To receive apologies for absence.

Apologies for absence were received from Councillors ACR Chappell, MD Lloyd-Hayes, MT McEvilly, A Seldon and D Summers.

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

Cllr EPJ Harvey attended as a substitute for Cllr MD Lloyd-Hayes and Cllr LC Tawn for Cllr A Seldon.

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

No declarations of interest were made at the start of the meeting. However, Councillor PE Crockett declared a disclosable pecuniary interest in agenda item number 8 as an employee of Wye Valley NHS Trust.

To approve and sign the minutes of the meeting held on 3 May 2016.

It was noted that a briefing paper requested of public health regarding the levels of immunisation and GCSE attainments of children in care had been circulated to members.  

RESOLVED

That the minutes of the meeting held on 3 May 2016 be approved as a correct record of the meeting.

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.)

None.

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). 

None.

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

The chairman thanked the chair and members of the task and finish group for their work on this review.

The chair of the task and finish group expressed her thanks to all who participated in the review and assisted with production of the report. In introducing her findings, she noted the significance of the impact of a lack of early years support on a child’s development. It was therefore remarkable that few children were seen during the group’s visits to various services and although there were programmes of events for parents at the children’s centres visited, it seemed that few were taking up the offer when the task and finish group made their visits. 

More specifically, there was concerning information regarding children not attaining an appropriate level of development in communication skills. This had an impact on ability to socialise and form friendships. It was found that the waiting list for speech and language therapy was unacceptably long, at between 40 and 60 weeks.  

Other observations were that outreach work was reported to have been unsuccessful in some areas alongside some services being described as hard to reach by some staff interviewed in some areas. This raised a question over the feasibility of village amenities such as village halls in providing more accessible services.  As part of the review, members also visited the Hope Centre in Bromyard which is run under a different model as a family centre and managed by a charitable organisation. This was found to be a busy centre, and it was noted that it was used by parents from Leominster, where there was also a children’s centre. It was felt that the Hope Centre model supported the whole family to be engaged and that this provided an example of a successful model.  It was noted during the item that the Hope Centre received a higher comparative level of funding to other centres. Although staff at other centres visited were dedicated, they reported feeling frustrated and constrained.

The group concluded that outcomes for children in early years required improvement, and resources could be used to better effect. The report identified a number of areas for improvement and recommendations to inform the wider review of early years provision.

A member asked about possible reasons for people not accessing children’s centres when they could benefit from them.  In response, the chair of the task and finish group explained that there were several factors observed: In some cases, the centres’ programmes of activity did not link up with public transport and transportation issues did not appear to be  taken into consideration in some scheduling; centres were not always well promoted and in some locations were hard to find.  In one case there was no link between the children’s centre and the local school’s reception and nursery class where there might have been opportunity to engage parents in activities being run at the centre; centres appeared to have their own formats. Location was not considered to be a factor however, for  ...  view the full minutes text for item 87.

To provide an update to scrutiny on the progress made in respect of the findings from the task and finish group report on ‘Short breaks and respite services for children with disabilities’

The vice-chairman, as chair of the task and finish group, introduced this update on progress to date for identifying further requirements or actions. He reminded the committee that this encompassed the short breaks service as a whole, of which 1 Ledbury Road was a part. An outcome of the review was the allocation of additional funding of just over £1million. The service is in a better place than a year ago, thanks to officers’ work, although there was more to achieve. 

The assistant director education and commissioning provided an update on the recommendations taken forward. The whole of the short breaks offer was undergoing recommissioning. The development of overnight short break respite in a family setting was progressing; three foster carers had been approved for short breaks, and a number were in process of application and assessment.  One child had been matched and others were in progress.

The registration documentation was being submitted this week to Ofsted by Wye Valley NHS Trust.

A member welcomed the positive update and that concerns were being addressed. She noted the importance of communication in restoring confidence in the service and that the council and partners must take care to avoid such problems in the future.     

Disappointment was noted regarding the breakdown in communication over rotas which led to families having to change arrangements, and it was hoped this was now addressed. 

A member commented on recent contact from a family regarding ongoing problems with rotas, noting that children using the service did not always respond well to change, and this could have an impact on their family.  She added that partnership working needed collective working and good communication, and this should have been understood in a small but hugely important service to the families who relied on it.   The member welcomed progress on the fostering service, adding that those carers needed appropriate support to ensure they were retained.

The assistant director commissioning and education acknowledged members’ comments regarding communication and offered to look into any individual concerns. He added that there were now more options available for families with the core aim of the service being able to meet assessed need.

Commenting on buddying arrangements, a member gave an example of numerous changes in buddies for one young person which led the family to consider alternative arrangements despite this taking time to achieve with possible adverse impact on the family.

In response the assistant director education and commissioning asked for the specific details so that these could be followed up.

A member commented on the range of providers referred to in the report, and that there needed to be firmer information on these to ensure they were concrete and met need.  

The assistant director education and commissioning confirmed that colleagues in both children’s and adults’ services were working together to identify options for housing, supporting transitions into adult life and short breaks to ensure a rigorous approach.

A member requested more assurance on maintaining communication with families and for funding to be supported  ...  view the full minutes text for item 88.

To review the performance of 2gether NHS Foundation Trust in providing mental health and learning disability services in Herefordshire in the light of the recent Care Quality Commission (CQC) Inspection.

 The director for adults and wellbeing introduced the presentations, which would give the commissioner and the service perspectives. Members were encouraged to focus on care provided in Herefordshire, given that the trust also covered Gloucestershire.

The programme manager, NHS Herefordshire Clinical Commissioning Group (CCG), outlined in terms of the CQC’s inspection, the trust was rated over all as “good”, with some areas that were found to be outstanding and others which required further improvement. The trust should be commended for their response to the findings and improvements made. The CCG monitored the trust’s performance and found that 80% of the performance indicators were met. In some cases, performance exceeded national targets, such as for waiting times for children and young peoples’ services and also for dementia assessments. Those areas that had not been achieving the required standards were being addressed, and it was noted that low levels of access to some services, such as “let’s talk”, were partly due to the stigma attached to mental health issues. This was being addressed with public health, and members were encouraged to work with constituents to encourage up take.

The chair of 2gether NHS Foundation Trust commented on the context of the CQC rating. Those areas that were found to be outstanding were in the top four best services nationally. There were opportunities for improvement but in recognising areas of excellence, she thanked those who contributed to the achievements.

The trust’s director of engagement and integration presented a summary of a guide to the trust, the CQC’s findings, and a specific focus for scrutiny in Herefordshire. She highlighted that the trust aimed to be part of the community and tackle stigma so that people would be encouraged to access services. The CQC inspection in October 2015 was very rigorous, so the positive feedback that acknowledged the contributions of staff and partners was welcomed.

In response to an observation from the chairman regarding there being no health-based place of safety provided by the trust, the medical director explained that this was a place defined by the Mental Health Act for someone with a mental disorder to be taken to keep them safe. There was a facility at the unit in Hereford which was unstaffed due to the requirement for police presence and which had implications for policing capacity.

A member commended the trust for its CQC rating. However, the presentation gave the impression there were no major concerns with regard to service provision in Herefordshire, although the member noted a number of points from the CQC report that were absent from the presentation. These included: staffing concerns in relation to high sickness absence rates; comments from staff about not having access to regular clinical or managerial supervision and appraisals; that staff reported feeling stressed and unsupported; and decisions made over resources that had an impact on acute services at the hospital.  

Responding to the concerns regarding resources, the trust’s locality director explained that the arrangement to host social care had come to an end  ...  view the full minutes text for item 89.

To consider the committee’s work programme and related scrutiny activities.

It was confirmed that there would be a spotlight review of the NHS five year sustainability and transformation plan on 19 September 2016.

RESOLVED

That the draft work programme be approved.