Agenda and minutes

To approve as a correct record the Minutes of the meeting of the Committee held on 11 August 2021.

The minutes of the meeting on 11 August 2021 were accepted as a true and correct record.

To remind Members of the need to record the existence and nature of any personal, disclosable pecuniary or other registrable interests in items on the agenda, in accordance with the Members’ Code of Conduct.

There were no declarations of interest.

Purpose: To consider any petitions requiring an Officer response.

There were no petitions received.

Purpose: This report presents a transparent and objective methodology which is designed to help prioritise which topics the Health Scrutiny Committee should be considering.

Gordon Oliver presented the report on the Health Scrutiny Committee Prioritisation Methodology (Agenda Item 5). He explained that this was a tool designed to help Members prioritise topics for future scrutiny, and was encouraged in the Government’s Statutory Guidance. In developing the methodology, reference had been made to guidance produced by the Local Government Association and the Centre for Governance and Scrutiny, as well as similar tools produced by other local authorities. The proposed methodology adopted criteria using the PAPER acronym: public interest, area affected, performance and priority; effectiveness; and resources available. An optional scoring system was also proposed for each of the criteria.

Councillor Andy Moore sought confirmation that each topic would be assessed in this way so they could get an idea as to which should be prioritised. He considered that it had picked up all relevant considerations and was a good starting point.

The Chairman expressed her thanks for the work undertaken in preparing the methodology and suggested that it set a good model for other areas of the Council.

Resolved that: the Health Scrutiny Committee adopt the PAPER criteria (Public interest, Area affected, Performance/Priority, Effectiveness, Resources) and associated scoring system to help prioritise its work programme.

Purpose: The report presents a draft protocol that sets out how the West Berkshire Health Scrutiny Committee will work together with bodies who commission or provide health and wellbeing services to residents of West Berkshire.

Gordon Oliver presented the report on the protocol between the West Berkshire Health Scrutiny Committee and local health bodies (Agenda Item 6). He explained that the need for a protocol was identified within the Terms of Reference for the Committee. The aim of the protocol was to encourage improved engagement and communication between the Committee and local health bodies. It also set clear standards for working together and would give confidence in planning for service change. The protocol included a series of seven working principles. It also set out the factors that would be considered when determining whether a proposed variation in health services was considered ‘substantial’ and therefore requiring formal consultation with the Health Scrutiny Committee. The protocol proposed that initial consultation on proposed changes in health services would take place with the Chairman and Vice Chairman of the Health Scrutiny Committee, who would make a recommendation to the rest of the committee as to whether the proposed change was considered to be ‘substantial’. It was explained that the protocol was closely modelled on that used by Oxfordshire Joint Health Scrutiny Committee.

Councillor Andy Moore felt it was a sensible approach. He noted that it was an agreement between the Committee and health bodies and asked if all partners would be required to sign the document and how many protocols would be needed. The Chairman noted that the recommendation sought to authorise consultation with local health bodies with a view to bringing a final version back for sign-off. This would give partners a chance to have their say on the draft protocol.

Councillor Tony Linden noted that a Joint Health Overview and Scrutiny Committee (JHOSC) had been set up to scrutinise the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System (BOB ICS). He asked if any meetings were planned. Gordon Oliver indicated that no meetings were planned yet, but officers at Oxfordshire County Council were drafting a protocol to be adopted by the JHOSC and were liaising on the need for future meetings.

Councillor Alan Macro asked if the fact that the proposed protocol was based on that used by Oxfordshire meant that it was more likely to be accepted by health partners. Gordon Oliver confirmed that there were some common health partners and the move towards the BOB ICS meant that it made sense to model the scrutiny protocol on the Oxfordshire model.

Councillor Graham Bridgman asked what would happen if one of the health bodies objected to a particular aspect of the protocol. He suggested that it would be good to try to have a common protocol across the BOB ICS area, since it would be easier for health partners. The Chairman agreed with Councillor Bridgman and suggested that protocols were only as good as the engagement from all partners.

Councillor Moore suggested including the list of bodies consulted in the protocol and that there should be some reference to their agreement or response to the consultation. The Chairman agreed and expressed her thanks for the work  ...  view the full minutes text for item 14.

Purpose: To understand how NHS Dentistry services are performing, how they have been affected by the Covid-19 pandemic and how services will be developed in order to respond to patients’ needs.

Hugh O’Keefe gave a presentation on NHS Dentistry Services (Agenda Item 7). The key points from the presentation were as follows:

·         Dental services were running at 65% of capacity due to Covid safety requirements.

·         Patients were prioritised according to need using criteria set at the national level.

·         Capacity allocated to NHS treatment was determined by each practice, resulting in variations in availability of appointments.

·         Action was being taken locally, with additional sessions offered to practices for patients who didn’t visit a dentist on a regular basis.

·         NHS patients were not ‘registered’ with a particular dentist.

·         Around 50% of the population attended an NHS dentist regularly, with the remainder going private or attending when they had a problem.

·         A pilot programme was being run for looked after children.

·         Significant investment was being made in community based referrals for out-of-hospital specialist oral surgery for the period to 31 March 2023.

·         The additional investment was intended to keep the system as open as possible, or at least stabilise waiting times for treatment, but while dentists continued to operate at reduced capacity, there would continue to be a backlog.

·         Feedback from dentists suggested that some patients failed to attend booked appointments, which was causing issues, since dentists had to set aside long time slots to allow for disinfection between patients.

·         There were some challenges with the workforce – the pandemic had resulted in challenging working conditions, and more dentists wanted to work part-time on the NHS – this meant that more dentists were required to keep up with demand.

·         The 65% capacity limit was scheduled to be reviewed in January 2022.

·         There would also be a national review in April 2022 to see what incentives and systems should be incorporated into contracts.

·         It was anticipated that there would be issues with availability of NHS dentistry appointments for some time.

Councillor Tony Linden asked if the dentistry workforce was facing similar issues to GPs with significant numbers due to retire in the near future.  Mr O’Keefe suggested that this was less of an issue with dentists. Contracts for dental services were instigated in 2006, which were accompanied by significant national investment. As a result of this additional capacity, there had been a 30% growth in patients attending the dentist across the Buckinghamshire, Oxfordshire and Berkshire West area. Mr O’Keefe confirmed that the workforce was relatively young and suggested that the issue was more related to the heavier case mix, making it a tougher environment – this was prompting some dentists to move to the private sector. However, this was more of an issue in other areas.

Council Alan Macro noted that a high proportion of children treated in hospital were there for dental problems. He suggested that many of these issues could have been identified earlier by a dentist and asked how this could be addressed. Mr O’Keefe highlighted the strong correlation between socio-economic factors and dental extractions in hospitals for children, with 40% of the community dental extractions in Berkshire coming from four postcodes.  ...  view the full minutes text for item 15.

Purpose: Healthwatch West Berkshire to report on views gathered on healthcare services in the district.

As part of the Healthwatch Update (Agenda Item 10), Lesley Wyman presented the report on Children’s and Adolescents’ Mental Health Services (CAMHS).

She explained that Healthwatch had surveyed the parents / guardians of current and former CAMHS users living in West Berkshire and the survey attracted 128 responses.

The survey report referenced a national report by the Children’s Commissioner on the state of CAMHS in 2021. This revealed a big increase in referrals, in part due to the Covid pandemic, and that this increase in need was expected to continue. However, capacity was not keeping pace with the increase in demand.

Berkshire West CCG had experienced one of the largest increases in waiting times in the country between 2017/18 and 2019/20, although this appeared have reduced slightly since 2018/19. A positive point was that Berkshire West CCG had one of the largest reductions in the number of referrals to CAMHS being closed. Figures were not available on CAMHS spend for Berkshire West relative to other areas.

The Healthwatch West Berkshire survey showed that one of the main issues was the very long waiting times, with 50% of respondents waiting between 1-3 years for a diagnosis or to access CAMHS. Families felt that there had been impacts on their children’s education and other family members had also been affected.

Three quarters of respondents felt the service had note made a difference to their child, 7 out of 10 had been unhappy with the information they got on discharge and 8 out of 10 wanted more information about where to go for help. There were many comments asking for waiting times to be decreased, and for better communication throughout the journey.

The report made a series of recommendations related to the above points (i.e. decreasing wait times, improving communications, and improving prevention / early intervention to reduce the need for CAMHS referrals).

It was noted that the CCG had recently published a refreshed version of the Local Transformation Plan (LTP). The Healthwatch recommendations had been linked to the previous version. The LTP detailed progress that had been made and outlined the Children and Young People’s Mental Health and Emotional Wellbeing Review. The LTP included a refreshed set of priorities and indicated how these would be met.

Lesley Wyman stated that the revised LTP gave a lot of reassurance that commissioners were focusing on and continuing to improve CAMHS locally.

Councillor Tony Linden was struck by the level of dissatisfaction with the service and the waiting times. He noted that the survey had attracted a small response and asked if those responding were more likely to have experienced problems. Lesley Wyman explained that some respondents had been satisfied with the service, but the number was relatively small compared to those who were dissatisfied. She suggested that this was to be expected from this type of survey.

Andrew Sharp stated that there were around 1,500 CAMHS referrals per year across Berkshire West, so the number of survey responses was significant. He indicated that Healthwatch  ...  view the full minutes text for item 16.

Purpose: The Berkshire West Clinical Commissioning Group to provide a presentation on patient access to GPs and the impact of the Covid-19 pandemic on primary care.

Katie Summers was invited to give a presentation on Access to GPs (Agenda Item 8). It was noted that the report had already been presented to Health and Wellbeing Board. Key points from the presentation were as follows:

·         Due to pressures in Primary Care, the CCG had been unable to get a GP to attend the meeting.

·         Around 50% of appointments were being carried out face-to-face, which was the preferred format for GPs.

·         Most practices had moved to a hybrid model, with telephone / video consultations used to triage patients and identify those who needed a face-to-face appointment.

·         Demand for appointments had increased considerably compared with the pre-Covid situation.

·         Many people had experienced delays in elective appointments, so there was a backlog of re-referrals to secondary care services.

·         Across Berkshire West, there had been a 76% increase in consultation activity, while some Primary Care Networks had experienced increases of up to 155%.

·         Face-to-face / telephone consultations had increased in some PCNs and decreased in others, but overall, there had been a 5% increase.

·         Each GP surgery recorded its activity slightly differently, but NHS England had recently established the General Practice Data Audit, which set out standard parameters for recording all GP activity.

·         Responding to online requests was a big challenge for most GP practices.

·         Face-to-face consultations were taking longer due to Covid infection control measures (14-16 minutes vs 8-10 minutes pre-Covid).

·         Housebound patients / those with transport difficulties had better access to GPs than before, which was a benefit of the new hybrid model.

·         The Respiratory Hub arrangements had been stepped down, with all patients managed within practices – patients were given pulse oximeters to monitor the oxygen in their blood.

·         There was a local campaign to inform patients about when to contact their GP or when to call 111 or 999.

·         Plans were underway for the next phase of the Covid vaccination programme.

·         A workshop had been held in May to agree remedial actions for primary care – a key outcome was that the CCG had commissioned 170 additional appointments per day to increase capacity up to March 2022.

·         The Government had launched a new Winter Access Fund for General Practice, with £74 million allocated to Buckinghamshire, Oxfordshire and Berkshire West.

·         Workforce challenges remained – there had been a 6.8% reduction in the number of salaried GPs in the 5 years to March 2021.

·         Efforts were being made to promote General Practice as a career for new doctors.

·         The Additional Roles Reimbursement Scheme was being used to create multi-disciplinary teams to support GPs (e.g. paramedics, pharmacists, mental health specialists, nurses and care navigators).

The Chairman asked if additional roles were being used to support GPs across all GP surgeries in West Berkshire. Katie Summers explained that the clinical director and partners for each Primary Care Network (PCN) made decisions about staffing. In some cases staff would be shared across surgeries within a PCN, while in other cases each surgery might have a dedicated resource.

Councillor Alan Macro expressed concern  ...  view the full minutes text for item 17.

Purpose: The Berkshire West Clinical Commissioning Group (CCG) to provide an update on activities and commissioning plans, including development of the Integrated Care System (ICS).

Katie Summers was invited to give a presentation on the work of the Clinical Commissioning Group (Agenda Item 9). Key points from the presentation included:

·         The CCG would no longer exist as of April 2022, but would be integrated into an Integrated Care Board (ICB) for Buckinghamshire, Oxfordshire and Berkshire West (BOB).

·         An Integrated Care Partnership (ICP) would be set up at the BOB ‘system’ level and discussions were ongoing regarding membership.

·         Place Based Partnerships (PBPs) would be created, including one for the Berkshire West ‘place’ to support the population health needs of local residents, with representation from West Berkshire, Reading and Wokingham.

·         Functions currently discharged by the CCG would transition to the ICB. These were being reviewed to see what could be delegated to PBPs.

·         An announcement regarding the appointment for the new ICB chief executive was expected shortly.

·         Javed Khan had been appointed as Chairman.

·         The non-executive directors would be recruited within the coming weeks.

Action: Councillor Graham Bridgman undertook to share the slide showing the ICS terminology with Health Scrutiny Committee Members.

It was noted that the terminology and acronyms were confusing, particularly with regards to the Integrated Care Partnership (ICP), which was currently operating at ‘place’ level, but would operate at ‘system’ level in future.

It was also noted that changes to legislation would be required, since Health and Wellbeing Boards were required to have CCG representatives as a matter of statute. Memberships would need to take account of the new structures.

The Chairman sought clarification about how the Health Scrutiny Committee would interface with the Integrated Care Board. It was confirmed that there would be no representation from the Health Scrutiny Committee, but a Joint Health Overview and Scrutiny Committee had been set up to undertake scrutiny at the ‘system’ level. There would be one local authority representative on the ICB and there would also be local authority representation on the ICP.

Katie Summers stressed that it was important to agree what would be delegated to ‘place’ level and it was critical to have the right form and governance for the PBP, including reporting to Health Scrutiny.

Councillor Andy Moore noted that the proposed changes were significant and asked if there was a parallel assessment to ensure that everything was being picked up by the new bodies. Katie Summers confirmed that NHS England was undertaking a review of all the individual functions, statutory roles and work programmes. However, she acknowledged that it would be appropriate for the Joint Health Scrutiny Committee to check that everything was being picked up.

Purpose: To confirm the dates of future meetings, receive new items and agree and prioritise the work programme of the Health Scrutiny Committee.

The Chairman invited Members to put forward items for consideration – all proposed items would be subject to the agreed prioritisation methodology and would then be reviewed by the Chairman and Vice Chairman.

It was highlighted that there was a form on the website to allow members of the public to nominate topics for health scrutiny, which could be accessed via the following link:

https://www.westberks.gov.uk/article/37170/Suggest-a-Topic-for-Scrutiny