for digital ‘enablers’ for delivering integrated care across the Devon system;

vi.    Patients were not always seen in the right place at the first point of entry;

vii.   A need to improve productivity and efficiency.

d)    Healthcare was facing considerable challenges, particularly across Devon and Plymouth. Factors included a growing population and an elderly population with increasingly complex comorbidities;

e)    There was a need to re-evaluate approaches to healthcare to ensure longer and healthier lives, as well as reducing the impact on health services;

f)     Under new leadership UHP had adopted a ‘One Method’ approach, focussing on avoiding admissions, managing patient arrivals in a considerate, kind and effective manner, and ensuring successful discharges. This had resulted in an 18% improvement;

g)    Working as isolated hospitals across the region was no longer sustainable and a collaborate approach was proposed to best optimise resources and demand across the region;

h)    Future system challenges would include meeting the demand of an increasingly elderly population, as well as addressing inequalities;

i)     The PASP was designed as a response to current financial and demand challenges, with the ambitions of developing sustainability for services, workforce and finances;

j)     Each of the acute providers in Devon and the Integrated Care System (ICS) were in NOF4, the highest level of regulation, due to failings in performance and financial spend;

k)    Across the peninsula there were enough staff to operate four hospitals however, there were five hospitals in operation. The hypothesis for building a sustainable acute service model was to improve diagnostic and assessment functions at the ‘front door’ of the hospitals to enable the redesign of ‘non-core’ elements and combat workforce challenges;

l)     Having engaged with clinicians, Healthwatch, patients and staff to understand the challenges, a shared view had been identified;

m)  The Case for Change was a technical document which set out the fundamental challenges faced, along with a vision for the future. The document would not include ‘solutions’ at this stage, but would help facilitate engagement and the development of modelling for solutions later on. The challenges identified were:

n)    People & Health Needs:

                      i.    There were approximately 1.3 million  ...  view the full minutes text for item 52.

Fergus Paterson (Chief Superintendent, D&C Police) delivered the ‘Right Care Right Person’ report and discussed:

a)    ‘Right Care Right Person’ was a cross-government approach to ensure people in need received the most appropriate care, from individuals and agencies with the right skills, experience and training;

b)    The Police had been serving as a ‘helper to all’, detracting from their core police responsibilities: ‘prevent and investigate crime’; ‘keep the King’s peace’; ‘save Life and prevent serious harm and suffering when crime is involved’; ‘help other agencies when needed’;

c)    The majority of Police lacked advanced medical training and were of an equivalent level to a workplace first-aider. It was therefore not appropriate for them to attend patients who required specific medical care or specialist services;

d)    It was important that agencies with the right skills and expertise attended events such as welfare checks, suicidal ideation, self harm, emotional distress and medical emergencies, while the police attended risk based behaviour under A2/A3 of the Human Rights Act: Save life (Section 2 Human Rights Act) and prevent serious harm and suffering (Section 3) when crime is involved;

e)    The Police had strong links with mental health providers in Plymouth including Livewell Southwest. A Joint Response Unit had been established, comprising of a Police officer and a mental health professional to conduct joint attendances;

f)     In response to recognition of failings due to high demand and resource diversion, Devon and Cornwall Police had committed to ‘prevent and investigate crime (including in health and social care settings and supporting victims in associated professions)’;

g)    A toolkit had been developed for call handlers, based on legal principles:

                      i.    Police may choose to accept an Article 2 and 3 duty when a more appropriate agency (better knowledge, skills, training, equipment, legal basis) could discharge that duty;

                     ii.    Police will “share” Article 2 and 3 duty to save life and prevent serious harm when the more appropriate state agency is unable to;

                    iii.    Police must consider the circumstances carefully before agreeing to take on a “duty of care” for non-police duties.

h)    The Police could not force entry to a property for a welfare check alone. It was required that there was reasonable belief that the person was inside, and that entry was required to save ‘life and limb’;

i)     The changes were being introduced in a phased approach, and were overseen by a scrutiny panel:

                   i.    ‘Concern for Welfare’ had gone live in January 2024, resulting in 35% fewer attendances than the previous year;

                  ii.    ‘Absconders and Mental Health Act Absence Without Leave’ had gone live in June 2024 in collaboration with mental health partners and acute trusts, introducing necessary steps before Police action was required;

                 iii.     ‘Section 136 and voluntary attendees’ would go live by the end of 2024, providing acute trusts and the ambulance service an understanding of police capabilities, as well as defining the appropriate time/stage they should be called;

                 iv.    ‘Transport of patients’ was the final phase, which would ensure transport for  ...  view the full minutes text for item 53.

For the Committee to review the progress of Tracking Decisions.

The Panel agreed to note the progress of the Tracking Decision Log.

For the Committee to discuss item on the work programme.

The Panel agreed to add the following items to the work programme:

a)    Adult Mental Health;

b)    End of Life Care Update;

c)    Policy Brief for Health and Adult Social Care.

To Consider passing a resolution under Section 100A(2/3/4) of the Local Government Act 1972 to exclude the press and public from the meeting for the following items of business, on the grounds that they involve the likely disclosure of exempt information as defined in paragraph 3 of Part 1 of Schedule 12A of the Act, as amended by the Freedom of Information Act 2000.

There were no items of exempt business.