Apologies were received from Cllr CA Gandy.

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 25 January 2018.

RESOLVED

That the minutes of the meeting held on 25 January 2018 be confirmed as a correct record and signed by the chairman.

To receive questions from members of the public.

Deadline for receipt of questions is 5pm on Thursday 22 March 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 Thursday 22 March 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 review the quality and performance of the substance misuse service commissioned by Herefordshire Council and delivered by Addaction.

The Addaction service manager gave a presentation which provided a service update following the update provided to committee on 21 September 2017, the main points being that:

·         There had been significant improvements and this was set to continue, both in terms of organisational performance and outcomes for service users

·         Improvements in outcomes for services users was supported by focusing on recovery and making use of support networks including volunteers, peer mentors and local communities

·         The council had reviewed the contract, effective from April 2018, which would mean some challenges to staff capacity, focused working such as time-limited and structured care, clearer pathways and use of group work. Although the outreach programme would be reduced, there would be increased information and signposting for referrals and more service advertising.

·         Addaction had listened to recommendations from the last meeting regarding publicity and this was being developed. 

The chairman welcomed the improvements and asked how people were accepting new approaches to treatment.  The service manager explained that service users understood and preferred having more contact and more on offer, particularly group work, to support recovery. There were some long-standing users who had resisted engagement but this was being addressed with the support of a key worker.

A member asked for more clarity on the groupings of types of substance misuse, and it was clarified that Public Health England had introduced a fourth primary group where there was combined use of alcohol and non-opiates. 

The member welcomed the group work approach, commenting that there should be more group work. He asked what was in place to enable support groups such as AA and Al-anon to continue, and whether the Stonebow Unit was being used for people with mental healthcare needs as well as substance misuse treatment needs.  The service manager confirmed that dual diagnosis clinics were being explored with 2gether NHS Foundation Trust and there was support to help upskill staff to refer into the service. As part of this work, it was recognised that mental healthcare needs could be addressed alongside substance recovery support and so the use of pathways was being reviewed so that people did not need to complete one care pathway or achieve recovery before accessing other care.  Addaction had clinical psychologist input but referred people to other support for one to one counselling.

The vice-chairman thanked Addaction for the opportunity for members to visit to the Leominster base, and asked what progress had been made in Leominster regarding group provision on offer and how the co-production panels were helping to increase engagement and community involvement with Addaction.  It was recognised that there was more that could be achieved around increasing Addaction’s presence in Leominster and the appointment of a new team leader would support development in this area. It had been found that the Leominster service was better suited to smaller groups of 4 or 5 people but the plan was to have a core user group each for cannabis, stimulants and low-level alcohol followed by an opiate user group.  ...  view the full minutes text for item 41.

To review the services commissioned by the council and the clinical commissioning group for adults with learning disabilities in Herefordshire.

A presentation was given by the senior commissioning officer, Herefordshire Council and the community learning disability team service manager, 2gether NHS Foundation Trust. It was noted that the presentation was a brief tour of the service, which provided long-term work covering each person’s life span, all health needs and all aspects of daily living.  

The presentation highlighted the following key points:

·         Although statistics could not be relied upon, it was estimated that 2.32% of the county’s population had a learning disability diagnosis, and this covered a wide spectrum of needs.  This figure broadly fitted national demographics; however it was noted that the county had a good reputation for the care of people with a learning disability which resulted in people moving here to access services

·         In terms of funding, learning disability services represented 30% of the adult social care budget, supporting 550 people, which was broadly equivalent of 25% of council tax income, and which was typical of national picture.

·         As shown in the adults and wellbeing blueprint, there was a move towards mainstreaming peoples’ experience and accessing universal services rather than looking to adult social care, which represented significant culture change. 

·         Work on developing access to information and improving the “front door” would help people know where to access information and support. Success in achieving changes to the pathway was facilitated by community brokers, in getting more consistent and richer information, and all information was being linked into WISH online which was starting to show success.

·         In terms of health provision, providers and commissioners were working together to ensure contracts were directed in the right way and meeting long term needs. The focus was on making sure reasonable adjustments were made so that people could routinely go straight to the service they needed.  This was supported, for example, in acute care by acute liaison nurses. Herefordshire had been successful in limiting the use of out of area placements for people with learning disabilities, and those people who were out of county were on planned return. This was an excellent position as continuing healthcare for this small cohort was known to present a challenge, and the intention was to bring everyone home to the county.  Service provision cost around £250k per person annually, so a possible way to support this outcome was to develop specialised services shared with neighbouring authorities.

·         Access to the community learning disability team was supported by a multi-disciplinary approach and an open referral system. The aim of the service was to provide person-centred support for people to access mainstream services whilst recognising the need for some specialist support.

·         The service was supporting access to annual health checks and there was a lead nurse providing training for GPs to increase access which was currently around 60%. Take-up of health checks was lower than in the general population, so this was being promoted with input from the Clinical Commissioning Group and the council. This was a critical area of focus as someone with a learning disability could  ...  view the full minutes text for item 42.