Venue: Council Chamber - Time Square, Market Street, Bracknell, RG12 1JD. View directions
Contact: Kirstine Berry
To approve as a correct record the minutes of the meeting of the Adult Social Care, Health and Housing Overview and Scrutiny Panel meeting held on 15 January 2019.
To review the Actions Log arising from the Minutes, to include an update on the Task & Finish Groups’ progress and to provide an update on any issues arising since the last meeting.
RESOLVED: that the Minutes of the Adult Social Care, Health and Housing Overview and Scrutiny Panel held on 15 January 2019 be approved as a correct record, and signed by the Chairman, subject to Janette Fullwood, Head of Children, Young People’s and Families: East Berkshire Clinical Commissioning Group CCG being recorded as Also Present at this meeting.
Arising from the Actions Log, Kirstine Berry, Governance and Scrutiny Co-ordinator advised Members that several items were awaiting a status update due to the short time lapse between this and the previous Panel meeting, but that any outstanding actions would be followed up and reported against at the next Panel meeting.
There were no Issues Arising since the last meeting on 15 January 2019.
Declarations of Interest and Party Whip
Members are asked to declare any disclosable pecuniary or affected interests and the nature of that interest, including the existence and nature of the party whip, in respect of any matter to be considered at this meeting.
Any Member with a Disclosable Pecuniary Interest in a matter should withdraw from the meeting when the matter is under consideration and should notify the Democratic Services Officer in attendance that they are withdrawing as they have such an interest. If the Disclosable Pecuniary Interest is not entered on the register of Members interests the Monitoring Officer must be notified of the interest within 28 days.
Any Member with an Affected Interest in a matter must disclose the interest to the meeting. There is no requirement to withdraw from the meeting when the interest is only an affected interest, but the Monitoring Officer should be notified of the interest, if not previously notified of it, within 28 days of the meeting.
There were no declarations of interest relating to any items on the agenda, nor any indication that Members would be participating under the party whip.
Urgent Items of Business
Any other items which, pursuant to Section 100B(4)(b) of the Local Government Act 1972, the Chairman decides are urgent.
There were no urgent items of business.
To receive submissions from members of the public which have been submitted in advance in accordance with the Council’s Public Participation Scheme for Overview and Scrutiny.
No submissions had been made by members of the public under the Council’s Public Participation Scheme for Overview and Scrutiny.
Catriona Khetyar: Head of Medicines Optimisation: East Berks Clinical Commissioning Group (CCG) to provide an update on the provision of the Freestyle Libre, flash glucose monitoring system to Type 1 diabetic patients within the Borough of Bracknell Forest.
Catriona Khetyar, Head of Medicines Optimisation: East Berkshire Clinical Commissioning Group (CCG) attended the Panel and explained the commissioning position on the provision of the Freestyle Libre, flash glucose monitoring system for Type 1 diabetics and explained that:
· The current prescribing recommendation was on the public website. https://www.eastberkshireccg.nhs.uk/wp-content/uploads/2018/06/EPPG-policy-22-Freestyle-Libre.pdf
· Freestyle Libre was the first flash glucose monitor on the market, others were in the pipeline.
· It had been possible to recharge the National Health Service (NHS) for Freestyle Libre since Nov 2017.
· The Clinical Commissioning Group (CCG) had taken time to consider the evidence surrounding the use of Freestyle Libre and they had balanced the clinical and cost effectiveness evidence available at the time.
· Concerns had been raised about the limited available evidence base surrounding this new technology.
· The National Institute for Clinical Excellence (NICE) information MedTech Innovation Briefing, at the point of CCG review did not mandate its use as a NICE Technology Appraisal would.
· At the point of review, there was no NICE Technology Appraisal in progress.
· The CCG had also discussed patient experiences and, although anecdotal evidence, they had been noted.
· At the time of evaluating, the CCG had considered that, on balance, Freestyle Libre would not be recommended for prescribing down to a lack of data on proven clinical benefit and lack of cost versus benefit evidence.
· The CCG agreed to revisit and review that decision again in April 2019.
· Last November, NHS England (NHSE) announced that the Freestyle Libre flash glucose monitoring system would be made available to Type 1 diabetic patients. The CCG welcomed that announcement.
· Prior to the announcement by NHS England on 14 November 2018 Freestyle Libre had been considered by NHSE Regional Medical Optimisation Committees (RMOC), these are advisory bodies only.
· Flash glucose monitoring systems had been mentioned in the NHS long term plan.
· The CCG was working in partnership with all health organisations in the Frimley Integrated Care System (ICS) to agree consistency in provision and an agreed process to ensure equity of access from 01 April 2019.
· NHS England (NHSE) still needed to provide clarity as to which Type 1 diabetic patients Flash Glucose Monitoring systems should be made available for.
· The CCG was working to the current RMOC statement and will amend if necessary in line with awaited NHSE criteria.
Following questions from Members, Catriona Khetyar, Head of Medicines Optimisation: East Berkshire Clinical Commissioning Group (CCG) advised that:
· The RMOC Freestyle Libre position statement looked at Type 1 diabetics who were testing 8 or more times a day. The exact numbers of patients locally were difficult to identify, but it was in the hundreds when test strip usage was looked at.
· Some patients were looked after by hospital specialists, some were cared for in community by GPs,
· There was no definitive number as to how many patients Freestyle Libre would be used by. To try to gauge the estimated usage, some numbers had been worked through in collaboration with clinicians locally.
· NHS England had made an announcement but hadn’t ... view the full minutes text for item 49.
Update on Heathlands
Executive Member for Adult Services, Health and Housing to provide an update on Heathlands.
Councillor Dale Birch, Executive Member for Adult Services, Health and Housing attended the Panel and provided an update on the development of Heathlands. It was explained that:
· Heathlands was going to be a care home with 66 beds for elderly and mentally infirm (EMI) patients who needed nursing care.
· One of the drivers behind the project was to have this kind of facility locally available as Bracknell Forest did not have one currently.
· Members were aware that the Council was working with Frimley Health and the East Berkshire CCG in order to design and fund Heathlands.
· The planning layout had come up against planning rules and regulations and had had to be redesigned.
· On the back of the redesign, the business case had been re-evaluated. The re-evaluation of the business case with all partners had concluded today (4 February 2019).
· The business case was sound. Funding sources would be identified and a paper would be brought to the Executive on 12 March 2019 to outline the business case and from that all the decisions and governance arrangements in the party organisations could be set up to approve the project.
· It was hoped that Heathlands would become a reality later in 2019 when work started.
· It was hoped that in 2020 the first residents would be welcomed into Heathlands.
· It was hoped that a patient’s stay at Heathlands would only be as a staging post on their way to homebased support or on into other localities.
· It would enable patients to take advantage of the facility in the Borough so that out of Borough placements would be reduced providing cost and quality control to Bracknell Forest Council.
· It was hoped Heathlands would be a model for future shared resourcing working with the health services in terms of pooling resources and people.
In response to questions from Members, Councillor Dale Birch, Executive Member for Adult Services, Health and Housing explained that:
· During the planning process, at the pre-application stage, the aspect of the building was not liked and that hurdle still had to be overcome.
· Heathlands was a 66 bed care home and it was planned for individual occupancy. There were no partner facilities.
· Heathlands was for elderly and mentally infirm (EMI) patients, not residential for dementia care.
· The item IO81949 in the Executive Work Programme entitled Proposal for an Integrated and Delegated Continuing Health Care Service Across East Berkshire was not related to Heathlands.
· Community Health Care was funded by the Council. The Council had a pilot to look at the integration of continuing health care and community healthcare, item IO81949 in the Executive Work Plan referred to that. Currently Heathlands was not part of the pilot project. In future there would be patients in Heathlands that would come under integrated continuing health care, but this was a pilot project currently. Ultimately, Heathlands should be included.
· The business case for Heathlands was a separate business case. Eventually continuing health care and Heathlands would get pulled together. Heathlands stood on its own ... view the full minutes text for item 50.
To provide the Panel with an update on the Family Safeguarding Model with an emphasis on adults.
Mairead Panetta, Head of Service: Safeguarding attended the Panel and provided a presentation that updated the Panel on the Family Safeguarding Model.
Further to the presentation, Mairead Panetta, Head of Service: Safeguarding advised the Panel that:
· The Family Safeguarding Model (FSM) had been launched in October 2017 in Bracknell Forest and it followed the successful model used in Hertfordshire.
· Bracknell Forest had taken the FSM wholesale from the Hertfordshire programme.
· The Multi-disciplinary team had been established in a staggered fashion and the last member had been appointed in July 2018.
· The multi-disciplinary workers had a range of skills to engage with the parents.
· Motivational Interviewing (MI) was a really important part of FSM. MI was a motivating conversation approach which used empathy and a collaborative style and was just one of the tools they used.
· The whole team had received MI training from an external trainer and they had monthly MI workshops with staff which featured a ‘MI technique of the week’ which kept the technique front of mind.
· The 8 module parent intervention programme had been trained by external trainers, and provided around 50 tools they could use with families.
· Families liked the approach with tailored interventions.
· Further training was being planned using in house trainers and would be offered to all staff going forwards.
· The final element was the recording system which had been supplied at no extra cost and was implemented in June 2018. The workbook was being tested with staff and the plan was to disseminate the workbook across teams in the future.
Further to the initial results of the FSM data provided in the presentation, Mairead Panetta, Head of Service: Safeguarding, verbally provided the Panel with some updated figures (to December 2018) which illustrated the results of the FSM. These were:
· Child Protection Plans reduced from 151 from the end of October 2017 to 109 by the end of December 2018 (reduction of 29.5%)
· Rate of children becoming Looked After reduced by 30.4% from the end of October 2017 to 109 end of December 2018
· 35.7% reduction in care proceedings in the two FSM teams (42 families January 2018 to 26 in December 2018)
· 34% reduction in children going missing (April to December 2017 compared to April to December 2018)
· 65% reduction in pre-proceedings (26 families September 2017 to 9 end of December 2018)
Mairead Panetta, Head of Service: Safeguarding further explained to the Panel that:
· York Consulting had been appointed to assess the quality of practice. They had evaluated by conducting surveys, focus groups, met families and conducted an annual survey.
· Feedback was encouraging and clients were very positive about the FSM.
· It was estimated that it would take about 3 years for MI to become fully established so that everyone was comfortable with using it.
· Adult workers met parents’ needs with a better co-ordinated service and could deal with issues such as alcohol addiction etc. better.
· Direct work with children had always been done in Bracknell Forest, but this was now being broadened ... view the full minutes text for item 51.
To outline the cold weather provisions for rough sleepers and to provide an update on the Severe Weather Emergency Protocol (SWEP).
Ellie Eghtedar, Interim Head of Housing attended and provided Panel Members with an introduction to the cold weather provisions and the Severe Weather Emergency Protocol (SWEP) within Bracknell Forest. In addition to the presentation, the Panel were advised that:
· There were 5 new agencies that had taken part in the estimated rough sleeper count
· The estimated count had taken place on the night of 14 Nov 2018 to the morning of 15 Nov 2018.
· The estimated rough sleeper count was used to devise the SWEP.
· The rough sleeper count within Bracknell Forest was estimated at 19 people.
· Extra funding had been secured from the Ministry of Housing, Communities and Local Government of £35,000 to provide the cold weather fund.
· What does it look like?
· The SWEP was not a statutory requirement. Best practice was that SWEP would be activated by a weather forecast predicting 3 consecutive nights or more of temperatures below zero degrees Celsius
· Bracknell Forest SWEP had enhanced this recommendation and was activated by a weather forecast predicting 2 consecutive nights or more of temperatures below zero degrees Celsius.
· Notifications were sent out to all agencies involved when SWEP was activated so they could refer rough sleepers to the emergency duty service or the welfare and housing team to provide accommodation.
· The categorisation of a person who was a rough sleeper did not include those who were ‘sofa surfing’.
· SWEP was provided to persons regardless of priority need and persons did not need to be eligible.
· The Homelessness Reduction Act meant those who needed assistance were identified earlier and personalised housing plans could be developed for those who met the threshold.
· There was closer working with partners which had meant early identification of support needs for people and vulnerabilities could be identified a lot sooner.
· The Homelessness Reduction Act had introduced a legal threshold for personalised housing plans to those threatened with homelessness or already homeless.
· The enhancement of SWEP in Bracknell in 2018/19 meant that those sleeping rough did not need to rely on the night shelter as the only provision for SWEP, however SWEP was not a statutory requirement.
· If an individual’s support needs were assessed as high, individual accommodation could be provided.
· A sustainability plan was also identified for those who were being helped.
· A Specialist Housing Officer was being recruited to support the sustainability plan and would be in post February 2019.
· Under the sustainability plan, a Welfare and Housing Case Worker or Specialist Housing Officer made contact with those in the night shelter or B&B accommodation to secure more permanent accommodation and support.
· They worked closely with the police, Community Mental Health Team and Drugs, Alcohol and Addiction Team (DAAT).
· They advised partners of the legislative framework.
In response to questions from Members, Ellie Eghtedar, Interim Head of Housing advised that:
· The rough sleeper count of 19 was an estimate made on one day and only a snapshot.
· A personalised housing plan was done for each person who approached the ... view the full minutes text for item 52.
To consider scheduled Executive Key and Non-Key Decisions relating to Adult Social Care, Health and Housing.
There was one item for consideration: IO81949, Proposal for an Integrated and Delegated Continuing Health Care Service Across East Berkshire.
There were no questions from Members.
Date of Next Meeting
The next meeting of the Adult Social Care, Health and Housing Panel has been scheduled for 26 March 2019.
The next meeting of the Adult Social Care, Health and Housing Overview and Scrutiny Panel has been scheduled for 26 March 2019.