To receive apologies for absence.

Apologies for absence were received from Cllrs CR Butler, CA Gandy and MD Lloyd-Hayes.

To receive details of any members nominated to attend the meeting in place of a member of the committee.

Cllr JF Johnson attended as a substitute for Cllr CA Gandy.

To receive any declarations of interest by members in respect of items on the agenda.

There were no declarations of interest.

To approve and sign the minutes of the meeting held on 27 February 2017.

RESOLVED

That the minutes of the meeting of 27 February 2017 be agreed as a correct record and be signed by the chairman.

To consider suggestions from members of the public on issues the committee could scrutinise in the future.

(There will be no discussion of the issue at the time when the matter is raised.  Consideration will be given to whether it should form part of the committee’s work programme when compared with other competing priorities.)

No suggestions were received from members of the public.

It was noted that the committee had not received an update from West Midlands Ambulance Service for some time and it was agreed to confirm this as an area for the future scrutiny work programme at the earliest opportunity.  A visit to the ambulance station in Hereford was being planned for scrutiny members during the year ahead. 

To note questions received from the public and the items to which they relate.

(Questions are welcomed for consideration at a scrutiny committee meeting so long as the question is directly related to an item listed on the agenda.  If you have a question you would like to ask then please submit it no later than two working days before the meeting to the committee officer.  This will help to ensure that an answer can be provided at the meeting). 

There were no questions received from the public.

It was noted that this facility was not well used and there would be some developmental work on this area to encourage public involvement. 

The chairman welcomed Councillor FM Norman as a member of the task and finish group (agenda item 7), Simon Adams of Healthwatch, and officers from 2gether NHS Foundation Trust. 

To consider the findings of the scrutiny task and finish group and to recommend the report to the executive for consideration.

The chairman noted that Councillor Powell would be leaving Herefordshire in the near future and thanked him for his work and contributions to the committee. 

Councillor Powell, as chair of the task and finish group, presented the report. In his opening comments he noted the quality and passion of people who met with members of the task and finish group, and who demonstrated an overwhelming desire to improve services.    He thanked the membership of the task and finish group for their hard work and dedication and also the officers who supported the work of the group.

Special acknowledgement was made of the wellbeing ambassadors who were clearly proud of their work, and should be commended and supported to continue and develop their role.

The following points of the report were highlighted:

·         the work was commissioned in order to establish whether or not there could be confidence in meeting corporate aims with regard to the health and wellbeing of children and young people in Herefordshire

·         a lot of research was undertaken by the group and although the strategies and structures seemed complex they appeared to be working well and plans were being realised

·         the findings of the group identified a number of areas listed in the report as recommendations for further attention to consolidate and strengthen service provision across its spectrum

Members of the task and finish group made the following additional comments:

·         a consistent message from people interviewed was that of the importance of early intervention

·         the good work happening in schools could be greatly assisted by a toolkit and greater clarity in supporting mental health needs. The excellent practice within some schools should be shared with others in order to support pastoral care without taking the focus off the curriculum.

·         There needed to be consistency and co-ordination of the support and resources available for schools

·         Participation in further scrutiny activity regarding perinatal services and care of under 5s was supported

A member emphasised that it was essential to maintain consistency within services in order to support young people.  He added that the safeguarding process also played a role in communicating within the referral process if there were mental health needs not being addressed that were impacting on welfare.

A member commented that commissioners should note the experiences of young people being referred and prescribed treatment by their GPs.  He commented further on the prevalence of attention deficit hyperactivity disorder (ADHD) and that there needed to be more awareness of this. In response the task and finish chair commented that there was a need to be clearer about clinical definitions and diagnoses and about record-keeping. He noted that professionals were clearly committed to getting this right and this would contribute to improved outcomes.

A member noted the learning from this report and commented that it highlighted issues that might not be common knowledge such as tier 4 inpatient arrangements. She spoke in support of a number of points in the report including the deeper reach and reviewing the upper age  ...  view the full minutes text for item 148.

To provide an overview of performance of substance misuse services (provided by Addaction) across Herefordshire in order to provide assurance.

The public health representative introduced the item and explained that the service had been recommissioned and was making the transition from a treatment maintenance model to a recovery model which was a more demanding approach.

The manager of Addaction Herefordshire presented the update, making the following points:

·         the contract had been running for 14 months and represented a significant culture shift for services users and staff, and this was now starting to be reflected in performance figures.

·         There were over 700 service users presenting a varied caseload within which the county’s older population was reflected. 

·         The service was working closely with commissioners and had developed a service improvement plan to encompass changes to treatment programmes in the move towards supporting recovery rather than maintaining a prescription for life. 

·         Steps to increase service user engagement and contact had taken service attendance to 85% attendance, with clearly identified goals for treatment and being clear with services users about reaching the end goal from the outset of treatment.

Members raised a number of questions and comments in response to further points covered during the presentation, with the following responses:

·         In answer to a question about performance compared with other areas, it was clarified that the service was at the top end of the lower quartile and was improving. The services was seeing more clients who had stopped engaging with the previous provider. It was expected that there would be a decline in completed casework because of adjustment to the new recovery where service users were required to be more accountable within their recovery plan and changing behaviour. Having more boundaries in place supports this but it is a challenge for service users. Staff use a case management tool which records substance use, state of health and social factors.  This information is reviewed every three months as required by the Care Quality Commission, and there is a plan in place to improve performance significantly.

·         Herefordshire had been identified as one of three sites for the roll-out of a new pathway for service users which would mean quicker assessment at the first point of contact with a new service user. The assessment would look at the whole service user’s circumstances and produce a risk assessment. A further appointment for a recovery choices session would then be offered, and a clear explanation given of expectations and a timetable of activities offered which help to promote recovery. There were good links with a range of providers that could be accessed for activities; these were client-led activities so there was a choice to attend or not. 

·         Regarding service development, there had been some recruitment activity to manage a vacancy and add a recovery worker to the team. It was a challenge to recruit into Herefordshire but there was a robust national recruitment system and national press would be used if required. Specifically regarding Leominster, the site was now open and this service was developing gradually. It was hoped that with some staffing issues being resolved and additional administrative  ...  view the full minutes text for item 149.

To seek the views of the committee on the proposed new carers strategy for Herefordshire.

The strategic housing and wellbeing manager gave a presentation describing the process so far in the development of a new carers strategy.  Extensive consultation had taken place during 2015 and 2016 and there was ongoing engagement which would follow with sharing the draft strategy with stakeholders prior to presenting to Cabinet in July.  

Referring to co-production of the strategy, a member commented that there appeared to be a period of extensive consultation and the final work was set for Cabinet in July. Noting that this seemed rushed, he asked what steps had been taken to make sure that as many carers as possible had been asked for their view given that they represented some 25% of the population, and whether this was considered to be true co-production. 

The strategic housing manager explained that consultation had extended beyond the known groups and had engaged with 155 carers in different ways including in their own home and electronically. It was recognised that not all carers were connected with the charity Herefordshire Carers Support and that work had been with a small number so far.  However, the consultation had been publicised widely on website and elsewhere and this was a continuing process. It was considered that within the estimated number of carers, not all people considered themselves to be carers.

In terms of the number of people taking part in the carer’s assessment, it was anticipated that this was below the requirements of the Care Act. However, some opportunities had been identified in the way assessments could be offered so they were deliverable.

A member commented on a point regarding the financial context for local government and the NHS, with increasing pressures on budgets.  He asked how funding might be used to support the role of carers to support the aim of avoiding hospital admissions. In response it was explained that some proposals had been outlined with the Clinical Commissioning Group regarding investment in carers support around this aspiration and also with regard to supporting hospital discharge.

Returning to the information in the presentation regarding engagement, it was explained that engagement continued to be offered throughout the further stages of the development process for the strategy and which included home visits, telephone calls and emails as well as attending events. 

From what people said, key themes emerged, which were:

·         identifying carers and how to support them

·         a carer’s needs tended to be identified at the point of crisis and there needed to be more focus on their long term needs being identified earlier and to address risks to them and the person they cared for

·         information and advice sources which included WISH were a key resources and there were  plans to invigorate and extend these

·         developing understanding of carers by professional and information sharing between agencies

·         anxieties of carers around continuity of care if something were to happen to them

·         making contact with carers not currently accessing support and helping to improve their quality of life

·         more information required regarding rights for carers  ...  view the full minutes text for item 150.