Health and Wellbeing Select Committee

Date: Wednesday, 27th September, 2017 Time: 10.00 am Venue: Council Chamber - Guildhall, Bath

Councillor Francine Haeberling Councillor Geoff Ward Councillor Bryan Organ Councillor Eleanor Jackson Councillor Tim Ball Councillor Lin Patterson Councillor Lizzie Gladwyn

Mark Durnford Democratic Services Lewis House, Manvers Street, Bath, BA1 1JG Telephone: 01225 394458 Web-site - http://www.bathnes.gov.uk E-mail: [email protected] NOTES: 1. Inspection of Papers: Papers are available for inspection as follows:

Council’s website: https://democracy.bathnes.gov.uk/ieDocHome.aspx?bcr=1

Paper copies are available for inspection at the Public Access points:- Reception: Civic Centre - Keynsham, Guildhall - Bath, The Hollies - Midsomer Norton. Bath Central and Midsomer Norton public libraries.

2. Details of decisions taken at this meeting can be found in the minutes which will be circulated with the agenda for the next meeting. In the meantime, details can be obtained by contacting as above.

3. Recording at Meetings:-

The Openness of Local Government Bodies Regulations 2014 now allows filming and recording by anyone attending a meeting. This is not within the Council’s control.

Some of our meetings are webcast. At the start of the meeting, the Chair will confirm if all or part of the meeting is to be filmed. If you would prefer not to be filmed for the webcast, please make yourself known to the camera operators.

To comply with the Data Protection Act 1998, we require the consent of parents or guardians before filming children or young people. For more information, please speak to the camera operator.

The Council will broadcast the images and sound live via the internet www.bathnes.gov.uk/webcast An archived recording of the proceedings will also be available for viewing after the meeting. The Council may also use the images/sound recordings on its social media site or share with other organisations, such as broadcasters.

4. Public Speaking at Meetings

The Council has a scheme to encourage the public to make their views known at meetings. They may make a statement relevant to what the meeting has power to do. They may also present a petition or a deputation on behalf of a group. They may also ask a question to which a written answer will be given. Advance notice is required not less than two full working days before the meeting. This means that for meetings held on Thursdays notice must be received in Democratic Services by 5.00pm the previous Monday. Further details of the scheme: https://democracy.bathnes.gov.uk/ecCatDisplay.aspx?sch=doc&cat=12942

5. Emergency Evacuation Procedure

When the continuous alarm sounds, you must evacuate the building by one of the designated exits and proceed to the named assembly point. The designated exits are signposted. Arrangements are in place for the safe evacuation of disabled people.

6. Supplementary information for meetings

Additional information and Protocols and procedures relating to meetings https://democracy.bathnes.gov.uk/ecCatDisplay.aspx?sch=doc&cat=13505 Health and Wellbeing Select Committee - Wednesday, 27th September, 2017

at 10.00 am in the Council Chamber - Guildhall, Bath

A G E N D A

1. WELCOME AND INTRODUCTIONS

2. EMERGENCY EVACUATION PROCEDURE

The Chair will draw attention to the emergency evacuation procedure as set out under Note 6.

3. APOLOGIES FOR ABSENCE AND SUBSTITUTIONS

4. DECLARATIONS OF INTEREST

At this point in the meeting declarations of interest are received from Members in any of the agenda items under consideration at the meeting. Members are asked to indicate: (a) The agenda item number in which they have an interest to declare. (b) The nature of their interest. (c) Whether their interest is a disclosable pecuniary interest or an other interest, (as defined in Part 2, A and B of the Code of Conduct and Rules for Registration of Interests) Any Member who needs to clarify any matters relating to the declaration of interests is recommended to seek advice from the Council’s Monitoring Officer or a member of his staff before the meeting to expedite dealing with the item during the meeting.

5. TO ANNOUNCE ANY URGENT BUSINESS AGREED BY THE CHAIRMAN

6. ITEMS FROM THE PUBLIC OR COUNCILLORS - TO RECEIVE DEPUTATIONS, STATEMENTS, PETITIONS OR QUESTIONS RELATING TO THE BUSINESS OF THIS MEETING

At the time of publication no notifications had been received.

7. MINUTES - 19TH JULY 2017 (Pages 7 - 24) 8. CLINICAL COMMISSIONING GROUP UPDATE

The Select Committee will receive an update from the Clinical Commissioning Group (CCG) on current issues.

9. CABINET MEMBER UPDATE

The Cabinet Member will update the Select Committee on any relevant issues. Select Committee members may ask questions on the update provided.

10. PUBLIC HEALTH UPDATE

Select Committee members are asked to consider the information presented within the report and note the key issues described.

11. HEALTHWATCH UPDATE

Select Committee members are asked to consider the information presented within the report and note the key issues described.

12. UPDATE ON THE TRANSFER OF SERVICES FROM THE RNHRD TO THE RUH (ADULT FATIGUE) (Pages 25 - 50)

This paper has been prepared to ensure that the B&NES Health and Wellbeing Select Committee are kept up-to-date with the proposed relocation of the Royal National Hospital for Rheumatic Diseases (RNHRD) Bath Centre for Fatigue Service (BCFS) from the Mineral Water Hospital site to a purpose built RNHRD and Therapies Centre on the RUH’s Combe Park site.

13. MENTAL HEALTH PATHWAY REVIEW (Pages 51 - 58)

In line with the Your Care, Your Way full business case, the Mental Health Pathway is currently being reviewed by commissioners. This report provides an update on that review with particular focus on key themes which have emerged during the engagement phase.

14. CARE HOME PROVISION (Pages 59 - 64)

This paper provides a briefing on the care homes market in Bath & North East Somerset (B&NES). It offers an overview of the quality and supply in current provision as well as introducing some key gaps and challenges in the sector.

15. SELECT COMMITTEE WORKPLAN (Pages 65 - 68)

This report presents the latest workplan for the Select Committee. Any suggestions for further items or amendments to the current programme will be logged and scheduled in consultation with the Chair of the Select Committee and supporting officers.

The Committee Administrator for this meeting is Mark Durnford who can be contacted on 01225 394458. This page is intentionally left blank Agenda Item 7 BATH AND NORTH EAST SOMERSET

HEALTH AND WELLBEING SELECT COMMITTEE

Wednesday, 19th July, 2017

Present:- Councillors Francine Haeberling (Chair), Geoff Ward, Bryan Organ, John Bull (in place of Eleanor Jackson), Tim Ball, Lin Patterson and Lizzie Gladwyn

Also in attendance: Jane Shayler (Deputy Director of Adult Care, Health and Housing Strategy and Commissioning), Bruce Laurence (Director of Public Health), Dr Ian Orpen (Clinical Chair, B&NES CCG), Alex Francis (Healthwatch B&NES Project Coordinator) and Sue Blackman (Your Care, Your Way Programme Manager)

15 WELCOME AND INTRODUCTIONS

The Chair welcomed everyone to the meeting. On behalf of the Select Committee she wished to send Councillor Eleanor Jackson their best wishes for a speedy recovery.

16 EMERGENCY EVACUATION PROCEDURE

The Chair drew attention to the emergency evacuation procedure.

17 APOLOGIES FOR ABSENCE AND SUBSTITUTIONS

Councillor Eleanor Jackson had sent her apologies to the Select Committee and Councillor John Bull was present as her substitute for the duration of the meeting.

18 DECLARATIONS OF INTEREST

There were none.

19 TO ANNOUNCE ANY URGENT BUSINESS AGREED BY THE CHAIRMAN

There was none.

20 ITEMS FROM THE PUBLIC OR COUNCILLORS - TO RECEIVE DEPUTATIONS, STATEMENTS, PETITIONS OR QUESTIONS RELATING TO THE BUSINESS OF THIS MEETING

Adam Reynolds addressed the Select Committee. A copy of his statement can be found online as an appendix to these minutes and on the Panel’s Minute Book, a summary is set out below.

There is much that people can do individually to protect their health including driving safely, avoiding tobacco smoke and air pollution, exercising regularly and having regular check-ups. But many health risks are also influenced by community factors, including transportation and land use planning decisions.

15 Health and Wellbeing Select Committee- Wednesday, 19th July, 2017 Page 7 Transport, in particular, affects health in various ways. Transport policies and planning decisions affect rates of cancer, cardiovascular disease and traffic collisions. Three of the largest causes of reduced longevity in the UK and can also affect people’s ability to access health-related goods and services such as food and health care.

I feel that B&NES Highways and Planning departments are biased in various ways that stimulate automobile dependency. There are many justifications for reforms to the approach Highways takes that will create more efficient and diverse transport systems, of which improving public health should be the primary factor in their design and decision making process.

Will the Committee consider making public health a core remit of the Highways and Planning departments?

Councillor Vic Pritchard, Cabinet Member for Adult Care, Health & Wellbeing replied that it was his responsibility together with colleagues in the Public Health team to oversee such matters. He added that the Health & Wellbeing Board had recently been reconfigured cover the elements raised.

He said that it was integral to the decision making process and he assured the Select Committee that discussions do take place between himself and the Cabinet Member for Transport and Highways and the Cabinet Member for Development.

Adam Reynolds commented that he felt that some schemes were still completed in isolation and he gave the example of the Two Headed Man junction.

Councillor Pritchard replied that the measures put in place at this particular site were designed to prevent congestion as the road is used by very few cyclists.

The Chair thanked Adam Reynolds for his statement on behalf of the Select Committee.

21 MINUTES - 24TH MAY 2017

Councillor John Bull asked a question on behalf of Councillor Eleanor Jackson. He said that she was still seeking a response to a question raised at a previous meeting in relation to the consistency of procedures and appointments at the RUH.

Councillor Vic Pritchard replied that if a little further information could be provided he would take it direct to the RUH as he sits as a member of their Board.

The Select Committee confirmed the minutes of the previous meeting as a true record and they were duly signed by the Chair.

22 CLINICAL COMMISSIONING GROUP UPDATE

Dr Ian Orpen addressed the Select Committee. A copy of the update can be found on their Minute Book and as an online appendix to these minutes, a summary of the update is set out below.

16 Health and Wellbeing Select Committee- Wednesday, 19th July, 2017 Page 8 A&E performance

Local system performance appears to have improved in June with 91 per cent of patients seen in A&E within the four hour target wait. Performance this month (as at 14/07/17) currently stands at 92.6 per cent. Both the June and July figures do require further validation.

Quarter one review with NHS England

We met with NHS England on 3 July to review our position at the end of the first quarter of 2017/18.This session included a detailed review of what we are doing in relation to diabetes care and childhood obesity as well as progress on our Financial Recovery Plan.

We have self-assessed ourselves using the CCG Improvement, Assurance & Assessment Framework. We continue to self- assess ourselves as ‘good’ in two out of the four domains and as ‘requires improvement’ against the ‘Better Care’ area (this reflects current performance issues against a number of NHS Constitution targets) and against ‘Sustainability’ due to the CCG’s financial position.

New Director of Nursing and Quality announced

We are pleased to announce that Lisa Harvey will be joining us as our new Director of Nursing and Quality after Dawn Clarke left for a new role in Shropshire. Lisa will officially join us from the 4 September 2017. She is currently working at South Gloucestershire CCG where she has been the Deputy Nurse Director since 2013.

Mental Health Pathway Review

We are working with Bath and North East Somerset Council to carry out a review of community mental health services between May – October 2017.

We will be engaging with a wide range of groups and individuals over the coming weeks, and will use this information, along with other research, to develop a set of models for future community mental health services. As part of our engagement, we have created a survey for those who provide services, people who use services, and those who care for them.

Preferred provider selected for urgent care services across B&NES, Swindon and Wiltshire

Medvivo has been selected to the preferred provider stage of a procurement process to run integrated urgent care services across Bath and North East Somerset (B&NES), Swindon and Wiltshire. The healthcare provider, which has very recently been rated as ‘Outstanding’ by CQC, will be the lead provider, working in collaboration with Vocare and B&NES Enhanced Medical Services (BEMS+).

If awarded the contract in the autumn, Medvivo will be responsible for running the NHS111 service across B&NES, Swindon and Wiltshire, developing the service model so callers can be put through to a ‘clinical hub’ of experienced health

17 Health and Wellbeing Select Committee- Wednesday, 19th July, 2017 Page 9 professionals who can make assessments and advise and arrange urgent care if required.

In collaboration with Swindon and Wiltshire CCGs and Wiltshire Council we are following a detailed and robust procurement process, with sharp focus on the requirement for innovation and continued development of services.

School project to raise antibiotic awareness wins national award

A local campaign to raise awareness of the importance of using antibiotics appropriately has won in the Community Engagement category of this year’s national Antibiotic Guardian awards.

The campaign – led by the CCG and B&NES Council with the support of Sirona Care and Health, local public health representatives and national and international science educators – saw Year 3 pupils design posters showing how to wash your hands, catch your sneezes and make sure you take antibiotics properly.

The awards were hosted in London by Antibiotic Guardian, a Public Health England campaign that was set up in 2014 to raise awareness among the general public of the very real threat posed by antimicrobial resistance – resistance to antibiotics.

New ambulance service standards

The new targets will save lives and remove “hidden” and long waits suffered by millions of patients, including reducing lengthy waits for the frail and elderly. The new system is backed by the Association of Ambulance Chief Executives, the Royal College of Emergency Medicine, the Stroke Association and the British Heart Foundation amongst others.

The redesigned system will focus on ensuring patients get rapid life-changing care for conditions such as stroke rather than simply “stopping the clock”. Currently one in four patients who need hospital treatment – more than a million people each year – undergo a “hidden wait” after the existing 8 minute target is met because the vehicle despatched, a bike or a car, cannot transport them to A&E.

Ambulances will now be expected to reach the most seriously ill patients in an average time of seven minutes. The ‘clock’ will only stop when the most appropriate response arrives on scene, rather than the first.

This will free up more vehicles and staff to respond to emergencies. Currently, three or even four vehicles may be sent to the same 999 call to be sure of meeting the 8 minute target, meaning that across the country one in four are stood down before reaching their destination.

The Chair commented that she would like to give some suggestions as to how access and information could be improved at the RUH Accident & Emergency service.

Dr Orpen asked that she email them to him.

18 Health and Wellbeing Select Committee- Wednesday, 19th July, 2017 Page 10 Councillor Geoff Ward suggested that additional signage be put in place within the triage area to explain the process.

Councillor Bryan Organ asked what was hoped to be gained by selecting Medvivo as the preferred provider of integrated urgent care services.

Dr Orpen replied that it is intended to provide an improvement of service and bring together the elements of urgent care and the NHS 111 service which are currently separate.

Councillor Tim Ball asked for further information relating to consultation about the urgent care service provision.

Dr Orpen replied that consultation has taken place on the matter and that the Select Committee itself had received previous briefings on the subject. He added that Your Health, Your Voice had taken part in the process and provided feedback.

The Director for Integrated Health & Care Commissioning added that it is not seen as a significant change to the format of the service and that informal engagement has taken place with service user groups.

Councillor Vic Pritchard, Cabinet Member for Adult Care, Health & Wellbeing stated that he was well aware of the process that had taken place so far.

Alex Francis, Team Manager - Healthwatch B&NES and Healthwatch South Gloucestershire commented that further discussions could take place with patients suffering from chronic conditions.

The Chair thanked Dr Orpen for the update on behalf of the Select Committee.

23 CABINET MEMBER UPDATE

Councillor Vic Pritchard, Cabinet Member for Adult Care, Health & Wellbeing addressed the Select Committee. A copy of the update can be found on their Minute Book and as an online appendix to these minutes, a summary of the update is set out below.

Better Care Fund (BCF) 2017-19 Guidance

On the 4th July 2017, NHS England, the Department of Health (DH) and Department of Communities and Local Government (DCLG) announced the publication of the Integration and BCF planning requirements for 2017-19. The document sets out the detailed requirements for plans based on the 2017-19 Integration and BCF policy framework published on 31st March 2017.

In B&NES, planning for the Better Care Fund has been underway for some time and the plan will now be finalised over the summer with the aim of being signed off by the Health and Wellbeing Board in early September before the submission deadline of 11th September 2017.

He stated that funding for Adult Social Care will require cross party support.

19 Health and Wellbeing Select Committee- Wednesday, 19th July, 2017 Page 11 AT- Home Project

The Council has been awarded £50,000 from the LGA to develop the use of Assistive Technology (AT) within the reablement services in B&NES.

Our adult social care pathway is focused on reducing the need for complex health and social care interventions. Within this, our integrated reablement and rehabilitation service provides therapy and support for adults in their home environment enabling them to maintain or regain their independence.

With a range of AT tools, we will pilot a variety of apps and devices, identifying those delivering the most benefits. Where we identify gaps in the market we will use the knowledge and enthusiasm of Bath:Hacked, our Council/community initiative that uses open data and smart thinking to benefit our residents, to generate new ideas and prototypes.

The project is expected to complete in March 2018.

Councillor John Bull said that he agreed with the comment made referring to cross party support for Adult Social Care. He asked on behalf of Councillor Eleanor Jackson for the Select Committee to carry out some scrutiny work in relation to Care Homes.

Councillor Pritchard replied that this request would be subject to available resources, both monetary and officer time.

The Chair commented that Care Homes are regularly inspected by the CQC and would not want to replicate their work.

Councillor Bull said that the work would relate more to levels of provision that are currently available and planned for the future.

The Director for Integrated Health & Care Commissioning said that a report could come to a future meeting of the Select Committee that would address the challenges of the Home Care market.

The Chair thanked Councillor Pritchard for his update on behalf of the Select Committee.

24 PUBLIC HEALTH UPDATE

Dr Bruce Laurence addressed the Select Committee. A copy of the update can be found on their Minute Book and as an online appendix to these minutes, a summary of the update is set out below.

Council to take Time to Change Employers Pledge

Bath and North East Somerset Council is in the process of working towards taking the Time to Change Employers Pledge. By signing the pledge the Council is demonstrating a commitment to change how we think and act about mental health in

20 Health and Wellbeing Select Committee- Wednesday, 19th July, 2017 Page 12 the workplace and make sure that employees who are facing mental health problems feel supported.

We are aiming to sign the Pledge on World Mental Health Day 10th October 2017 and are planning some media promotion to surround it.

Adopting HarmLess as an approach to supporting young people who self- harm

In Autumn 2017 we will be replacing the existing Multiagency Guidance for Staff Working with Young People who Self-harm with a new web based support resource called HarmLess. Created by Child and Adolescent Mental Health Services (CAMHS) colleagues at Oxford Health, HarmLess provides more comprehensive information and links as well as an assessment tool designed and trialled for used by teachers / youth workers/ GPs etc.

Family Nurse Partnership Service

The FNP service delivers a licensed, evidence-based home visiting intervention for first time vulnerable younger mothers from 16 weeks in their pregnancy up until the child’s 2 year review.

The team consists of one full time supervisor with a maximum caseload of 5 and 4 (0.8WTE) family nurses with a case load of 18 families each, and there is one vacancy currently.

There has been a reduction in teenage pregnancies locally, and consequent reduction in notifications of under-19s to FNP. In agreement with the National FNP Unit B&NES have extended the eligibility criteria to include under-25s with 2 additional vulnerability factors. For 4 months the service did not see any increase in notifications, which raised the issue of how women are identified as vulnerable in early pregnancy and how they are signposted to early help services. Many of the women identified are in their second time pregnancies.

Domestic abuse: Some successes with funding

Approximately £270k over 3 years funding has been secured for Home Office transformation fund for domestic abuse services. This provides additional prevention work in the community, a youth based domestic abuse awareness programme and enhanced provision for survivors of domestic abuse with complex needs.

This is in addition to:

£100k from DCLG over 2 years for enhanced resettlement services 40k for two years from St. John’s Hospital to Southdown for support to low and medium risk cases.

A successful Avon-wide, police-led bid to support our MARAC process (MARAC being Multi-Agency Risk Assessment Conference), which manages cases in the community.

21 Health and Wellbeing Select Committee- Wednesday, 19th July, 2017 Page 13 But… the situation for our domestic abuse services is still very fragile with a severe lack of mainstream recurrent funding from the Council and NHS, leaving a number of key services vulnerable to ending next year.

NHS Health Checks

Over 6,500 people in B&NES took up the offer of a free NHS Health Check during 16/17. Our outreach service have been visiting workplaces to encourage more men and younger people to have a health check and over the course of the year they have worked with employers such as Rotork, Horstman, the Royal United Hospital and Bath Taxi drivers (in partnership with our colleagues in Public Protection).

The B&NES NHS Health Check programme benchmarks extremely well against national and regional comparators. We rank 15/152 local authorities for our performance on offers made for a health check (99.3% of the eligible population in B&NES have now been offered a check) and 18/152 for our performance on the proportion of people who have received a health check (49.9%). Over the coming year we will be working with Virgin Care to continue to look at how we can increase the uptake of checks amongst those living in our more disadvantaged neighbourhoods

Councillor Lin Patterson asked what provision is in place for women who are violently abused by their husbands.

Dr Bruce Laurence replied that provision is available at the Southside Centre, but this can become stretched on occasions. He added that it should be acknowledged that domestic abuse can also be female on male, male on male and female on female.

Councillor Lizzie Gladwyn asked what age level was covered by the work and support for young people who self-harm.

Dr Bruce Laurence replied that he was not sure and that he would find out.

Councillor Tim Ball commented that he was concerned that paediatricians were not diagnosing initial signs of mental health in children and that this could to problems further down the line.

Dr Bruce Laurence replied that he would be happy to have a further conversation with Councillor Ball outside the forum of the Select Committee.

The Chair thanked Dr Laurence for his update on behalf of the Select Committee.

25 HEALTHWATCH UPDATE

Alex Francis, Team Manager - Healthwatch B&NES and Healthwatch South Gloucestershire addressed the Select Committee. A copy of the update can be found on their Minute Book and as an online appendix to these minutes, a summary of the update is set out below.

NHS Quality Accounts

22 Health and Wellbeing Select Committee- Wednesday, 19th July, 2017 Page 14 During quarter one, Healthwatch B&NES undertook its role to receive, review and respond to the NHS Quality Accounts. These reports, which are published annually, capture the work that NHS providers are carrying out to improve the quality of care and treatment that they provide.

Healthwatch B&NES responded to five Quality Accounts during this period, including:  Royal United Hospitals Bath NHS Foundation Trust  Avon and Wiltshire Mental Health Partnership NHS Trust  Arriva Transport Solutions Limited  Care UK  South West Ambulance Service NHS Foundation Trust

Healthwatch will arrange to meet with providers throughout the year to seek updates on the work that is being carried out and track their progress. It is hoped that a closer working relationship with NHS providers around the Quality Accounts will enable Healthwatch to have a stronger understanding of the improvements that are being made locally, and the impact that patients can expect to see in the services that they receive.

Work plan: Healthwatch B&NES 2017/18

In March 2017, the Healthwatch B&NES advisory group met to discuss the project’s work priorities for the year. Based upon feedback received from local residents and Healthwatch champions during the past 12 months; intelligence gathered by Healthwatch representatives and staff at meetings and boards; and consideration of the strategic priorities for health and wellbeing in B&NES, the following topics have been selected for staff and volunteers to focus on:

 Mental Health  Accessible Information Standard (AIS)  Urgent Care  Sustainability and Transformation Plan (STP)

New Healthwatch B&NES team

Following some staff changes at The Care Forum during April and May, I am pleased to announce a new member of the team, Dan Hull, who is joining us as Healthwatch B&NES engagement officer. Dan will work alongside me and Pat Foster (Volunteer Support Officer) to engage with the public, gather their views on local services, and help to promote the project and its role as an independent voice for local people.

Councillor Tim Ball asked what help can be given to members of the public who have autism and have difficulty in accessing information.

Alex Francis replied that she had had a recent conversation with a member of the public in South Gloucestershire on this matter and acknowledged that it is a difficult

23 Health and Wellbeing Select Committee- Wednesday, 19th July, 2017 Page 15 area to know where to signpost people. She added that she thought that within B&NES there was an Autism Planning Group.

The Director of Integrated Health & Care Commissioning said that she would see what further information was available locally.

Councillor Bryan Organ asked the purpose of scrutinising the Arriva Transport Solutions Quality Account.

Alex Francis replied that they provide Non-Emergency Patient Transport.

The Chair thanked Alex Francis for the update on behalf of the Select Committee.

26 YOUR CARE YOUR WAY UPDATE - HEALTH AND SOCIAL CARE COMMUNITY SERVICES : 100 DAY REPORT

The YCYW Community Services Programme Lead introduced this item to the Select Committee. She stated they were confident that the process had gone well in the majority of areas. She said that Virgin Care are now operating under as business as usual state. She asked for the Select Committee to consider what future reporting process it would like to establish.

Jayne Carroll, Virgin Care highlighted some of the key issues that had been identified since the beginning of the contract.

Staff Pay

During the first pay run following the transfer in April Virgin Care reported that all 1,300 colleagues who had transferred were paid successfully with only a few issues raised.

During the May pay run the vast majority of colleagues received salary payments in full but a proportion of Virgin Care colleagues, those who received increments or who were undertaking additional, hourly-paid work experienced an issue with their pay. Virgin Care took immediate action to swiftly resolve these issues.

Virgin Care reports that the most recent pay run in June was successful and no further issues are anticipated.

Bank Staff

At the time of transfer it was not possible to migrate the Bank Solution from Sirona Care and Health to Virgin Care, it was recognised that there was a risk to both operational safety and agency costs on an ongoing basis.

Virgin Care undertook a proactive campaign to recruit bank staff and this has resulted in 250 members joining the bank and Virgin Care are undertaking a number of actions to support this; to continue the successful recruitment campaigns, to put in some additional resource to support bank allocation and additionally to implement a new IT software package for arranging and booking bank so staff find it easier to identify and post shifts they need to fill via bank.

24 Health and Wellbeing Select Committee- Wednesday, 19th July, 2017 Page 16 Virtual Desktop and Network Roll Out

As part of its 100 day plan, Virgin Care has undertaken a complete replacement of the IT infrastructure used by the services they deliver. This project lays the foundations for the delivery of the new services and the transformation planned for the future, but was also driven by necessity as Virgin Care were only able to use the existing IT network for 100 days after transfer.

This large scale project required all devices and networking equipment to be replaced across 32 sites in Bath and North East Somerset by 1 July 2017 with all colleagues provided with new equipment and access details for both IT and telephony.

As would be expected with any project of this scale, users reported some issues and these were logged and resolved or mitigated in line with the project plan. As the new system was rolled out to more users, the number of issues being raised increased but Virgin Care continued to mitigate and resolve issues so that services were able to continue to operate, making use of business continuity plans wherever necessary.

On 3 July 2017, Virgin Care took the precaution of enacting their Internal Major Incident Plan, providing a formal framework and allowing additional resource to be diverted to support the operation of frontline services. Virgin Care also liaised with commissioners, the CQC and other local providers to ensure the system was aware that services were operating business continuity plans and were aware of the actions being taken.

GP Practice System Configuration

As a result of the new network roll out Virgin Care have reported a localised issue with how Community Matrons access the GP records system (SystmOne). This is primarily linked to Virgin Care’s requirement to continue to operate within nationally prescribed Information Governance regulations. For an interim period of 5 days there were a small number of Nursing Staff who could only access GP systems from another GP site, not the newly networked sites. Access to information was possible, but not at these staff bases. Access has been restored at the newly networked sites to ensure the necessary information is available to the nursing teams directly affected.

Early areas of service redesign

A key service review of future Community Mental Health Services arrangements has been launched and engagement on this is currently underway. Partnership working between the Council, CCG and Virgin Care and other key partners has been strong around this review.

Virgin Care has urgently prioritised Home First. This has included working closely with the RUH to ensure that people are discharged from hospital and assessed at home wherever possible. Significant progress has been made in ensuring that these pathways are established across the community and that acute and community colleagues are working jointly to ensure safe handovers are in place.

25 Health and Wellbeing Select Committee- Wednesday, 19th July, 2017 Page 17 A review of Continuing Health Care processes was requested urgently by Commissioners and Virgin Care has undertaken this within the 100 days and has developed an action plan for improvement. This development work will be jointly led across the CCG & Virgin Care teams to ensure a single, coherent approach is achieved.

Mike MacCallam, Chair of the Safe Transfer Group said that staff have welcomed the mobile working functionality that Virgin Care have introduced. He added that he has been impressed with their openness and transparency, their ability to provide quick solutions when problems are raised and willingness to work with other partners.

He stated that he was confident that safe transfer had occurred and that strong governance arrangements were in place regarding the contract agreed with Virgin Care.

The Chair asked if the teething problems that occurred affected mainly staff or service users.

The YCYW Community Services Programme Lead replied that the frustrations from staff were mainly due to IT problems. She added that only a small number of patient appointments had to be amended.

Jayne Carroll added that she understood the frustrations that had been raised by colleagues. She said that the printer configuration had been acknowledged as an error made by the suppliers and praised IT support in general as amazing, with all major issues now having been addressed.

She stated that Virgin Care only had access to the previous system run by Sirona until the end of June which was why they had undertaken the complete replacement of the IT infrastructure.

Councillor Lizzie Gladwyn asked if there was to be any patient experience feedback carried out.

Jayne Carroll replied that there would be and that they are in dialogue with the RUH on their experience.

Councillor Tim Ball asked for further clarification of the pay issues that had occurred, particularly in relation to bank staff.

Jayne Carroll replied that contact numbers were immediately made available to colleagues and emergency payments were made where necessary.

Councillor Lin Patterson asked for the costs associated with the IT infrastructure replacement and whether it was within budget.

Jayne Carroll replied that she did not have the exact figures to hand but assured the Select Committee that it was not over the budget level that they had set for the project.

26 Health and Wellbeing Select Committee- Wednesday, 19th July, 2017 Page 18 Councillor Lin Patterson commented that she was pleased to see a number of reviews were planned and asked for any further information relating to the Continuing Health Care action plan for improvement and the review of future Community Mental Health Services.

Jayne Carroll replied that a joint action plan has been agreed between the CCG & Virgin Care in relation to Continuing Health Care and that improvements were already being recognised.

The YCYW Community Services Programme Lead added that staff have given themselves a two year window to carry out the review of future Community Mental Health Services. She added that it was hoped that in September 2017 they would be able to present the outcomes of the strategy engagement and that by April 2018 the shape of the model would be identified. She added that AWP and the voluntary sector will be involved in the process.

Councillor Tim Ball proposed that the Select Committee receives quarterly updates on this work area as a whole.

Councillor Lin Patterson requested that the Select Committee receives the Community Mental Health Services update in September.

The Director for Integrated Health & Care Commissioning replied that she would discuss that issue further with the officer concerned.

The Select Committee RESOLVED to;

(i) Note the progress made during the First 100 Days (ii) Receive quarterly updates on this work area.

27 HOME FIRST SERVICE DEVELOPMENT

The Senior Commissioning Manager and the Commissioning Project Manager introduced this item by giving a presentation to the Select Committee. A copy of the presentation can be found on their Minute Book and as an online appendix to these minutes, a summary of the presentation is set out below.

Time is the currency

 Time is the currency of health and social care  It is used to measure a range of aspects from waiting times, A&E Performance Times, DTOC’s to the length of social care visits.  However time is also the most important currency for our patient's. We know that the average patient admitted to hospital is within their last 1000 days.

The Last 1000 Days

 If you had 1000 days remaining, how many would you choose to spend in hospital?

27 Health and Wellbeing Select Committee- Wednesday, 19th July, 2017 Page 19  This thought has led to development of a social movement within the NHS called the Last 1000 days. This is about recognising that time is the most important thing for our patients and thus patient’s time must be important to those who care for them.  The Select Committee were shown video of a poem by a nurse called Molly Case, which was commissioned by NHS England that outlines the importance of this movement.

Home First

 Home First (also known as discharge to assess) is based upon the principle that it is aimed, where safe, for all patients to be discharged home as soon as they no longer require care that can only be provided in an acute hospital bed.  Here Rehabilitation, Reablement and outstanding health and social care assessments can be undertaken at the right time and in the most appropriate environment for the patient to increase independence & fully assess their long term needs.  It ensures patients aren’t making decisions about their long term care needs whilst in crisis  If patients are unable to safely return home then temporary options need to exist to allow assessments to be undertaken in an environment which will best meet their needs.

Benefits

 It reduces the risks associated with prolonged hospital stays such as increased risk of infection and functional decline.  It ensures patients independence & functioning is optimised, allowing for a true assessment of their long term care needs.  It improves patient flow through the hospital, ensuring patients are discharged in a timely manner, decreasing delayed transfers of care and improving A&E performance.

Home First Pathways

 Whilst the rationale for Home First is clear, responsive pathways need to exist to support this principle.  Within B&NES it has been agreed with other system partners in Wiltshire and Somerset, that we will utilise a number pathway options for the RUH facing system. This ranges from patients needing no additional support to go home, to those who need support in long term care settings.  Within B&NES Pathway 1, home with additional support, has had the most significant work to date.

Home First Pathway 1

 Within B&NES the Home First Service (Pathway 1) is delivered by the Integrated Reablement Team. The Reablement team are currently commissioned to provide Home First discharge slots for 20 patients per week between Mon and Fri.

28 Health and Wellbeing Select Committee- Wednesday, 19th July, 2017 Page 20  Additionally they provide care, support and assessment to all Home First patients on their caseload across 7 days, for a maximum of 6 weeks.  It was agreed that this service provision should consist of the following:- o A 24 hour turnaround from ward referral to discharge. o An initial assessment by a Registered Physiotherapist of Occupational Therapist within 2 hours of discharge to identify immediate care and equipment needs. o Care support of up to 4 visits per day, delivered by the Reablement Team or Reablement Strategic Domiciliary Care Partners. o Equipment provision to support the patients care and mobility needs. o On-going rehabilitation and reablement to increase independent functioning. o On-going assessment to fully assess long term care needs. o Onward referral to appropriate services once long term needs are apparent.

Home First Pathway – Performance & Plan

 Since May 2017, 126 patients have been discharged into the B&NES Home First Service, an average of 14 per week. Whilst it is recognised that this is below the commissioned activity expectations; work is currently being led by the Home First Operational Group to deliver improvements.  Planned improvement work includes the development of a single point of access ensuring a streamlined referral process, agreement of 10 triage questions to identify all eligible patients and the development of a Home First performance dashboard to assess performance.  Additionally, the service is planned to be expanded to deliver 7 day referrals and discharges to ensure the service is responsive to patients discharge need.

Home First Pathway 2

 This Pathway is for patients that are unable to go home and need further support to get them home; temporary bedded options need to exist to support such patients.  Currently within B&NES this is provided solely by community hospitals. It is noted that this is distinct from comparator areas, which have a diversity in their bed base which goes beyond community hospitals and includes rehabilitation and assessment beds within residential and nursing homes.  Plan within B&NES to procure 5 beds within a nursing home which will deliver bed based rehabilitation and assessments for up to 6 weeks. Additionally the beds aim to support the social care model of reablement, which aims to optimise independent functioning by increasing a patient’s ability to undertake activities of daily living such as washing and dressing.

Home First Pathway 3

 Pathway 3 is for patients whose long term needs are known and will be entering long term care facilities directly. Work is being undertaken to ascertain how nursing and residential homes could be best supported in the

29 Health and Wellbeing Select Committee- Wednesday, 19th July, 2017 Page 21 management of such patients and ensure such support can be accessed in a timely manner.  This is likely to include in reach Reablement support to reduce functional decline and benchmarking against the NHS Care Home Vanguard site guidance to develop further actions.  Additionally it is noted that Pathways 2 & 3 developments are to be discussed at a system-wide discharge workshop on the 24th July.

Councillor Lin Patterson said that it sounded like a wonderful service. She asked if a nursing home had been allocated to provide the 5 beds mentioned within Pathway 2.

The Senior Commissioning Manager replied that they were about to embark on this process by asking for an expression of interest.

Councillor Geoff Ward commented that this was an interesting element of health care and felt that loneliness can also be a factor in some cases as their own home can at times feels like a prison for elderly people. He asked how this scenario was handled.

The Commissioning Project Manager replied that Age UK have been involved in some soft support discussions.

The Senior Commissioning Manager added that some Virgin Care / Community Services are available in this respect. She added technology can also play a part in this scenario with the use of apps such as Skype.

Councillor Lizzie Gladwyn said that she had some concerns as the system relies a great deal on communication, especially relating to the assessments that are carried out at home. She asked what contingency plans were in place.

The Commissioning Project Manager replied that this is why a single point of access is so important. He added that the ward should ensure that medication needs are addressed before discharge. He said that re-admission would be a last resort and informed Councillors that weekly operational meetings take place.

Councillor John Bull agreed with the comments made with reference to loneliness. He asked what steps were taken to ensure patients are safe when returning to home.

The Senior Commissioning Manager replied that patients are assessed initially in hospital before discharge and then at home to view their ability to use stairs, cook, make hot drinks and dress themselves.

Councillor Lin Patterson asked who oversees the assessment in hospital.

The Senior Commissioning Manager replied that this could be carried out by a number of ward staff including Doctor, Nurse, Occupational Therapist and Physiotherapist.

The Commissioning Project Manager added that this is where the development of the 10 triage questions will become important.

30 Health and Wellbeing Select Committee- Wednesday, 19th July, 2017 Page 22 Alex Francis, Healthwatch asked if there had been any delay in provision of care or equipment to patients returning to their home.

The Senior Commissioning Manager replied that she was not aware of any delays in care provision, but that there was work to do on how quickly equipment can be provided as it was possible to go home with some but other items do need to be ordered.

She added that most patients assessed so far are not requiring any additional care.

Alex Francis asked what the expected level of demand for the service was.

The Senior Commissioning Manager replied that the service will have to demonstrate its benefits before an expansion can be considered. She added that review will take place after it has been active for 12 months.

The Select Committee RESOLVED to note the report and presentation provided regarding the Home First service model.

28 SELECT COMMITTEE WORKPLAN

The Director for Integrated Health & Care Commissioning advised the Select Committee that they could place on their workplan for September the following reports.

Mental Health Pathway Review

Care Home Provision

The Select Committee RESOLVED to approve these items for their workplan.

The meeting ended at 12.55 pm

Chair(person)

Date Confirmed and Signed

Prepared by Democratic Services

31 Health and Wellbeing Select Committee- Wednesday, 19th July, 2017 Page 23 This page is intentionally left blank Agenda Item 12

Bath & North East Somerset Council

MEETING/ DECISION Health & Wellbeing Select Committee MAKER:

EXECUTIVE FORWARD MEETING/ PLAN REFERENCE: DECISION 27th September 2017 DATE:

Royal United Hospitals Bath NHS Foundation Trust update on the proposed relocation of the RNHRD’s Bath Centre for Fatigue Services from the Mineral TITLE: Water Hospital site to a purpose built RNHRD and Therapies Centre on the RUH’s Combe Park site WARD:

AN OPEN PUBLIC ITEM

List of attachments to this report Appendix 1: Report on the outcomes of Patient and Public Engagement activities on the proposed relocation of the Royal National Hospital for Rheumatic Diseases Bath Centre for Fatigue Services from the Mineral Water Hospital site to a purpose built RNHRD and Therapies Centre on the RUH’s Combe Park site. Appendix 2: Equality Impact Assessment Appendix 3: Summary Impact Assessment

1 THE ISSUE

This paper has been prepared to ensure that the B&NES Health and Wellbeing Select Committee are kept up-to-date with the proposed relocation of the Royal National Hospital for Rheumatic Diseases (RNHRD) Bath Centre for Fatigue Service (BCFS) from the Mineral Water Hospital site to a purpose built RNHRD and Therapies Centre on the RUH’s Combe Park site. Indicative timeframe to relocate these services is 2019.

The attached report (see appendix 1) provides the Committee with the outcomes of Patient and Public Engagement activities completed relating to the proposal to relocate the RNHRD ‘s BCFS. An Impact Assessment and Equality Impact Assessment are also enclosed (see appendices 2 and 3).

Committee members have received previous reports and briefings in relation to a phased programme of service relocations following the acquisition of the Royal National Hospital for Rheumatic Diseases, which outlined the rationale for change and provided an update on activities at their July 2015, November 2015, January 2016, July 2016 and March 2017 committee meetings. In addition, the RUH Commercial Director invited panel members to suggest any questions they would like asked during patient and public engagement activities in a letter dated 26th June 2017 and circulated via the Committee’s Policy Development and Scrutiny Project Officer. Bath and North East Somerset Health and Wellbeing Select Committee members did not indicate that they would like to receive reassurance around any specific aspect of the proposed relocation.

1 Page 25 2 RECOMMENDATION

The committee are asked to:

 Note the outcome of the impact assessments and patient and public engagement activities which provided opportunities for patients, staff, stakeholders and the public to provide feedback on the proposed move, and which confirmed that the effects of this change are considered minimal and that there are a number of positive aspects to the change, for current and future patients.

 Endorse the proposal to relocate the RNHRD Bath Centre for Fatigue Services from the Mineral Water Hospital site to a purpose built RNHRD and Therapies Centre on the RUH’s Combe Park site.

3 RESOURCE IMPLICATIONS (FINANCE, PROPERTY, PEOPLE)

There will be no change in the level of service provision for patients of the RNHRD Bath Centre for Fatigue Services. The same range of outpatient services will be provided at the new RNRHD and Therapies Centre and patients will continue to be seen and treated by the same team to the same high standards, only the location will change.

There are no impacts on patient choice as a result of the plan to relocate the services to the RNHRD and Therapies Centre on the RUH’s Combe Park site.

In order to ensure the continued sustainability of the services currently provided at the Mineral Water Hospital site the ability to fully integrate and align services on a single site was a core component of the original business case for the acquisition of the RNHRD by the Royal United Hospitals Bath (RUH). It will improve efficiency and effectiveness, improve patient experience, ensuring continuity of care, and quality of service delivery as well as increasing value for money from the public purse. Clinicians continue to be integral to planning the future of their services to ensure the delivery of high quality effective services.

4 STATUTORY CONSIDERATIONS AND BASIS FOR PROPOSAL

Patient and Public Engagement (PPE) activities were conducted in line with the Government’s Consultation Principles for Public Bodies (October 2013), the Equality Act (2010) and Section 242, Subsection (1B)(b) of the Health Act 2006 (as amended).

5 THE REPORT

A phased approach to support Patient and Public Engagement (PPE) relating to enabling the continued integration of the RUH and RNHRD hospitals is underway and is considered most appropriate by the Local Health Economy Forum (LHE), providing general context of the full relocation at the outset but planning and completing each programme of PPE service by service. The RUH is working with Clinical Commissioning Group (CCG) and NHS England Engagement leads, and patients to ensure PPE is carried out in line with the Government’s Consultation Principles for Public Bodies (October 2013). This phase of PPE activities relating to plans to relocate the RNHRD’s Bath Centre for Fatigue Service is now complete.

There will be no change in the level or range of service provision for patients attending the RNHRD and Therapies Centre, patients will have access to the same services and support, provided by the same team.

2 Page 26 There is no impact on patient choice, as relocating the service does not reduce the number of appointments or clinics available. Satellite clinics will continue in their current location.

A detailed outline of the RNHRD’s Bath Centre for Fatigue Service, engagement methods and feedback captured throughout the engagement period can be found in Appendix 1.

Benefits for Bath Centre for Fatigue Services patients and staff

Relocating provides continuity for the RNHRD’s high quality services. The proposed new location will provide better facilities, including enhanced group rooms and improved waiting room facilities. There will be improved physical access, including flat access to the new Centre, ground floor clinic and group rooms and a purpose designed building which can better accommodate those with restricted mobility. BCFS patients will have use of clinic and group rooms located closest to the main entrance of the new building.

The Centre will provide therapeutic surroundings to support patient recovery, treatment, wellbeing and the management of long-term conditions. The new Centre will continue to promote the RNHRD’s trusted brand combining clinical excellence and therapeutic space, in an environment designed in conjunction with patients and clinicians, with the aim of reducing stress and creating a beneficial healing environment for patients and their families.

For some patients with long-term conditions, including cancer, there is the potential for improved integrated care, with access to several services within the same space.

Patients and staff will have easier access to wider support services on the RUH site and staff will benefit from easier access to training and development opportunities and more opportunities for shared learning.

The RUH’s Combe Park site is located less than two miles from the Mineral Water Hospital site, any difference in cost or time associated with travelling should be minimal. The RUH has good public transport links and is accessible via the Odd Down Park and Ride. For some patients the proposed new location will be easier to access due to the availability of onsite parking. The RUH provides over 350 visitor and patient spaces across the site, and around 100 blue badge spaces. Other than two Blue Badge parking spaces, there is no patient or visitor parking available at the Mineral Water Hospital.

Disbenefits for Bath Centre for Fatigue Services patients and staff

The RNHRD is more easily accessible from Bath Spa bus or rail station for those who access the BCFS service in this way or for those whose fatigue prevents them from driving the distance e.g. Swindon, Salisbury and other parts of Wiltshire. All assessments and individual follow up appointments currently take place at the RNHRD site.

Scale and scope

At present, the BCFS operates from the Mineral Water Hospital site in Bath, known locally as the ‘Min’.

Bath Centre for Fatigue Services

3 Page 27 The BCFS is a specialist, outpatient service for people experiencing longstanding fatigue that is significantly impacting daily functioning and activities. It serves adults with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME), people living with and beyond cancer (as part of the Macmillan Step Up service) and people living with fatigue associated with other long term conditions such as MS.

The service is clinically and operationally led by Consultant Associated Health Practitioners, who oversee and supervise an interdisciplinary workforce delivering supported self- management and recovery packages, including work and vocational rehabilitation interventions.

BCFS is a local, regional and national service for adults with CFS/ME and for those with fatigue linked to other long-term conditions including cancer related fatigue. Additionally, education and training is provided to health and social care professionals including general practitioners, lectures for higher education establishments in the region, and supervision of under-graduate and post graduate therapy and psychology students on clinical placements.

The majority of the outpatient activity is delivered in the Mineral Water Hospital building. Community based clinics are also provided across the region including Semington and Salisbury in Wiltshire, plus domiciliary visits for people severely affected by fatigue and advocacy meetings, or employment settings for work and vocational rehabilitation purposes if required. These services will continue in their current locations subject to commissioners’ intentions. Only the services provided on the Mineral Water Hospital site will relocate. Additionally, the BCFS team regularly provide end of active treatment interventions at the main RUH site for people living with and beyond cancer.

The BCFS accepts referrals locally, regionally and nationally. Services are commissioned by BaNES, Bristol, Gloucestershire, South Gloucestershire, North Somerset, Somerset, Swindon and Wiltshire, with the bulk of activity from BaNES and Wiltshire.

The table below outlines the number of new and follow up patients accessing the BCFS on the Mineral Water Hospital site for the years 2013/14, 14/15 and 15/16. The activity includes patients attending CFS/ME and Macmillan Step Up programmes and excludes those who have only accessed telephone appointments or satellite clinics or other services not at the Mineral Water Hospital site. ‘Other’ describes remaining CCGs and may also include activity exempt from charging or private/overseas patients.

Number of Patients (Accessing services at the Mineral Water Hospital site) 13/14 14/15 15/16 NHS BATH AND NORTH EAST SOMERSET CCG 288 323 359 Follow Up 156 185 203 New 132 138 156 NHS BRISTOL CCG 20 32 26 Follow Up 9 17 18 New 11 15 8 NHS GLOUCESTERSHIRE CCG 17 15 30 Follow Up 8 9 12 New 9 6 18 NHS NORTH SOMERSET CCG 11 12 12 Follow Up 6 6 9 New 5 6 3 NHS SOMERSET CCG 64 84 105 Follow Up 34 43 56

4 Page 28 New 30 41 49 NHS SOUTH GLOUCESTERSHIRE CCG 34 39 40 Follow Up 16 21 21 New 18 18 19 NHS SWINDON CCG 15 15 16 Follow Up 7 9 6 New 8 6 10 NHS WILTSHIRE CCG 293 303 422 Follow Up 140 160 211 New 153 143 211 Non-Contracted Activity 14 14 22 Follow Up 6 7 14 New 8 7 8 Grand Total 756 837 1032

Impact of proposals to relocate the RNHRD’s BCFS

The Trust is proposing to relocate the RNHRD’s Bath Centre for Fatigue Services from the Mineral Water Hospital site, to the RUH’s Combe Park site where a purpose built RNHRD and Therapies Centre is being developed.

Clinicians and staff who work in these services have been involved in the design and planning process to ensure the new RNHRD and Therapies Centre will continue to support the delivery of high quality effective services.

Feedback

Focussed clinical and patient and public engagement on the planned relocation ran from 26th June to 4th September, a period of ten weeks, asking people to share their thoughts on the plans to relocate, including any benefits, concerns or anything additional people felt we needed to consider ahead of moving.

Information on the proposal and opportunities to provide feedback was made available through a range of channels including the RNHRD and RUH websites, social media, display boards, have your say’ feedback boxes at the RNHRD, display screens in the Trusts, information and opportunities to provide feedback circulated by the RUH and cascaded via relevant individuals and stakeholder organisations. The BCFS service leads and Local Health Economy Communications Working Group patient representative provided guidance on additional stakeholder groups and individuals to seek feedback from as part of the process. (see appendix 1).

The low level of engagement during the formal engagement period may indicate that after a two year phased programme of engagement on plans to relocate RNHRD services (at an overall and service specific level) many stakeholders may already have had any concerns addressed and feel reassured that subject to commissioner intentions, the same high quality RNHRD services will continue and only the location will change.

A total of 22 people completed at least some of the engagement questionnaire, with 17 completing the full questionnaire.

There was a spectrum of questionnaire opinions on the proposal: 5 Page 29 “If facilities are improved, then I think it is a positive change. If it’s the same facilities, then I would rather it stayed put.”

“I think it’s a very good idea and will be beneficial to patients.”

“I really like the Mineral Hospital and most of the experience I’ve had there…I’m disappointed that may change in future as I’m not convinced as to the direct benefit for patients.”

However, respondents could identify a range of benefits as a result of relocating the BCFS, including newer facilities, better integration with other services, better access and easier parking.

Potential or perceived disadvantages raised by respondents and the actions the RUH has taken or will take to address these concerns include:

 Parking

The Trust has taken steps to improve parking facilities on the RUH site and has taken into account the increase in people visiting the Combe Park site when the new Centre is opened. A new 300 space car park at the main entrance to the RUH was completed and opened in September 2016. The RUH provides over 350 visitor and patient spaces across the site, and around 100 blue badge spaces. Not all patients with CFS/ME are not eligible for a blue badge due to lack of understanding of the fluctuation in symptoms and their impact.

 Accessing via public transport  Moving from a city centre location

The RUH is less than two miles from Bath city centre and is accessible via bus from bus routes serving the city centre, or via park and ride services. Bath Spa train station is less than two miles away, and is located next to the bus station. For some patients who currently access the RNHRD via Bath Spa rail or bus, relocating the service to the RUH’s Combe Park site will extend their journey time,

 Less warm and inviting

The vision for the new RNRHD and Therapies Centre is to create a supportive environment with dedicated facilities for providing high quality care. The building is being designed in conjunction with clinicians and patients and will operate exclusively as a day patient centre, with a separate entrance to the acute hospital. The interior design will sensitively reflect its heritage and the specific needs of its patient groups. The environment is an integral part of the design to reduce stress and ensure a healing environment, for patients and their families, acknowledging the importance of addressing psychosocial needs and will include:

 Use of natural light – to give bright, spacious interiors not dependent on harsh artificial lighting.  Reduction of noise – (including ventilation and plumbing) and use of sound absorbent surfaces.  Art, nature and greenery – appropriately located for a positive impact on patient recovery.  Garden areas – creating an ‘oasis’ and offering a calming view / place to sit, reducing stress and providing a sense of normality.  Improved staff links with research centres.

6 Page 30 Concerns around parking and public transport will also be addressed through clear communications in the period ahead of the proposed relocation of the BCFS.

Engagement Event

Around thirty attendees at an informal engagement session which was convened earlier in the year, as an addition to a pre-arranged Friends and Family event, had the opportunity to see plans and hear about the detail for the new Centre. Attendees were generally positive about new and improved facilities on the understanding of the same quality of service at the new location.

As part of the formal engagement activity, the Trust arranged engagement events in Wiltshire and BaNES, where attendees would have the opportunity to meet with clinicians, hear more about the new RNHRD and Therapies Centre, provide feedback on plans to relocate and have any further questions answered. These events were cancelled, as only one person expressed an interest in attending – alternative ways of providing feedback were provided for this person. We recognise that for many of this patient group, due to the nature of their condition, travelling to and attending a feedback session can be a significant challenge, however the Trust felt it was important to offer stakeholders a range of ways to provide feedback.

Further details including an outline of PPE activities and feedback can be found in the BCFS PPE Briefing Report.

Next steps:

Subject to the Committee’s endorsement of the plan to relocate the RNHRD’s Bath Centre for Fatigue Services to a purpose built RNHRD and Therapies Centre on the RUH’s Combe Park site, construction of the Centre will get underway in 2017, and the services will relocate when the new build is complete, scheduled for 2019.

The next phase of PPE activities relate to proposals to relocate the RNHRD’s Pain Management services. Planning is underway to launch the final round of PPE activity in early 2018.

6 RATIONALE

This paper has been prepared to ensure that the committee are kept up-to-date with the outcomes of impact and equality impact assessments and Public and Patient Engagement activities completed relating to the proposed relocation of the services from their current location. The rationale for this relocation is both to enable delivery of the promised benefits of acquisition of the RNRHD and provide opportunity to realise benefits of co-location with RUH services.

7 OTHER OPTIONS CONSIDERED

As part of the original business case for acquisition of the RNHRD, options were considered in relation to services continuing on the Mineral Water Hospital site or relocating services. The ability to integrate and align services on a single site, was a core component of the original business case for acquisition and sustainability of services.

7 Page 31 8 CONSULTATION

In addition to the service related public and patient engagement activity outlined in this report, the RUH has been working with the Local Health Economy (LHE) Forum, whose membership includes Executives from B&NES, Wiltshire and Somerset Clinical Commissioning Groups (CCGs), NHS England, RUH Governor and patient representation, to agree the process for communication and engagement activities to support the relocation of clinical services from the Mineral Water Hospital Site.

To support this activity, the RUH has established an LHE Communications Working Group (which is comprised of RUH and NHS England and CCG communications and engagement leads and a patient representative) to ensure all service related PPE is conducted in line with the Government’s Consultation Principles for Public Bodies (Oct 2013).

9 RISK MANAGEMENT

An integration programme governance structure is in place to ensure that any programme issues are identified and, if required, added to the RUH risk register.

Contact Clare O’Farrell, Deputy Chief Operating Officer, RUH person Tracey Cox, Chief Officer, NHS Bath and North East Somerset Clinical Commissioning Group Background Update to Health and Wellbeing Select Committee 29th July 2015 papers Update to Health and Wellbeing Select Committee 25th November 2015 Update to Health and Wellbeing Select Committee 27th January 2016 Update to Health and Wellbeing Select Committee 20th July 2016 Update to Health and Wellbeing Select Committee 22nd March 2017

Please contact the report author if you need to access this report in an alternative format

8 Page 32 Public and Patient Engagement Report: Relocation of RNHRD’s Bath Centre for Fatigue Services

Background to the engagement The Royal National Hospital for Rheumatic Diseases’ (RNHRD) Bath Centre for Fatigue Services (BCFS) operate from the Mineral Water Hospital site in Bath, known locally as the ‘Min’. The service is clinically and operationally led by Consultant Associated Health Practitioners, who oversee and supervise an interdisciplinary workforce delivering supported self-management and recovery packages, including work and vocational rehabilitation interventions. The BCFS provides outpatient services for people experiencing longstanding fatigue that is significantly impacting daily functioning and activities. It serves adults with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME), people living with and beyond cancer (as part of the Macmillan Step Up service) and people living with fatigue associated with other long term conditions such as MS.

The Trust is proposing to relocate these services along with clinicians and support staff, to a purpose built RNHRD and Therapies Centre at the RUH’s Combe Park site. The Centre will also house the RUH’s therapies and pain services, and the RNRHD Rheumatology and Therapies services. The Trust is also proposing to relocate the RNHRD’s Complex Regional Pain Syndrome and Breast Radiation Injury Rehabilitation Service to the RNHRD and Therapies Centre. The relocation of these pain management services will be subject to separate patient and public engagement activity in early 2018.

The same range of fatigue services would be provided from the RNHRD and Therapies Centre, and patients will continue to be seen and treated by the same teams to the same high standards, only the location will change. The new Centre will provide a supportive environment, designed in conjunction with patients and clinicians taking into account psychosocial needs. The Centre will provide therapeutic surroundings to support patient recovery, treatment, wellbeing and the management of long-term conditions.

The RUH’s Combe Park site is located less than two miles from the Mineral Water Hospital site so differences in cost or time associated with travelling will be minimal, although for some patients this will be an inconvenience. For some patients the new location will be easier to access, due to the availability of onsite parking. The RUH provides over 350 visitor and patient spaces across the site, and around 100 blue badge spaces.

In order to ensure the continued sustainability of the services currently provided at the Mineral Water Hospital site, the ability to fully integrate and align services on a single site was a core component of the original business case for the acquisition of the RNHRD by the Royal United Hospitals Bath (RUH). It will improve efficiency and effectiveness, improve patient experience, ensure continuity of care, and quality of service delivery as well as increase value for money

Date: 20 September 2017 Public and Patient Engagement RNHRD Bath Centre for Fatigue Services Page 1 of 12 Page 33 from the public purse. Clinicians continue to be integral to planning the future of their services to ensure the delivery of high quality effective services.

This report outlines what the Bath Centre for Fatigue Services currently provides and the outcomes of the engagement work carried out to inform relocating these services.

What does the Bath Centre for Fatigue Services Currently Provide?

BCFS is a local, regional and national service for adults with Chronic Fatigue Syndrome/ Myalgic Encephalopathy and for those with fatigue linked to other long-term conditions including cancer related fatigue. Education and training is provided to health and social care professionals including general practitioners, lectures for Higher Education establishments in the region, and supervision of under-graduate and post graduate therapy and psychology students on clinical placements.

The majority of outpatient activity is delivered in the Mineral Water Hospital building, with community based clinics across the region including Semington and Salisbury in Wiltshire, domiciliary visits for people severely affected by fatigue and advocacy meetings, in patient’s employment settings for work and vocational rehabilitation purposes if required. Additionally, the BCFS team regularly provide end of active treatment interventions at the main RUH site for people living with and beyond cancer.

The table below outlines the number of new and follow up patients accessing these services. Activity includes patients attending CFS/ME and Macmillan Step Up programmes and excludes those who have only accessed telephone appointments or satellite appointments. Activity is broken down by CCGs, ‘Other’ describes wider CCG activity and may also include private/overseas patients.

Number of Patients (Accessing services at the Mineral Water Hospital site)

13/14 14/15 15/16 NHS BATH AND NORTH EAST SOMERSET CCG 288 323 359 Follow Up 156 185 203 New 132 138 156 NHS BRISTOL CCG 20 32 26 Follow Up 9 17 18 New 11 15 8 NHS GLOUCESTERSHIRE CCG 17 15 30 Follow Up 8 9 12 New 9 6 18 NHS NORTH SOMERSET CCG 11 12 12 Follow Up 6 6 9 New 5 6 3

Date: 20 September 2017 Public and Patient Engagement RNHRD Bath Centre for Fatigue Services Page 2 of 12 Page 34 NHS SOMERSET CCG 64 84 105 Follow Up 34 43 56 New 30 41 49 NHS SOUTH GLOUCESTERSHIRE CCG 34 39 40 Follow Up 16 21 21 New 18 18 19 NHS SWINDON CCG 15 15 16 Follow Up 7 9 6 New 8 6 10 NHS WILTSHIRE CCG 293 303 422 Follow Up 140 160 211 New 153 143 211 Non-Contracted Activity 14 14 22 Follow Up 6 7 14 New 8 7 8 Grand Total 756 837 1032

What service changes are being proposed for the future?

Subject to the outcome of engagement activity, the RUH is proposing to relocate the RNHRD’s Bath Centre for Fatigue Service from the Mineral Water Hospital site, to a purpose built RNHRD and Therapies Centre on the RUH site. This building will bring together a number of outpatient services from the RNHRD and RUH which support patients to live independently in the community. There will be no change in service provision and patients will still have access to the same clinical teams. There will be no adverse impact on patient choice.

Telephone appointments and outreach activity will not be impacted by the proposed relocation.

The design of the new RNHRD and Therapies Centre has been developed in conjunction with clinicians, staff and patients, over a two year period, to provide an improved environment, with better facilities for providing treatment, care and education for patients to recover from episodes of illness or injury, or to manage their long-term condition.

Methodology A programme of Public and Patient Engagement (PPE) was carried out to seek the views of patients, staff, local health care providers and anyone with an interest in these services using a variety of channels to capture:

 benefits,  concerns,  what is good about the current service,

Date: 20 September 2017 Public and Patient Engagement RNHRD Bath Centre for Fatigue Services Page 3 of 12 Page 35  how the service could be improved in the future,  anything else people would like us to consider ahead of moving the service

A questionnaire was also developed to address these key issues, and capture open ended information from stakeholders. Engagement activities on the plan to relocate these services ran for a ten week period, from 26th June to 4th September 2017, to allow people to share their views on the proposed move.

Engagement activities included;

 Writing to BaNES, Wiltshire and Somerset scrutiny bodies, to advise of plans and intention to carry out PPE and to invite additional questions.  Providing information (posters, paper questionnaires, display boards, flyer with website link) at the RNHRD, outlining the plan to relocate the BCFS and inviting feedback.  Providing information on the RUH and RNHRD website, outlining the plan and encouraging feedback via an on online survey or comments via email.  Providing a website link and poster to relevant stakeholders, for sharing with their staff groups, key individuals and associated groups.  Promoting two engagement events, where attendees would have the opportunity to hear about the proposal to relocate these services, hear about the plans for the new RNHRD and Therapies Centre, provide feedback and have any further questions addressed. These events did not go ahead as only one patient expressed an interest in attending ahead of the cutoff date.  Providing information via social media, to outline the plans and encourage people to provide feedback.  Providing a dedicated email address to provide feedback.  Including feedback from a Friends and Family session, which took place before the formal engagement period began.  A detailed list of all engagement activities can be found at the end of this report.

Those who completed the engagement questionnaire described where they had heard about the plans and the opportunity to provide feedback, social media was the main source mentioned.

Bath Centre for Fatigue Services Engagement Feedback (you said)

The Trust arranged engagement events in Wiltshire and BaNES, where attendees would have the opportunity to meet with clinicians, hear more about the new RNHRD and Therapies Centre, provide feedback on plans to relocate and have any further questions answered. These events were widely publicised via social media, website, information at the RNHRD and through key stakeholders. The events did not go ahead as there was a lack of expression of interest in attending. We recognise that for many of this patient group, due to the nature of their condition, travelling to and attending a feedback session can be a significant challenge, however the Trust felt it was important to offer stakeholders a range of ways to provide feedback.

Date: 20 September 2017 Public and Patient Engagement RNHRD Bath Centre for Fatigue Services Page 4 of 12 Page 36 A total of 22 people completed at least some of the engagement questionnaire, with 17 completing the questionnaire in full (respondents were able to complete as many or as few questions as they wished). Respondents were mostly from the BA and BS postcode area, with a few from further afield. As the number of respondents is low, it is not possible to provide detailed analysis, of the results, and data is therefore presented qualitatively in this report.

Around half of those responding had accessed a service provided by the BCFS, specifically those provided from the Mineral Water Hospital site.

There was positive feedback for the current service provided at the Mineral Water Hospital site:

“Provides vital treatment to cope with fatigue –very lucky to have such a service in Bath, vital to aid recovery. Staff excellent.”

“The staff ‘get it’ and understand. They are honest and don’t force treatment on you, but offer help. The building is old but feels ‘friendly.’

Respondents believe being treated with dignity and respect, the expertise of clinicians, and seeing the same group of professionals each time you visit are the three most important factors to consider when thinking about what matters to patients who use the BCFS. Being given information that is easy to understand, being able to access a wide range of services in the same location and providing emotional support for patients were also rated as being very important.

Opinions shared via the online questionnaire covered a wide spectrum on the RUH’s proposal to relocate the service from the Mineral Water Hospital site:

“If facilities are improved, then I think it is a positive change. If it’s the same facilities, then I would rather it stayed put.”

“I think it’s a very good idea and will be beneficial to patients.”

“I really like the Mineral Hospital and most of the experience I’ve had there…I’m disappointed that may change in future as I’m not convinced as to the direct benefit for patients.”

Patients wanted reassurance that there would be no loss of service.

“please do not lose what is currently available, the service should be retained and valued.”

The proposed relocation to the RNHRD and Therapies Centre would enable the same service to be provided by the same team, only the location will change.

Date: 20 September 2017 Public and Patient Engagement RNHRD Bath Centre for Fatigue Services Page 5 of 12 Page 37 Respondents who provided feedback during an informal engagement session (held as part of a Family and Friends session), where they had the opportunity to see plans and hear about the proposed new Centre in more detail, were more positive.

Many of those who responded to the questionnaire recognise there are some benefits to relocating the BCFS to the RNHRD and Therapies Centre, including newer facilities, better integration with other services, better access and easier parking.

“Newer buildings, newer technology”

“Able to contact/bring in other expertise when needed quickly; better integration with other services and service providers (like a one stop shop approach) for the patient they can attend both therapy sessions and any other medical appointments.”

“closer to all the other services provided by the RUH including urgent care if required”

“co-ordination with other specialties…where my care has overlapped.”

“Easier access for car drivers.”

“Fatigue is a major component of many chronic pain/cancer conditions and I think a lot of the depts. at the RUH would benefit from their expertise.” (clinician feedback via email)

Respondents were also asked if they could identify any disadvantages to relocating the Rheumatology Service. Potential or perceived disadvantages raised by respondents and the actions the RUH has taken or will take to address these concerns include:

 Parking and access to new Centre on the RUH site

“Difficulty and expense of parking”

“Need to walk considerable distances to get around the RUH site.”

The Trust acknowledges the historic challenges with parking and capacity on the Combe Park site and has taken recent steps to considerably improve parking facilities. The Trust has also taken into account the projected increase in people visiting the Combe Park site when the new Centre is opened. A new 300 space car park at the main entrance to the RUH was completed and opened in September 2016. The RUH provides over 350 visitor and patient spaces across the site, and around 100 blue badge spaces.

Patients accessing the BCFS often struggle with day to day activities, which may including walking and plans for the service in the new Centre have taken this into account. The new Centre will have blue badge parking located close by, and BCFS day and clinic rooms will be located on the ground floor, nearest the entrance for ease of access. There will be quiet spaces and a clinic room available for those patients who would prefer to lie down ahead of their appointment.

Date: 20 September 2017 Public and Patient Engagement RNHRD Bath Centre for Fatigue Services Page 6 of 12 Page 38  Accessing via public transport

“Less accessible by public transport. Longer journey as need to travel into city to get back out to RUH site.”

The RUH is less than two miles from Bath city centre and is accessible via bus from bus routes serving the city centre, or via park and ride services. Bath Spa train station is less than two miles away, and is located next to the bus station. The new location will be less convenient for some, and more convenient for others. Patients currently travel to the Mineral Water Hospital site in a range of ways.

 Change in environment

“It will feel more ‘hospital’ like, RNHRD doesn’t feel intimidating.”

“I imagine it will be more clinical, and less warm and inviting”

“CFS patients need a quiet atmosphere to work in however so the CFS dept cannot be located anywhere near any noisy or busy clinical settings. A quiet place is as important to CFS from a therapeutic perspective as infection control is to Theatres/PACU “(clinician feedback via email)

The vision for the new RNRHD and Therapies Centre is to create an environment with dedicated facilities for supporting patient recovery, treatment, wellbeing and the management of long-term conditions. The building has been designed in conjunction with clinicians and patients and will operate exclusively as a day patient centre, with a separate entrance to the acute hospital. The environment is an integral part of the design to ensure a healing environment, for patients and their families, acknowledging the importance of addressing psychosocial needs and will include:

 Use of natural light – to give bright, spacious interiors not dependent on harsh artificial lighting.  Reduction of noise – (including ventilation and plumbing) and use of sound absorbent surfaces.  Art, nature and greenery – appropriately located for a positive impact on patient recovery.  Garden areas – creating an ‘oasis’ and offering a calming view / place to sit, reducing stress and providing a sense of normality.  Improved staff links with research centres.

BCFS service leads have highlighted that patients accessing the Macmillan Step Up Service are living with and beyond cancer, and many would prefer not being seen in an acute hospital setting, as it can be distressing to return to the site of diagnosis, tests and treatment. The new Centre is designed as a stand-alone outpatient centre, with its own dedicated entrance, so there is no need for BCFS patients to enter the main hospital building.

Date: 20 September 2017 Public and Patient Engagement RNHRD Bath Centre for Fatigue Services Page 7 of 12 Page 39 Concerns around parking and public transport, will also be addressed through clear communications in the period ahead of the proposed relocation of the BCFS.

The RUH have taken a phased approach to public and patient engagement to support the proposed relocation of all RNRHD services, beginning with a period of engagement around the overall proposal to relocate all services out of the Mineral Water Hospital site. Staff and clinicians have played a key role in shaping the future of these services, There have been numerous opportunities over the last two years to hear more or provide feedback on the RUH’s plans and information has been available to patients and the public throughout this time. Local media has reported extensively on the Trust’s plans to all relocate services out of the Mineral Water Hospital site and the development of the proposed new home for many of these services, The RNRHD and Therapies Centre. The low number of people choosing to provide feedback at this stage during the formal engagement period, despite the opportunities provided, may indicate that many stakeholders are sufficiently reassured that services will continue to be delivered to the same high standard, in a new location.

Other sources of feedback

Ahead of the formal engagement period, the BCFS team sought feedback from patients to identify how the new home for this service should ideally look and feel and over thirty patients shared their view via a brief questionnaire. The proposed new location for the BCFS is in keeping with many of these wishes:

“Light pleasant room” – the new Centre includes waiting rooms, large group rooms and smaller clinic rooms, designed to make use of natural light where possible.

“Relaxing environment”, Calm, tranquil environment” – art, nature, greenery and garden areas are all incorporated into the design of the new Centre, to provide a therapeutic environment.

“Decent parking areas”, “Car park on site with plenty of spaces so can park close to the hospital” – the RUH site offers around 100 dedicated free blue badge parking spaces, some of which will be located opposite the Centre entrance. A 300 space car park is located near the main entrance to the Centre.

“The same care and attention I experienced at the RNHRD” – the same service will be provided by the same staff, only the location will change.

“Privacy, not being right on top other people” – the new Centre will include two waiting rooms and offer a dedicated ‘quiet’ waiting room. A clinic room will also be available for those patients who require privacy and a place to lie down, ahead of attending their appointment or group session.

“Comfortable seating” – there will be a mix of seating in the waiting rooms, including high backed chairs, to meet the needs of a range of patients. Date: 20 September 2017 Public and Patient Engagement RNHRD Bath Centre for Fatigue Services Page 8 of 12 Page 40 “Minimal steps” – reception, waiting rooms, clinic rooms and group rooms are all located on the ground floor, and the BCFS will have use of clinic and group rooms closest to the entrance to the Centre.

“Good signage” –signage will be developed to meet current accessible information standards.

“Fully accessible in a location with ample parking on a regular bus route” – the new Centre is purpose built and designed to accommodate those with restricted mobility, located on a site with over 350 patient and visitor parking spaces, and 100 dedicated free Blue Badge parking spaces. The RUH site is on major bus routes and park and ride routes.

Feedback on the proposal to move and plans for the new RNHRD and Therapies Centre was also sought from patients attending a CFS/ME Family and Friends session in March 2017, again this took place ahead of the formal engagement period. These sessions are held by the team for patients to attend along with those who support them, to provide information about CFS/ME and strategies to manage it, and to discuss the best way for friends and family to provide that support. Around thirty people attended the March event, where patients also had the opportunity to hear from clinicians about the plans for the future of the service, hear from the RUH’s Commercial Projects team how the plans for the new Centre were developing, ask any questions and share views on key aspects of the new Centre, such as how the new waiting rooms should look and feel. At this event, patients were free to ask questions on all aspects of the proposed relocation. Attendees sought reassurance on the continuity of service provision, access and availability of parking at the new site, the size of group rooms and opportunities for the service to grow in the future. There was enthusiasm for the new Centre, and the potential benefits on the understanding that the same service would be provided and only the location would change.

Next Steps

This report will be provided to the appropriate Scrutiny committees to seek their endorsement on the proposal to relocate these services. Following the appropriate approvals services will relocate to the RNHRD and Therapies Centre in 2019 subject to completion of the new build.

We would like to thank all of the people who took part in this programme of engagement and provided feedback on the planned relocation.

Date: 20 September 2017 Public and Patient Engagement RNHRD Bath Centre for Fatigue Services Page 9 of 12 Page 41 Summary of communication and engagement activities:

Activity Purpose Throughout 2016/17 – information To raise awareness of proposed relocations, and available on RUH and RNHRD provide opportunities for feedback. website, outlining proposal to relocate specified RNHRD services to a purpose built RNHRD and Therapies Centre on the RUH site. Opportunities to provide feedback at any time. Spring 2017 – BCFS team outlined To seek patient views on expectations around proposal to relocate service and environment of new service. sought feedback on preferred environment February – August 2017 meetings To ensure the Bath Centre for Fatigue Services with the Head of Therapies and team had input in engagement activity, so that service leads to develop Public engagement activity was meaningful and Patient Engagement Template relevant. To develop a stakeholder list to ensure relevant individuals/groups could be informed of the plan to relocate and have the opportunity to provide feedback and to agree on the best way to reach stakeholders. Note – engagement activity was put on hold due to General Election. February 2017 Public Patient To gain feedback from group and agreement on Engagement Template developed to engagement approach and key stakeholders to support engagement activity engage with. circulated to LHE communications working group March 2017 Informal engagement Opportunity for current patients to hear more session as part of CFS/ME Friends about the plans for a purpose built RNHRD and and Family Session Therapies Centre on the RUH’s Combe Park site and to provide feedback on the proposal to relocate BCFS to the new Centre. Over thirty attendees.

Public Patient Engagement Template To gain feedback from group and agreement on to support engagement activity engagement approach and key stakeholders to circulated to LHE communications engage with. working group June 2017, letter to Update on the next stage of the RUH’s planned Banes CCG service relocations - relocation of Bath Centre for Bristol CCG Fatigue Services from the RNHRD cascade Gloucester CCG information and engagement opportunity to

Date: 20 September 2017 Public and Patient Engagement RNHRD Bath Centre for Fatigue Services Page 10 of 12 Page 42 North Somerset CCG relevant stakeholders Wiltshire CCG Somerset CCG Request to cascade information within South Gloucester CCG organisation as appropriate, and with scrutiny Swindon CCG officer.

Request for scrutiny to suggest any further questions to feed into PPE activity

June 2017, email to members of the Update on the next stage of the RUH’s planned LHE working group from: service relocations relocation of Bath Centre for Banes CCG Fatigue Services from the RNHRD to the RUH, Bristol CCG cascade information and engagement opportunity Gloucester CCG to relevant stakeholders North Somerset CCG Wiltshire CCG Request to cascade information as appropriate Somerset CCG and to support the spread of the message South Gloucester CCG through any appropriate channels. Swindon CCG

June 2017 Information about the Inform current and future patients of proposals proposal to relocate BCFS to the and signpost opportunities to feedback and RUH available and opportunities to influence. provide feedback, including via an online questionnaire, available on the 22 respondents completed questionnaire. RUH Website June 2017 Posters, display boards Inform current patients of proposals and signpost and paper copies of feedback opportunities to feedback and influence. questionnaires distributed and displayed at the Mineral Water Hospital site. Information about the proposal to relocate BCFS to the RUH available and opportunities to provide feedback July 2017, information/weblink/poster Outline proposal and invite feedback. circulated to onward cascade to To request onward cascade to other relevant Banes Healthwatch stakeholders, to ensure broad reach of North Somerset Healthwatch engagement Wiltshire Healthwatch Action for ME ME Association Better Together Frome Lymphoma Association Parkinsons Support Group RUH clinical stakeholders Macmillan Cancer Rehab/Recovery Date: 20 September 2017 Public and Patient Engagement RNHRD Bath Centre for Fatigue Services Page 11 of 12 Page 43 Project Lead Stronger Together Radstock Key patients identified by team Wellbeing College Fairfield Surgery Bath June 2017 @RUH Bath article, Invite feedback. highlighting engagement underway and opportunities to provide feedback August 2017 engagement events in Intended to outline proposal and invite feedback. BaNES and Wiltshire planned and Events cancelled due to lack of expression of publicized across a range of interest from stakeholders. channels. August 2017 @RUHBath article, Outline proposal and invite feedback. outlining proposal to relocate, engagement underway and engagement events June – Sept information update and Outline proposal and invite feedback sharing via RUH social media and relevant stakeholders

Date: 20 September 2017 Public and Patient Engagement RNHRD Bath Centre for Fatigue Services Page 12 of 12 Page 44 Equality Impact Assessment (EIA) Template

1. Title of document/service for assessment RNHRD Bath Centre for Fatigue Services 2. Date of assessment 4th September 3. Date for review 4. Directorate/Service 5. Approval Committee Local Health Economy Communications Working Group

6. Does the document/service affect one group less or more favourably than another on the basis of: Protected characteristic: Yes/No Rationale  Age N No major change. The service will be universally applied to patients and is not expected to have an impact relating to age  Disability N No major change. The service will be universally applied to patients and is not expected to have an negative impact relating to disability. There will be improved access for patients with reduced mobility, due to the proposed ground floor location, increased availability of blue badge parking and modern purpose built Centre designed in conjunction with staff and patients.  Gender reassignment N No major change. The service will be universally applied to patients and is not expected to have an impact relating to gender reassignment  Pregnancy and maternity N No major change. The service will be universally applied to patients and is not expected to have an impact relating to pregnancy and maternity  Race N No major change. The service will be universally applied to patients and is not expected to have an impact relating to race  Religion and belief N No major change. The service will be universally applied to patients and is not expected to have an impact relating to religion and belief. The proposed new location will have access to a Multi-faith centre in the nearby RUH acute hospital building.  Sex N No major change. The service will be universally applied to patients and is not expected to have an impact relating to sex  Sexual orientation N No major change. The service is universally applied to patients and is not expected to have an impact relating to sexual orientation  Marriage and civil N No major change . The service is universally applied to patients and is not expected to have an impact partnership relating to marriage and civil partnership 7. If you have identified potential discrimination, are the exceptions valid, legal and/or justified?N/A

8. If the answers to the above question is ‘no’ then adjust the element of the document / service to remove the disadvantage identified.

Page 45 9. If neither of the above is possible, take no further action until you have contacted your EIA Divisional / Directorate link for review and support

Signature of person completing the Equality Impact Assessment Name Clare O’Farrell, Deputy Chief Operating Officer, RUH Time Date 15th September 2017

Chair of decision making Board / Group / Committee approval and sign off Name Emma Mooney, Head of Communications

Approval on behalf of the Local Health Economy Communications Working Group.

Time Date 15th September

Page 46 Appendix 3: Summary Impact Assessments

Patients, carers and public representative views – summary of the potential impact of proposed service changes

Patients, carers and public representatives are asked to comment on the following areas, in relation to the proposed service changes:

Bath Centre for Fatigue Services

Benefits of the proposed service Continuation of RNHRD Bath Centre for changes Fatigue Services.

Patients will have access to the same services and clinical teams.

Proposed new location, purpose built RNHRD and Therapies Centre designed in conjunction with patients and staff will provide a supportive environment with dedicated facilities for outpatient care.

Better facilities – enhanced group rooms, improved waiting rooms.

For some patients with long-term conditions, potential for improved integrated care, with access to services on same site.

Better physical access –flat access to new Centre, BCFS will have use of clinic and group rooms located closest to Centre entrance.

Any disbenefits, including how None identified during PPE activities. you think these could be managed Any issues for Some stakeholders would prefer to travel to patients/carers/families in the city centre, rather than the RUH’s accessing the new service Combe Park site. particularly if a change of location has been suggested The RUH is less than two miles from the Mineral Water Hospital site, is accessible via public transport from Bath city centre and elsewhere and provides over 350 onsite parking spaces for patients, carers, families and visitors to the Trust.

How do you think the proposed The quality of the services will be changes will affect the quality of maintained. the service Improved environment and facilities. Impact of the proposed changes Positive impact for those with a disability

Page 47 on health inequalities who hold a blue badge – free parking on RUH site and over 100 dedicated spaces.

Positive impact for those with a disability (physical) – purpose designed RNHRD and Therapies Centre with improved access and flow.

If you are a representative of an PPE activities have included liaising with organisation, such as BaNES, Wiltshire and Somerset Healthwatch LINKs, please Healthwatch. indicate how you have drawn on the views of others from your group Who have you engaged with in Patients drawing together these views? Carers and relatives Public Clinicians Voluntary and charitable organisations When was this consultation PPE ran from 26th June 2017 to 4th made? September 2017 Involvement of ‘protected’ equality Wide ranging PPE activity to engage with all groups patient groups. Summarise the outcomes of Feedback obtained during PPE activities stakeholder involvement carried indicates broad ranging support for out to date relocation of service from across a variety of stakeholders.

No potentially adverse impact to patients in relocating the services to the RUH site which cannot be mitigated against.

Potential concerns raised include Parking. The Trust has taken steps to improve parking facilities on the RUH and has taken into account the projected increase in people visiting the Combe Park site when the new Centre is opened. A new 300 space car park at the main entrance to the RUH was completed and opened in September 2016. The RUH now provides over 350 spaces for patients and visitors, and around 100 spaces for blue badge holders.

Access via public transport. The RUH is less than two miles from Bath city centre and is accessible via bus from bus routes serving the city centre, or via park and ride services. Bath Spa train station is less than two miles away, and is located next to the bus station.

Page 48 Change to ambience/environment. The vision for the new RNRHD and Therapies Centre is to create a supporting environment with dedicated facilities for supporting patient recovery, treatment, wellbeing and the management of long-term conditions. The building is being designed in conjunction with clinicians and patients and will operate exclusively as a day patient centre, with a separate entrance to the acute hospital. The environment is an integral part of the design to ensure a healing environment, for patients and their families, acknowledging the importance of addressing psychosocial needs and will include:  Use of natural light – to give bright, spacious interiors not dependent on harsh artificial lighting.  Reduction of noise – (including ventilation and plumbing) and use of sound absorbent surfaces.  Art, nature and greenery – appropriately located for a positive impact on patient recovery.  Garden areas – creating an ‘oasis’ and offering a calming view / place to sit, reducing stress and providing a sense of normality.

Many service users felt there would be benefits to relocating the service, including a new purpose built building with better facilities. Any other comments There will be no change in the level of service provision for patients; they will have access to the same clinical teams and support, in a purpose built environment with improved facilities.

There are no impacts on patient choice for this service as a result of the proposal to relocate the services to a RNHRD and Therapies Centre on the RUH’s Combe Park site.

Notes: The RUH has completed this summary impact form on the basis of the responses received through the engagement activities. PART THREE – Impacts at a glance

Page 49 Impacts NHS View Patient/carer/public representatives’ view Impact on patients  = positive impact  = positive impact for majority

Impact on carers  = positive impact  = positive impact for majority

Impact on health  = positive impact  = positive impact inequalities

Impact on local health  = positive impact  = positive impact community

 = significant negative impact  = negative impact for some  = positive impact

GLOSSARY - list definitions of any technical terms, acronyms etc

Page 50 Agenda Item 13

Bath & North East Somerset Council

MEETING Health and Wellbeing Select Committee

EXECUTIVE FORWARD MEETING PLAN REFERENCE: 27th September 2017 DATE

TITLE: Update on the Mental Health Pathway Review

WARD: All

AN OPEN PUBLIC ITEM

List of attachments to this report: Appendix 1: Summary of themes emerging from engagement.

1. THE ISSUE

1.1. In line with the your care, your way full business case, the mental health pathway is currently being reviewed by commissioners. This report provides an update on that review with particular focus on key themes which have emerged during the engagement phase .It also describes the next steps in the review process.

2. RECOMMENDATION

2.1. Health and Wellbeing Select Committee is asked to note and comment on the themes emerging from the review.

3. RESOURCE IMPLICATIONS (FINANCE, PROPERTY, PEOPLE)

3.1. None directly related to this report.

4. STATUTORY CONSIDERATIONS AND BASIS FOR PROPOSAL

4.1. None directly related to this report.

Printed on recycled paper Page 51 5. THE REPORT

Background

5.1. In line with proposals in the your care, your way full business case and following the appointment of Virgin Care as the Prime Provider a review of the mental health pathway is being undertaken by the Council and Clinical Commissioning Group in order to determine the best model for the future commissioning of community and statutory mental health services across health and social care.

5.2. The review builds on the innovative mental health work undertaken in B&NES, which has helped develop a flourishing voluntary sector with a strong network of services. This was led by the previous mental health lead commissioner, Andrea Morland, over a number of years. B&NES were one of the first authorities to commission a wellbeing college, implement social prescribing, pilot a Wellbeing House and were praised by the then Health Secretary for their Mental Health Crisis Concordat. Within Avon & Wiltshire Mental Health Partnership NHS Trust (AWP), B&NES locality is the highest performing area, with services such as IAPT (Improved Access to Psychological Therapies) and recovery rates being some of the highest nationally. The review is therefore building on a strong base and aiming to further develop integrated services for the people of B&NES.

5.3. The review builds on the work already undertaken through the your care your way process which focused on early intervention, prevention and self-care with people only accessing statutory services where this is needed.

5.4. The review aims to identify how people access services, the quality of the services received, how they leave services and ongoing support. It will identify how services link together and in particular how physical and mental health services work together. It will identify any capacity and resource issues within the mental health system. The review will also identify areas of best practices within B&NES, what is working well, where there are gaps, duplication, potential for sharing resources and areas for improvement.

5.5. The first step in reviewing the system has been to engage widely with our target community, building on the comprehensive consultation which has already been carried out through the your care, your way process.

5.6. During the review we have met with over 62 groups, individuals, providers service user and carer groups.

Emerging Themes

5.7. Appendix One describes in detail some of the things that people told us and provides some initial thoughts on possible solutions. The five key headline themes are :

 Focus on preventing escalation and admission.

 Improve Community Based Support.

 Join up services.

 Drive parity of esteem between medical and social interventions. Printed on recycled paper Page 52  Improve the signposting of services.

Next Steps of Review

5.8. Building on the emerging themes, the review will also consider activity, performance and benchmarking data relating to all aspects of the current pathway. It will learn from local and national policy and evidence and then will develop options for change. These will describe the options, risks, benefits and cost analysis of different options.

5.9. It is anticipated that an initial assessment of options will be considered by the Council/CCG Joint Commissioning Committee in October 2017. This will be followed by a more detailed options appraisal to be presented in November/December 2017 with the aim of implementing from April 2018.

6. RATIONALE

6.1. This report provides an update on the mental health pathway review to enable Committee members to comment on the key themes emerging from stakeholder engagement.

7. OTHER OPTIONS CONSIDERED

7.1. This is a paper for information and discussion rather than presenting different options for decision making.

8. CONSULTATION

8.1. There has been extensive consultation as part of your care, your way and during this review.

9. RISK MANAGEMENT

9.1. A risk assessment related to the issue and recommendations has been undertaken, in compliance with the Council's decision making risk management guidance.

Contact person George O’Neill, Senior Commissioning Manager , 01225 831513

Background papers

Please contact the report author if you need to access this report in an alternative format

Printed on recycled paper Page 53 This page is intentionally left blank Appendix 1

Initial Analysis of Mental Health Review Engagement Interviews May-July 2017.

The below analysis is based on the initial engagement interviews.

Focus on preventing escalation and admission [YCYW: Focus on Prevention] Things people told us Possible Solutions

 People's expectations of the care  Develop a Safe Haven / Evening Café to coordination system are not always met, create a welcoming environment for pre- with some people saying there are crisis support out of hours. lengthy waits for allocation.  A clear and well publicised single point of  Community based services should be contact for emerging mental health available 7 days per week. They should emergencies. provide social and clinical care.  Redesign the role of wellbeing house to  Some people said there were not enough meet the needs of those in crisis/pre- community resources. crisis  Some people said they thought there  Reduce waiting periods for IAPT services. were long waits for IAPT services.

Page 55 Appendix 1

Improve community based support [YCYW: Build Community Capacity; Reduce Social Isolation; YCYW: Value the Workforce and Volunteers] Things people told us Possible Solutions

 The voluntary sector in BANES is  Create the Mental Health Collaborative excellent – but statutory services need to led by Virgin Care to ensure ongoing support them and service users and support and direction for the voluntary carers to use and further develop them. sector.  There are a wide range of groups  Provide a Community Fund to assist available, but they tend to operate groups to establish themselves outside of Monday-Friday 9-5. normal working hours and across the  Peer working, peer mentoring, whole of B&NES volunteering and befriending are  Establish a B&NES wide system for peer important elements of the recovery workers, peer mentors, volunteering and process and require further befriending. development.  Offer training for services which regularly  Some people told us that assistance with work with individuals with mental health housing, finance and benefits are needs, e.g. Citizens Advice Bureau. Work important aspects of mental wellbeing, with the Housing Department to ensure but that support in these areas is not the needs of people with mental health always consistent. issues are addressed as part of their  There are not many services available for ongoing strategy. younger people who may have left  Design and commission services for CAMHs, but do not meet the criteria for younger people. AWP services.

Page 56 Appendix 1

Join up the services [YCYW: Provide more joined up care; share information more effectively] Things people told us Possible Solutions

 Transitions between CAMHs and adult  Build on the Transitions work being mental health services sometimes do not undertaken by the STP and ensure that work well. the CHIMAT standards are adopted with  People's physical as well as mental health B&NES. needs are not always addressed.  Develop a model of care around GP  Communication between services and clusters which ensures integration of with services users and carers, physical and mental health with the particularly in times of crisis does not wellbeing service at initial point of always work well. This includes contact. communication between different AWP  Build on the current Intensive service teams. which is available 24/7 to ensure there is  There are a lot of different services in a timely response in times of crisis. B&NES but they do not always work well  Establish the Mental Health Collaborative together. to oversee the pathway.  Some people told us that if the criteria  Establish a single liaison service - for for receiving secondary mental health substance misuse and mental health - services is not met, they are not routinely staff should be multi-skilled so they can signposted to other services which may ensure people substance misuse and be able to support them. mental health needs are being met.  Dual diagnosis (substance misuse and Consider having substance misuse mental health) service users can fall workers as part of the initial point of between gaps - too risky for IAPT but not contact for physical and mental health severe enough for other services. services.

Page 57 Appendix 1

Drive parity of esteem between medical and social interventions [YCYW: consider the whole person] Things people told us Possible Solutions

 Some people told us that social  Establish the Mental Health Collaborative determinants of mental health are not and at its inception ensure that social routinely given prominence. Within AWP care as well as clinical care are given some people thought that the medical equal prominence in the pathway. Then model was dominant and social care little help build community capacity to to be seen. improve social provision and support.  Some carers told us they feel  Work with careers to ensure that a Carers undervalued and often don’t get the Charter is implemented throughout the support and/or information they require. pathway.

Improve the signposting of services [YCYW: guide people through the system] Things people told us Possible Solutions

 Signposting is inconsistent within PCLS,  Develop a single point of contact model GPs and within the voluntary sector. around GP clusters which includes  Signposting needs to be online and physical and mental health and possibly paper, such as the Hope Guide as often includes social prescribing and IAPT. people who are marginalised do not  A simple digital resource which GPs can access IT regularly. signpost individuals to and which also has an area for clinicians that outlines all of the relevant services. Could also include resources and tools.

Page 58 Agenda Item 14

Bath & North East Somerset Council

MEETING: Health & Wellbeing Select Committee

EXECUTIVE FORWARD th MEETING 27 September 2017 PLAN REFERENCE: DATE: N/A

TITLE: Care home provision in Bath & North East Somerset

WARD: All

AN OPEN PUBLIC ITEM

List of attachments to this report: None

1 THE ISSUE

1.1 This paper provides a briefing on the care homes market in Bath & North East Somerset (B&NES). It offers an overview of the quality and supply in current provision as well as introducing some key gaps and challenges in the sector; notably in relation to dementia care for older people. A range of active projects and emerging initiatives that seek to address these challenges are also outlined.

2 RECOMMENDATION

2.1 That the content of the report is noted and facilitates further targeted enquiry.

3 RESOURCE IMPLICATIONS (FINANCE, PROPERTY, PEOPLE)

3.1 There are no direct resource implications to this report which is presented for information and to raise awareness of the care home market.

4 STATUTORY CONSIDERATIONS AND BASIS FOR PROPOSAL

4.1 Public Health & Inequalities: The Council has a duty under the Care Act (2014) to facilitate and oversee the care homes market and also ensure that all its residents have access to good quality, sustainable care and support.

Printed on recycled paper Page 59 5 THE REPORT

Capacity

5.1 The Care Quality Commission (CQC) lists 60 care homes in B&NES. The ‘Older Persons’ portion of that market consists of 36 homes offering 1,375 beds in total. Roughly a quarter of this capacity supports dementia care. Five homes offer nursing dementia care, another three provide residential dementia care and a further four homes offer dementia care to the under 65’s. Capacity breaks down as:

RESIDENTIAL 33% NURSING 41.5%

RESIDENTIAL DEMENTIA 8.5% NURSING DEMENTIA 17%

5.2 At 11th September 2017, there are 40 available vacancies across B&NES and 11 of these are for nursing beds. However, the bed types do not always match the needs of people assessed and not all of them are affordable to the Council. Almost half of the 40 vacancies are in one particularly expensive home. This puts a lot of pressure on the Council when securing placements and can also cause delays in hospital discharge. Actions to address this are explained further in the paper.

5.3 The Council currently has 320 active placements in B&NES, including 34 Continuing Healthcare beds on behalf of the CCG. This is a market share of 23%. The remaining beds are either vacant or occupied by placements from other Local Authorities/CCGs or self-funders. The Council and CCG also make some out of area placements though this is a minority.

Quality

5.4 The main responsibility for quality assurance lies with CQC as industry regulator. The majority of care homes in B&NES are rated by CQC as ‘Good’ though a few do ‘Require Improvement’ in one respect or another.

5.5 The Council has an active role in reviewing, maintaining and improving care home quality. Effective and regular communication between commissioners, CQC inspectors, care homes and local safeguarding leads ensure that their roles are complementary to each other.

5.6 A small number of local care homes do occasionally require targeted support and the Council actively works with these homes to support them to improve their quality of care. This is a key priority for the Commissioning team.

Market conditions

5.7 It is well-documented publically that the UK care homes sector is challenging financially and also in quality, supply vs. demand and sustainability of homes & care businesses themselves. The national picture resonates in B&NES.

5.8 As explained in 5.2, although there are a number of vacancies available they may not be affordable to the Council, attractive to local people or meeting the right level of need. For these reasons, together with the pressure to discharge Printed on recycled paper Page 60 people in a timely way from hospital, the Council has seen bed prices for care homes increase significantly in the last 18 months. In a commercial market where the balance of power favours providers, charges can increase. Competition in the market is more between purchasers of care for access to services, rather than between providers.

5.9 As people with complex needs live independently in the community for longer; so their needs are higher when they need residential care. This again impacts on cost and also means less demand for ‘traditional’ residential care beds. Costs for these beds are not reducing, largely because the mismatch between supply & assessed need, as well as the priority to support hospital discharge maintains a demand for access to these homes, despite their limitations.

5.10 Much of that ‘traditional’ residential care is provided in older, smaller properties. In many cases properties are either limited in development potential or otherwise unaffordable for owners to develop to modern standards and expectations. People with high levels of personal care can then be placed in a nursing home purely to access a more suitable physical environment or higher staffing levels.

5.11 The majority of new provision tends to be in large facilities and pitched at the luxury self-funding end of the market. However when self-funders’ savings and assets become reduced below the level where they are eligible for financial support from the Council, the Council then picks up the responsibility for funding their future care needs.

5.12 Between 2016 and 2017, 6 care homes in B&NES closed with the loss of almost 200 beds. This is due to a range of factors but again has reduced capacity significantly, pushed up fees and led to greater pressure on hospital discharges. The commissioning team has a successful track record in managing these closures and ensuring continuity of care for residents. The team continues to have an active relationship with CQC so it can plan contingencies for any further potential closures or transfers of care home ownership.

Current initiatives, opportunities and intentions

5.13 Whilst there are many challenges in the current care home market, Commissioners are working together with the Clinical Commissioning Group (CCG) and also with care homes themselves, to develop new models and meet the needs of our changing population. Keeping people at home for longer means that often their needs are more complex when they are admitted to care homes. Many people are admitted to care homes from hospital too, a trend which local authorities are working to address, by offering alternatives before a permanent decision about care needs is made. 5.14 The Council has invested significantly in the Community Resource Centres through £700k capital funding and service redesign. People reliant on the Council’s financial support will have increased access to forward-thinking specialist dementia care as well as care for people with more complex general needs, such as needing 2 carers to help them mobilise. 5.15 ‘Discharge 2 Assess’ beds: A result of joint commissioning across the Council and CCG in partnership with the not-for-profit sector; commissioners are piloting a scheme to deliver 5 short-stay beds to assess people’s long term care needs. This alleviates pressure on hospital discharge and allows people’s long term needs to

Printed on recycled paper Page 61 be more accurately assessed outside the acute hospital setting. It will also help the Council to place people in a more planned way and negotiate fees with providers with more time. 5.16 Workforce development: B&NES is a member of the ‘Proud to Care-South West’ campaign. This seeks to make social care a more attractive career option and tackle the longstanding challenges of recruitment and retention in care homes. Qualified nurses are in particularly short supply. There are enduring issues of staff turnover and shortage, with close attention on the possible impact of the UK leaving the European Union. Proud to Care has a presence on the Council website which will continue to evolve alongside a commissioning web portal. 5.17 Joint commissioning: Council and CCG commissioners increasingly find benefits in working together on a range of care home contracting and quality assurance initiatives. This increases consistency for providers. Regional and sub-regional commissioning initiatives across the South West and Sustainability and Transformation (STP) footprint with Wiltshire and Swindon are also progressing. 5.18 With both care home services and premises largely in private hands, there is a need to acknowledge the gap between the fair price of care concept, and the realities of the commercial market where providers often report funding shortfalls. Funding models based on quality of accommodation as well as the care offered, may be more viable for the future. This reflects the nature of the ‘hotel’ business model often operated by providers and is an approach that Commissioners will be developing with providers for future years. 5.19 To support an affordable care homes market in future it may be necessary, as other Councils have found, to develop fair and reasonable positions regarding: increased use of care homes in neighbouring local areas; ‘top-up’ funding from third parties for accessing preferred environments costing more than the Council’s duty to fund; and reserving the right to move self-funders to more affordable homes when their assets drop below the funding threshold. 5.20 Other emerging priorities likely to have a positive impact include: i. Greater competition in specialist service areas e.g. complex residential and nursing dementia care. ii. Better communication with Planning teams so commissioners can influence development applications; ensuring social care priorities are embedded. iii. Integrated strategic commissioning structures across the Council and CCG which include market oversight & contingency planning. iv. Reduce demand by increasing self-care & preventative approaches. v. Enhance negotiation capacity through Brokerage and focussing on people’s strengths in support planning. vi. New-build opportunities and alternative service models e.g. developments in Extra Care e.g. the Council is working with Hanover Housing Association on developing innovative Extra Care services at Lansdowne Road. The potential to develop high needs Extra Care mitigates risks from old care home stock going offline while helping more people with developing care needs live independently in the community for longer.

5.21 These ideas are part of the Council’s emerging market position. The Care Act (2014) places a duty on commissioners to facilitate a vibrant, good quality care market that is sustainable and for which possible service interruptions are planned for. A key requirement of this is the Market Position Statement (MPS, in-draft) Printed on recycled paper Page 62 which lays out commissioners’ long term intentions in these areas and how they will collaborate across the sector to create and capitalise on opportunities for meeting the community’s evolving needs. 6 RATIONALE

6.1 The care homes market is complex, with many independent organisations and connections with other care sectors. Tackling the issues means multiple efforts working in parallel, with a greater understanding of the commercial market and ability to respond to a rapidly changing and sometimes vulnerable provider sector. This requires a balance between many competing factors and interests.

7 OTHER OPTIONS CONSIDERED

7.1 Many of the initiatives discussed in this paper are early in development; emerging alongside other projects outside of this paper’s scope. Accordingly there remains significant potential for considering other options during the commissioning process and generation of specific recommendations.

8 CONSULTATION

8.1 Cllr Vic Pritchard – Cabinet Member, Adult Care, Health & Wellbeing

8.2 Jane Shayler – Director, Integrated Health & Care Commissioning

8.3 Caroline Holmes – Senior Commissioning Manager, Better Care

8.4 Tammy Randall – Commercial Finance Manager

9 RISK MANAGEMENT

9.1 This paper offers a general introduction the local care homes market so a formal risk assessment is not required at this stage. Following this advisory paper, a risk assessment related to specific issues and recommendations will be undertaken in compliance with the Council's decision making risk management guidance.

9.2 Financial risks have been identified in the Council’s published savings strategy.

9.3 To meet its statutory duties in residential care, the Council is required to make an ongoing assessment of the impact on communities and care organisations.

Contact person Vincent Edwards, 01225 477289 [email protected]

Background papers None

Please contact the report author if you need to access this report in an alternative format

Printed on recycled paper Page 63 This page is intentionally left blank HEALTH AND WELLBEING SELECT COMMITTEE

This Forward Plan lists all the items coming to the Panel over the next few months.

Inevitably, some of the published information may change; Government guidance recognises that the plan is a best assessment, at the time of publication, of anticipated decision making. The online Forward Plan is updated regularly and

Page 65 Page can be seen on the Council’s website at:

http://democracy.bathnes.gov.uk/mgPlansHome.aspx?bcr=1

The Forward Plan demonstrates the Council’s commitment to openness and participation in decision making. It assists the Panel in planning their input to policy formulation and development, and in reviewing the work of the Cabinet. Agenda Item 15 Should you wish to make representations, please contact the report author or Mark Durnford, Democratic Services (01225 394458). A formal agenda will be issued 5 clear working days before the meeting.

Agenda papers can be inspected on the Council’s website and at the Guildhall (Bath), Hollies (Midsomer Norton), Civic Centre (Keynsham) and at Bath Central, Keynsham and Midsomer Norton public libraries. Ref Decision Report Author Title Strategic Director Lead Date Maker/s Contact 27TH SEPT 2017 27 Sep 2017 HWSC Update on the Transfer of Services from the RNHRD to Emma Mooney Tracey Cox the RUH (Adult Fatigue) Tel: 01225 825849

27 Sep 2017 HWSC Mental Health Pathway Review Jane Shayler

27 Sep 2017 HWSC Page 66 Page Care Home Provision Caroline Holmes Jane Shayler Tel: 01225 477313

29TH NOV 2017 29 Nov 2017 HWSC Dami Howard, Reg Strategic Director - Local Safeguarding Adult's Board Annual Report Pengelly People

ITEMS YET TO BE SCHEDULED HWSC Update on the Transfer of Services from the RNHRD to Emma Mooney Tracey Cox the RUH (Pain Services) Tel: 01225 825849

HWSC Sue Blackman, Your Care Your Way Update Jane Shayler Jayne Carroll Tel: 01225 396180,

1 Ref Decision Report Author Strategic Director Title Date Maker/s Contact Lead HWSC Integrated Urgent Care Procurement Catherine Phillips Tracey Cox Tel: 01225 831868

HWSC Dentistry Services Ruth Bartram Tel: 01138 251522

HWSC Non-Emergency Patient Transport Service Tracey Cox

HWSC

Page 67 Page Eye Care

HWSC NHS 111 update Tracey Cox

HWSC Strategic Director - Loneliness report - update People

HWSC Strategic Director - Homecare Review People

The Forward Plan is administered by DEMOCRATIC SERVICES: Mark Durnford 01225 394458 [email protected]

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