Apologies were received from Councillor MJK Cooper.  

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

There were no substitutes.

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 16 May 2018.

RESOLVED:

That the minutes of the meeting held on 16 May 2018 be confirmed as a correct record and signed by the chairman.

The chairman noted that the item on continuing healthcare was not on the agenda due to a request from the Clinical Commissioning Group to ensure their governance process was met. This would now be covered at a specially convened meeting on 20 September 2018.

In response to comments made at a recent meeting of Full council, the Chairman wished it to be emphasised that the service previously based at 1 Ledbury Road was run by Wye Valley NHS Trust and not Herefordshire Council, and it was the decision of Wye Valley NHS Trust to close the setting and not the decision of Herefordshire Council.

To receive questions from members of the public.

Deadline for receipt of questions is 5pm on 11 July 2018.

Accepted questions will be published as a supplement prior the meeting.

For guidance on how to submit a question to the committee, please see: https://www.herefordshire.gov.uk/getinvolved

Please submit questions to: councillorservices@herefordshire.gov.uk

There were no questions from members of the public.

To receive questions from councillors.

Deadline for receipt of questions is 5pm on 11 July 2018.

Accepted questions will be published as a supplement prior the meeting.

Please submit questions to: councillorservices@herefordshire.gov.uk

There were no questions from councillors.

To provide the committee with information about:

·         the current approach taken by the council in relation to Deprivation of Liberty Safeguards (DoLS) and how they are delivered

·         the approach taken by the council to manage risks in relation to the Deprivation of Liberty Safeguards

in order that the committee may determine any recommendations it wishes to make to the executive with a view to further mitigating risks and securing improvement.

The specialist services manager presented her report which highlighted the current position with regard to deprivation of liberty safeguards (DOLS).

She explained that the purpose of DOLS was to protect members of the public in hospital or residential or nursing home settings where they lacked capacity to agree to be there. DOLS did not apply to people outside of a registered care home or hospital setting.

By way of background, she made the following points:

·         DOLS had been in place since 2008 in response to changes to the Mental Health Act to address a gap in the law, known as the Bournewood gap, where there was no legal process to legally authorise someone’s deprivation of liberty as a requirement of the Human Rights Act.

·         The initial common assumption had been that DOLS applied where someone objected to the arrangements made on their behalf, but in 2014 major case law redefined DOLS and determined that the objection was not the over-riding or relevant factor but whether or not someone was free to leave; whether the person had continuous supervision; or was under continuous care which infringed or restricted them. 

·         This meant that more people met the criteria and this had significant implications in Herefordshire where casework increased 15-fold compared with 10-fold nationally. This led to local authorities being unable to meet demand and therefore meet legal responsibilities within required timeframes, resulting in backlogs. In Herefordshire this backlog had reached nearly 600 cases but despite pressures, had now reduced to 290.

The manager described how the arrangements worked locally:

·         The backlog was carefully triaged in terms of risks to the individual, using the ADASS prioritisation tool to ensure people at high risk were assessed in a timely manner.

·         The triage system looked at a range of factors as they affected the individual, including the level of restrictions, the family’s and power of attorney’s views and safeguarding issues, to reduce impact of restrictions.

·         The process was intensive and involved 6 assessments, which covered age, mental capacity, whether there was anyone who was granted powers such as lasting power of attorney, who it was that was objecting, doctor’s eligibility assessment, doctor’s mental health assessment, and best interest assessment to determine that criteria was met and that it was in the person’s interest and proportionate to the risk of harm.

·         The process was complex, and required a senior officer for final authorisation. The authorisation could last up to 12 months, after which, if the person were in the same setting, it would be necessary to repeat the process. Although a streamlined process was in place to make it quicker, it still took time to evidence the 6 assessments.

·         The requirements meant that the process took time and effort for the 13000 referrals, with a backlog of 290, although compared with other authorities, this was good service performance. 

The director for adults and wellbeing commented that some councils had invested funding to clear their backlogs but the funding had to be sustained to keep up with  ...  view the full minutes text for item 7.

To consider the committee’s work programme for the 2018-19 municipal year.

Members considered the draft work programme for the current municipal year. 

The following points were noted:

·         It would be a challenge to cover business in the time before the purdah period commenced ahead of the council election in May 2019.

·         A report on the issue of continuing healthcare was planned for the meeting on 20 September, once it had passed through the governance process for the Clinical Commissioning Group.

·         An item covering the draft domestic abuse strategy be considered on 20 September following a member’s workshop this afternoon.

·         Consideration of the annual budget was identified for the meeting on 2 October, subject to meeting the timeline for governance of this item. It was noted that the process for budget recommendations would be for the adults and children’s scrutiny committees to pass their comments to the general scrutiny committee for collective submission.

·         A report on public health activity was timely, for the new director of public health to present her proposals for delivery and to show how they fit with national programmes. The report would need to show how initiatives would have impact, and it was agreed that Healthwatch be invited to contribute to this item.   It was noted that there was a children’s scrutiny spotlight review on children’s dental health and childhood obesity which incorporated good work by Healthwatch with the public, and that there was a link to adult dental health and obesity as a family wide issue.  This item was identified for the 2 October meeting and would include public health improvement plans that had been set by the directorate. It was agreed to share these plans for the committee to identify specific focus areas, although an ensuing discussion suggested the inclusion of flu vaccination promotion for the health and care workforce.

·         It was suggested to consider the matter of the Clinical Commissioning Group and Wye Valley NHS Trust’s plans for responding to housing growth in the county and the corresponding demand for services. It was noted that the effects across the Sustainability and Transformation Partnership footprint would need to be included in this.   Timing for this item would be the 29 January 2019 meeting.

·         An update on Home First be included on 19 March 2019, which would include input from Healthwatch on their work in this area.

·         A service review on Addaction to be included on the agenda for 19 March 2019.

·         An update on WISH was suggested, which could be covered by way of a briefing note.

RESOLVED

That

a)    subject to the additions and amendments discussed, the draft work programme for 2018-19 be agreed; and

b)    where recommendations have been made to the executive, these be collated on an action tracking document for review and follow-up.