(a)

the Long Term Plan slots into the operational plan on how the NHS would run from year to year and how this looks for Devon for the next 5 years.   They were aware of the workforce challenges and the skills, competencies and workforce would look different in the future;

(b)

they were really clear on the deliverables for next year, such as a reduction of people presenting at hospital, also a priority was mental health and crisis cafes and being able to deliver a better offer within the community and provide that low level support;

(c)

with regard to preventable illnesses, such as obesity and smoking, smoking rates had reduce significantly and were seeing the benefits, however, there were still a large cohort of people that smoked despite the increase in taxation and smoking bans.

They were working on the Green Paper on prevention but unfortunately there was no magic wand;

(d)

with regard to making the argument for more funding, it was reported that they always raise this and work with local members to have that influence and requested Members to do the same.

(a)

they were currently in the process of looking to replace the electronic systems that supports clinical processes.  At the last meeting Healthwatch mentioned how e-consult was working in general practice to help streamline the interaction and there was a potential to introduce e-consult to the emergency department to streamline the patients journey;

(b)

joining up information from primary care to the hospital was an important issue and a huge project was currently taking place across Devon, however, they had focused on the immediate actions within the emergency department but was a valid point to include this area of work within the plan to support the future streamlining of the emergency department;

(c)

the challenge for the hospital was to achieve greater connectivity between the various systems, not only within the emergency department, outpatients and for more timely information back to the GP and the hospital were actively exploring this;

(d)

Recently set up a digital board and the technology issues are long standing issues and not unique to the hospital and appreciate the impact to the patients and clinicians.  Two possible solutions, one that integrates with the community and other an internal system and have been assessing these two options and would keep the Committee updated;

(e)

the duplication of asking for name, address etc does get replicated a lot but if a front end system that collects the information at the start of the patients journey stops the need to constantly requesting the same information would help the patients pathway;

(f)

the training for triage nurses would be a combination of formal training and internal training.  They were also looking at the advanced nurse practitioner to help support the junior nurses be able make some of the decisions at the front end.

(a)

the estimated number of patients have used the facilities at Broadreach and Longreach was 20 in-patient and 10 in re-hab.  Plymouth City Council was not a major customer;

(b)

the Alliance had a conversation with the administrator and it became apparent that the business model was unsustainable.  Plymouth City Council were made aware of the closure 4 days before they closed;

(c)

it was disappointing that they didn’t disclose their current position, however, there were extenuating circumstances on why they didn’t share this information with us.  The unfortunate closure had helped them to work differently partners on subsidiaries that were available, if they need financial assistance;

(d)

this was a national problem with many rehabilitation centres closing over the last decade due to cuts in local authority budgets, on-going national discussions were taking place on the current model and whether it was sustainable;

(e)

a lot of people choose not to have their rehabilitation locally because they want to get away from drug dealers and their current environment, also Boswyns have a flexible arrangements in place such as the use of SKYPE to communicate with patients.

(a)

Healthwatch were continuing to reach out and engage with the BME community to gain a better understanding of the different cultures to ensure that services were accessible;

(b)

with regard to children’s dental health, parents have approached us regarding access to dental services for their children.  These 2 cases were dealt with and children were seen at the Dental Access Centre.  The Local Dental Network visit schools to educate children on oral hygiene and oral education.  There was a need to think about the homeless population and people living in sheltered accommodation, it was also highlighted that access to dental services crosses a whole age range across the city;

(c)

patients wanting a routine appointment were now having to wait 3 weeks for an appointment.  The primary care network which are made up of individual surgeries working together at scale to provide additional services but there were some groups of surgeries that are meant to work together but there were issues around patients being offered appointments outside of their locality and transport issues.  Primary Care Networks potentially one way to provide additional services.

(a)

they were not seeing a large number of people going into care homes but currently have a static population and this number would gradually reduce over time.  They want to minimise the number of people entering care by providing enablement and for people to stay at home longer;

(b)

over time residential care and the profile of what would be required will change and that information would be analysed.  In the next agenda item the market position statement sets out the future needs for residential nursing and extra care provision for the next 10 – 15 years;

(c)

There were night sitting services across the city and how we can more intelligently deploy this services and what we do to enhance what was currently available moving forward;

(a)

there were a range of services within the system that were not necessarily joined together in a cohesive way.  They were looking at providing a consistent offer to ensure timely access to services, however, they still had some improvements to make around joining services together to improve pathways and manage the demand;

(b)

the work they were undertaking would address managing demand in particular looking at the services for people living more complex lives and how services would be provided in a more appropriate way;

(c)

the workforce relates to the social care workforce and it was reported that they were reviewing the operating model and have found that there was a high dependency on highly professional staff providing information and advice.  As part of the review they were looking at the access to advice out in the communities and this would then reduce the interfaces with the highly professional staff.  They were also looking at ways of building a more resilient workforce and how they promoting career opportunities within the social and healthcare landscape;

(d)

from the outcomes adult social care were performing well over and there had been big improvements on hospital discharges, they have expanded extra care which was about the right care, right time and right place and were opening disability schemes this years, however they do need to do better for the vulnerable adults in the city;

(e)

the quality care team were now focussing on the domiciliary care work, working with the providers, workshops to ensure they were inspection ready and want to improve the quality standard;

(f)

there was a requirement by law for providers to pay their staff the national living wage;

(g)

some of the challenges with care and keeping people in their own homes and how they acquire services right for them as well as respecting confidentiality and how family members are supported.  Real peoples experiences help them to understand how improvements can be made to services;

(h)

the workforce agenda was a conversation taking place across the STP and they were engaged in a number of initiatives such as Proud to Care and giving more recognition for choosing a role in care sector.  It was also not just about money but other values a person would find in the role, they were also looking at career paths and what motivates people to return to care and having the right mechanisms in place to catch them, more flexible arrangements for a more sustainable workforce;

(i)

as part of the assessment in the home it was a requirement to identify children in the home and this was taken into consideration when planning support and to  ...  view the full minutes text for item 23.