Agenda and draft minutes

The Chairman welcomed all present.

To note any declarations of interest from Councillors. They are asked to indicate the relevant agenda item, the nature of the interest and in particular whether it is a disclosable pecuniary interest.

None.

There was no Chair’s Business.

25 October 2019, to approve as a correct record (attached).

Resolved:  that the minutes of the meeting on 25^th October 2019 be approved subject to the following typographic correction: a reference in Minute 3 to a local hospital be amended to read “Thornbury Hospital”.

To receive written submissions from any person who wishes to address the Committee. (Please see the attached Public Information Sheet). The Chairman will select the order of the matters to be received.

Please ensure that any submissions meet the required time limits and would take no longer than five minutes to read out.

Requests and full statements must be submitted in writing to the Head of Legal and Democratic Services, or to the officer mentioned at the top of this agenda letter, by noon on the day before the meeting.

There were no items referred to the Committee under Public Forum.

For review and agreement: see attached Terms of Reference.
Some minor amendments have been proposed (as highlighted in the text) to reflect developments in the health sector.

Resolved:  that the proposed minor amendments to the Committee’s Terms of Reference, as set out on the agenda, be adopted.

Chris Burton (Medical Director NBT and Chair for the BNSSG Stroke Programme Board) in introducing the presentation on the Stroke programme, emphasised the partnership approach taken to the development of the programme which brought together a diverse range of people around a shared vision for future stroke care in the region. These included: key clinicians; the charitable sector; social care staff and service managers; and people with lived experience.

The presentation was structured around the following four aims:

·       to share progress on the BNSSG Stroke Programme;

Members received an outline of the challenges associated with strokes; the programme vision for stroke care; national evidence; the case for change; the co-design/partnership approach to programme development; and the emergent engagement themes. This part of the presentation also included representation from two participants in the “lived experience group”, whose personal experience had contributed to guiding the development of the programme.  

·       to seek JHOSC feedback on the plan for public consultation;

·       to seek JHOSC feedback on the draft evaluation criteria for decision-making; and

·       to agree how JHOSC would like to engage with the proposals for change once approved for consultation by the BNSSG CCG Governing Body

Before inviting Members comments and queries on the presentation, the Chairman thanked the team for the comprehensive and detailed presentation and particularly welcomed the open and frank contributions from the lived experience group representatives.

The Stroke Programme team responded to Members’ comments and queries as follows:-

a)      Had the team factored-in post-covid issues such as blood clots and other cardiology issues? - These problems presented early and had already been picked up in the programme.

b)      Parish & Town Councils needed to be involved in the consultation, together with local resident groups and the farming community – This would be taken into account;

c)       Would any weighting be attached to the evaluation criteria? – It was likely that a combination of quantitative and qualitative factors would be used in the evaluation. A group had been established, as part of the governance structure, with oversight of the evaluation process.

d)      The clear focus on prevention was welcomed: was this something that BNSSG was leading on or working with Public Health and if so, what would this look like? -  They were still working with partners on this.  It would build on work already going on in Primary Care around, for example, lifestyle, hearty rhythm disturbances, public health lifestyle measures etc).

e)      It made sense for hyperacute services to be focussed where there was expertise but were there any concerns around services being moving away from local hospitals and anticipated difficulties convincing local communities of the need for these changes? - There was a shortage of workforce with the required skills. Clinical evidence and NICE Guidance were that workforce should be consolidated to maximise available skills.  Proposals to move care were necessary if the programme ambitions were to be achieved and they were carefully considering how best to introduce this into the conversation going forward. Where distances were greater such  ...  view the full minutes text for item 7.

Christina Gray (Director of Public Health BCC) and Sara Blackmore (Director of Public Health SGC) presented the report updating Members on the extraordinary work of the Bristol and South Gloucestershire local authorities, local communities and partners around the recent community surge testing and analysis undertaken between 7^th and 15^th February in response to the recent emergence of known variants of concern of the Covid-19 virus in the Bristol and South Gloucestershire areas.

Members noted the following recommendations set out in the report:-

·       that we should expect, and prepare for, the emergence of changes in the virus;

·       that case identification and isolation of case and contacts remains the most important action in containing the virus;

·       that local authorities will need to maintain capacity and capability to support outbreak management and to support individuals to isolate; and

·       that it will continue to be important to support national and global efforts to understand and enable science to “stay ahead” of the virus.  This may well require the collection of additional case samples to support this effort.

Resolved: that the report and recommendations set out above be noted.

Sebastian Habbibi (programme director Healthier Together Partnership) and David Moss (Integrated Care Partnership Discovery Programme Director) presented the report providing an update on the ICS programme.  The report covered:

·       ICS designation and continuing evolution of partnership working;

·       structural implications of the Government white paper: ‘Integration and Innovation: working together to improve health and social care for all;

·       progress on formalising how we will work together through the development of a Memorandum of Understanding; and

·       ICS work at “place” level – the integrated Care Partnership Discovery Programme

Members raised the following points (with responses shown in italics): -

a)    There were considerable uncertainties about: the future shape of the ICS, particularly around social care funding; the role of local authorities and democratic accountability; and the question of whether the Government ends competitive procurement.  The report indicated that further conversations were needed before the legislation was enacted. Were those opportunities being offered by Government/officials? - to some extent yes though the draft bill had not yet been published.  Links were being provided to NHS England officials (on behalf of the Department of Health and Social Care) who had been identified as leading on the development of guidance around key issues such as governance, new financial framework for ICSs,  and workforce development etc.

b)    There were also considerable concerns about budgets and these might be pooled or shared.  It was noted that there were plans for the ICS to be in place as shadow form from April.  How would this happen without clarity on funding? -  the notion of shadow running within April next month specifically related to the Integrated Care Partnerships and providers at “place” level.  This was mostly about reaching an understanding with providers on footprints and the specifics of community mental health.  Assurance was given that there was no expected changes to the current financial regime in the 2021-22 financial year.  At high level, the understanding was that local government would continue to hold statutory responsibility (and funding) for social care and a new ICS body would hold responsibility for Health budgets (expanded to include some of budgets currently held by NHS England, notably budgets for local primary care and some specialised services.

In concluding discussions, a view was put that Members required much more clarity going forward and it was formally requested that regular updates be provided to Members as negotiations progressed.

It was also requested that it be formally noted that, for accountable Councillors serving local residents, there was considerable concern and dissatisfaction with the process as it was currently unfolding.

Before closing the meeting, the Chairman agreed that these concerns be formally recorded in the minutes.