Apologies for absence had been received from Board Members: Cllr Pauline Crockett Cabinet Member for Health and Wellbeing.

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

There were no substitutes. A substitute was still to be arranged for Cllr Seldon.

To receive any declarations of interests in respect of schedule 1, schedule 2 or other interests from members of the Committee in respect of items on the agenda.

No declarations of interest were made.

To approve the minutes of the meeting held on 10 January 2022.

The minutes of the previous meeting were received. The chair outlined an accuracy correction, the second bullet point on page 11 should read HVOSS (Herefordshire Voluntary Organisations Support Service) and not HBOS.

Resolved:             That the minutes of the meeting held on Monday 10 January 2022 be approved and be signed by the chairperson.

To receive any written questions from members of the public.

Deadline for receipt of questions is 5.00pm on Tuesday 2 March 2022.

Accepted questions and answers will be published as a supplement prior to the meeting. Please submit questions to: councillorservices@herefordshire.gov.uk

Further information and guidance is available at www.herefordshire.gov.uk/getinvolved

No questions had been received from members of the public.

To receive any written questions from members of the Council.

Deadline for receipt of questions is 5.00pm on Tuesday 1 March 2022.

Accepted questions and answers will be published as a supplement prior to the meeting. Please submit questions to councillorservices@herefordshire.gov.uk

No questions had been received from councillors.

To consider whether the public and press should be excluded from the meeting in accordance with the Access to Information Procedure Rules set out in the Constitution pursuant to Schedule 12A of the Local Government Act 1972 as amended:

2.    Information which is likely to reveal the identity of an individual – due to small numbers in the data reported in the appendix to the following item.

The Committee was asked to consider whether it should go into private session for item 8 because of the appendix.  The Chair had discussed this with members prior to the meeting and felt the committee could avoid the need to do this by not referring to the statistics given in the appendix and talking in general terms only.

Resolved:  The committee agreed to proceed with the meeting in public.

To provide members of the Committee with an overview of substance use services in Herefordshire and the work of the new service provider, Turning Point.

Before the item was presented, the committee enquired if a glossary of terms expanding on abbreviations and acronyms used in reports and recorded in the pre-scrutiny committee meeting (01/03/22) as an action had been produced and circulated. The Acting Director for Adults and Communities, explained that it had not had been actioned and that any abbreviations or acronyms coming up during the meeting could be explained. The committee expressed frustration at this and pointed out that heavy use of abbreviations often made it difficult and time consuming to understand reports. The Acting Director for Adults and Communities gave an assurance that a glossary would be produced and the chair recommended that the committee proceed with items on the agenda.

The committee received a report focusing on Substance Use Services, which was presented by Chris Franks (Operations Manager, Turning Point Herefordshire) andKevin McNamara (Senior Quality Assurance Advisor, Turning Point).

The committee congratulated the Turning Point attendees on the improved performance the service had made in relatively short period of time.

The committee enquired about the pathway for referring to community based aftercare and whether Turning Point worked with AA (Alcoholics Anonymous), NA (Narcotics Anonymous) and existing support groups.

The operations manager explained that Turning Point worked with local GPs to enhance pre-interventions and structured pre-interventions. In addition to working with local GPs, Turning point was also linked up with the probation services and social services. Aftercare was a key area of focus and there was an emphasis on a mindfulness based approach, which helped people understand triggers and how to prevent risk of relapse. It was explained that Turning Point did have existing links with recovery communities including AA and NA and would be looking to strengthen them in the future via post-Covid face-to-face activity. The operations manager also discussed SMART (Self-management and Recovery Training) recovery and described how it was a cognitive behavioural therapy based, peer-led intervention. It was emphasised that there was a choice of ways for people to access suitable aftercare in the community.

The committee asked the operations manager how the figures in the report were produced, where Turning Point was located, who its mental health partners were and how much work had been started with the schools.

The operations manager explained that the performance figures from data analysts were reported through a national data system then from an on-site case data management system which fed into a national database.

Kayte Thompson-Dixon expanded that other drug services have to report their data onto a NDTMS (National Drug and Alcohol Data Treatment Monitoring System) and that this is fed through to UKHSA (UK Health Security Agency). The data is two-pronged with local data and the data that is compiled by UKHSA.

It was explained that Turning Point was located at multiple sites around the county, with off street access available in Hereford, as well as remote access via telephone.

In relation to mental health, Turning Point had established strong links with Wye Valley Trust, healthy living  ...  view the full minutes text for item 51.

For the Committee to consider and comment on the measures being taken to improve patients’ access to GP services.

The committee received a report regarding GP Access within Herefordshire, which was presented by Charmaine Hawker (Herefordshire & Worcestershire Clinical Commissioning Group Associate Director, Primary Care), Dr Jonathan Leach (OBE, NHS England Medical Director for COVID-19 Immunisation, NHS England Associate Medical Director for Armed Forces & Veterans Health and General Practitioner Davenal House Surgery Bromsgrove) and Dr Mike Hearne (Managing Director of Taurus Healthcare representing Herefordshire General Practice).

An outline of changes to how primary care during the Covid-19 period was restructured and delivered was given to the committee along with an overview of the data and information contained within the report. A number of key points were expanded on including: workforce issues (especially in terms frontline recruitment), the pros and cons of face-to-face and remote appointments and the increased use of wider healthcare professionals. It was suggested that people needed to consider whether it was the GP or GP team that couldn’t be accessed and that there was a need for greater awareness about the wider GP team and the changing role of GPs. The presentation also highlighted the desire among GPs and the GP teams for greater flexibility in the hours they were expected to work

The committee congratulated those involved in the vaccine rollout within the county, for being efficient and quick. The vital role volunteers played was also noted. The teams in Herefordshire had achieved the second highest level of Covid vaccination in the country.

The committee made a number of comments:

·       It questioned whether public opinions on GP access were based on perception or reality?

·       It noted that there was a multiplicity of ways to access the service and that changes within the service were happening at pace.

·       It questioned how successfully changes to the service were being communicated to the public.

·       It noted the need to raise public awareness in relation to the different ways of accessing services.

·       The committee welcomed the idea of GP teams with a wide range of skills and expertise, but questioned who ultimately makes the decisions about which GP team member should deal with certain individuals and cases?

It was explained to the committee by the report presenters that the GPs along with trained care navigators make those decisions. The role of the GP was likened to a conductor of an orchestra.

The committee noted that within the county rural areas sometimes benefitted from better access than those in the city, call waiting times in city practices were cited as being notably lengthy and problematic.

The committee gave a number of examples (from both personal experience and constituents) of instances where the time taken to get through (via telephone) to the merged practice in Hereford HMG (Hereford Medical Group) was unacceptably long. People had reported waiting in a queue of 50 and in some instances, having endured a lengthy wait, they were cut off before being able to speak with anybody. It was suggested by the committee that some of the fears of people who had been sceptical about the  ...  view the full minutes text for item 52.

To update the Committee on NHS Continuing Healthcare.

The committee received a briefing from Mandy Appleby (Assistant Director Adult Social Care Operations) and Jane Lodwig (Associate Director of Nursing and Quality, NHS Herefordshire and Worcestershire CCG). The Assistant Director gave a background to the paper and pointed out that she felt a point had been reached where there was now a joined up strategy, policy procedures and training schedule that would provide the basis and opportunity for meeting the needs of the Herefordshire citizens in meeting statutory duties towards the continuing healthcare framework. The Assistant Director pointed out that the report covered off most of the historical questions raised by the committee, other than those relating to the minor injuries unit, which would be addressed separately by the clinical commissioning group.

The committee noted that a dynamic system change was in operation and that in many ways the questions being asked over a year ago where now almost irrelevant, but that once the change was complete they could go back to review it.

The committee heard that work was still ongoing regarding discharge to assess and that funding decisions still needed to be made.The Acting Director for Adults and Communities pointed out that the council and its partners were working on a new model for discharge to assess and that when finalised it would go through governance in order to be embedded and that scrutiny could look at that model as required.

The committee felt the report had suitably covered off everything for the time being, but reserved the right to return to the subject at a point in the future should any concerns be raised.

The committee thanked those responsible for the report.

The recommendations below were proposed and seconded and carried unanimously.

RESOLVED:

The Committee recommended that:

a)    The updated briefing paper be noted.

b)    The Committee is sighted on the review plans that come forward and reserve the right to return to the item in 12 months.

For the Adults and Wellbeing Scrutiny Committee to consider and comment on the Care and Support Charging Policy.

The committee received an introduction and presentation on the care and support charging policy from officers Susie Binns (Welfare and Financial Assistant Team Leader) and Lee Davis (Head of Prevention and Support).

The key points were given in summary:

·         The proposals would cost the council £596K and put money back in the pockets for the majority of service users.

·         If all the proposals went ahead it was expected 73% (822) of people affected by them would have a reduction in changes, 8% (90) of those people would no longer have to pay for care, and 27% (308) may have an increase in charges.

·         It was estimated those with increased charges would pay on average £6.03 a week more, there were 28 working age people whose charges could increase by £23 a week, these people would be offered a full review.

·         The aim was to implement the changes on 11^th April 2022 when benefits change to save duplicating work and confusion for service users.

Paul Smith (Acting Director for Adults and Communities, Herefordshire Council) pointed out that a significant amount of work had been done on the consultation, every single person in the system had been contacted in writing, but there had been a disappointingly low response.

The committee noted and commended the depth of the consultation.

The committee raised concerns about the small group of people being impacted adversely, especially those with no capital reserve. The committee felt it would be important to reach out to these individuals and possibly arrange face-to-face meetings with them to discuss the changes.

The committee anticipated that it was likely to hear disproportionately from the 28 individuals paying more and that the option should be available for them to have a face-to-face before they have to pay.

The committee felt the proposals made sense and would benefit most people, but early engagement with those impacted would be vital

The policy needed to be well publicised, with clear communications highlighting the fact that many people would be benefit from the changes.

The committee asked about measures to account for rapidly rising inflation and whether there was a safety net for to accommodate for rising prices and fuel costs.

It was explained that those with income above the minimum benefits will have a small percentage taken back in charges. People of pensionable age who have a savings element to their pension may get a savings credit of approximately £10 a week depending on circumstance.

The committee questioned the mixed use of percentages and statistics throughout the report and suggested using numbers of people (on a consistent basis) instead of percentages, to avoid any ambiguity and confusion.

The committee questioned timescale of letters going out to people and potential anxiety, uncertainty and worry the changes might cause.

The Welfare and Financial Assistant Team Leader explained people would be contacted in April so they are aware of changes before being billed at the end of May. The letters would be personalised and illustrate how much better/worse off  ...  view the full minutes text for item 54.

To review the attached work programme for 2021/22 and the responses to recommendations previously made by the Committee.

The item was timed out and the committee agreed that a work programme session would be held on the earliest convenient date.

The date of the next meeting of the Committee is to be confirmed.

The next scheduled meeting was to be confirmed at the work programme session.