Health & Adult Social Care Select Committee - Thursday 4 December 2025, 10:00am - Buckinghamshire Council Webcasting

Health & Adult Social Care Select Committee
Thursday, 4th December 2025 at 10:00am 

Agenda

Slides

Transcript

Map

Resources

Forums

Speakers

Votes

 
Share this agenda point
  1. Zoe McIintosh - Chief Executive, Healthwatch Bucks
  2. Cllr Stuart Wilson
Share this agenda point
  1. Sally Moore - Senior Scrutiny Officer
  2. Cllr Stuart Wilson
Share this agenda point
  1. Cllr Julia Wassell
  2. Cllr Stuart Wilson
Share this agenda point
  1. Cllr Stuart Wilson
Share this agenda point
  1. Sally Moore - Senior Scrutiny Officer
  2. Cllr Stuart Wilson
  3. Mr Andrew McLaren
  4. Cllr Stuart Wilson
  5. Sally Moore - Senior Scrutiny Officer
  6. Cllr Stuart Wilson
  7. Dr Amanda Bartlett
  8. Cllr Stuart Wilson
  9. Sally Moore - Senior Scrutiny Officer
  10. Cllr Stuart Wilson
  11. Gemma Thomas
  12. Cllr Stuart Wilson
Share this agenda point
  1. Raghuv Bhasin
  2. Cllr Stuart Wilson
  3. Gemma Thomas
  4. Cllr Julia Wassell
  5. Cllr Stuart Wilson
  6. Cllr Trevor Snaith
  7. Cllr Stuart Wilson
  8. Raghuv Bhasin
  9. Cllr Stuart Wilson
Share this agenda point
  1. Cllr Isobel Darby
  2. Cllr Carol Heap
  3. Craig McArdle - Corporate Director, Adults and Social Care
  4. David Munday
  5. Mr Andrew McLaren
  6. Raghuv Bhasin
  7. Nicola Newstone
  8. Gemma Thomas
  9. Dr Amanda Bartlett
  10. Cllr Stuart Wilson
  11. Gemma Thomas
  12. Nicola Newstone
  13. Cllr Stuart Wilson
  14. Cllr Simon Rouse
  15. David Munday
  16. David Munday - Director of Public Health
  17. Cllr Stuart Wilson
  18. Gemma Thomas
  19. Cllr Stuart Wilson
  20. Cllr Simon Rouse
  21. Cllr Stuart Wilson
  22. David Munday - Director of Public Health
  23. Cllr Stuart Wilson
  24. Cllr Robin Stuchbury
  25. Cllr Stuart Wilson
  26. Raghuv Bhasin
  27. Mr Andrew McLaren
  28. Cllr Stuart Wilson
  29. Cllr Robin Stuchbury
  30. Raghuv Bhasin
  31. Cllr Stuart Wilson
  32. Cllr Dominic Pinkney
  33. Raghuv Bhasin
  34. Craig McArdle - Corporate Director, Adults and Social Care
  35. Cllr Stuart Wilson
  36. Cllr Dominic Pinkney
  37. Raghuv Bhasin
  38. Cllr Dominic Pinkney
  39. Cllr Stuart Wilson
  40. Cllr Shade Adoh
  41. Cllr Stuart Wilson
  42. Zoe McIintosh - Chief Executive, Healthwatch Bucks
  43. Cllr Stuart Wilson
  44. Cllr Phil Gomm
  45. Cllr Stuart Wilson
  46. Gemma Thomas
  47. Cllr Phil Gomm
  48. Gemma Thomas
  49. Cllr Stuart Wilson
  50. Cllr Phil Gomm
  51. Cllr Stuart Wilson
  52. Cllr Julia Wassell
  53. Cllr Stuart Wilson
  54. Gemma Thomas
  55. Mr Andrew McLaren
  56. David Munday - Director of Public Health
  57. Dr Amanda Bartlett
  58. Cllr Stuart Wilson
  59. Cllr Julia Wassell
  60. Cllr Stuart Wilson
  61. Cllr Shade Adoh
  62. Cllr Stuart Wilson
  63. Raghuv Bhasin
  64. Cllr Stuart Wilson
  65. Cllr Shade Adoh
  66. Raghuv Bhasin
  67. Cllr Stuart Wilson
  68. Cllr Julia Wassell
  69. Cllr Stuart Wilson
  70. Cllr Thomas Hogg
  71. Cllr Stuart Wilson
  72. Raghuv Bhasin
  73. Cllr Thomas Hogg
  74. Cllr Stuart Wilson
  75. Raghuv Bhasin
  76. Mr Andrew McLaren
  77. Cllr Stuart Wilson
  78. Cllr Frances Kneller
  79. Gemma Thomas
  80. Cllr Frances Kneller
  81. Cllr Stuart Wilson
  82. Cllr Carol Heap
  83. Cllr Stuart Wilson
  84. Gemma Thomas
  85. Cllr Stuart Wilson
Share this agenda point
  1. Cllr Isobel Darby
  2. Cllr Carol Heap
  3. Cllr Stuart Wilson
  4. Cllr Julia Wassell
  5. Craig McArdle - Corporate Director, Adults and Social Care
  6. David Munday - Director of Public Health
  7. Cllr Isobel Darby
  8. Cllr Julia Wassell
  9. Dr Amanda Bartlett
  10. Cllr Stuart Wilson
  11. Cllr Frances Kneller
  12. Cllr Stuart Wilson
  13. Craig McArdle - Corporate Director, Adults and Social Care
  14. Conrad Eydmann
  15. Conrad Eydmann - Head of Strategic Commissioning - OP
  16. Cllr Frances Kneller
  17. Cllr Stuart Wilson
  18. Craig McArdle - Corporate Director, Adults and Social Care
  19. Cllr Stuart Wilson
  20. Zoe McIintosh - Chief Executive, Healthwatch Bucks
  21. Conrad Eydmann - Head of Strategic Commissioning - OP
  22. Cllr Stuart Wilson
  23. Cllr Dominic Pinkney
  24. Conrad Eydmann - Head of Strategic Commissioning - OP
  25. Cllr Stuart Wilson
  26. Cllr Carol Heap
  27. Cllr Stuart Wilson
  28. Cllr Phil Gomm
  29. Cllr Stuart Wilson
  30. Cllr Shade Adoh
  31. Cllr Stuart Wilson
  32. Dr Amanda Bartlett
  33. Craig McArdle - Corporate Director, Adults and Social Care
  34. David Munday - Director of Public Health
  35. Cllr Stuart Wilson
  36. Conrad Eydmann - Head of Strategic Commissioning - OP
  37. Cllr Robin Stuchbury
  38. Cllr Stuart Wilson
  39. Cllr Carol Heap
  40. David Munday - Director of Public Health
  41. Cllr Robin Stuchbury
  42. Cllr Stuart Wilson
  43. David Munday - Director of Public Health
  44. Cllr Stuart Wilson
  45. Cllr Thomas Hogg
  46. David Munday - Director of Public Health
  47. Conrad Eydmann - Head of Strategic Commissioning - OP
  48. Cllr Thomas Hogg
  49. Craig McArdle - Corporate Director, Adults and Social Care
  50. Cllr Stuart Wilson
  51. Cllr Carol Heap
  52. Cllr Stuart Wilson
  53. Craig McArdle - Corporate Director, Adults and Social Care
  54. Cllr Stuart Wilson
  55. Craig McArdle - Corporate Director, Adults and Social Care
  56. Cllr Stuart Wilson
  57. Cllr Julia Wassell
  58. Cllr Stuart Wilson
Share this agenda point
  1. Cllr Isobel Darby
  2. Cllr Stuart Wilson
  3. Craig McArdle - Corporate Director, Adults and Social Care
  4. Cllr Stuart Wilson
  5. Cllr Julia Wassell
  6. Cllr Isobel Darby
  7. Craig McArdle - Corporate Director, Adults and Social Care
  8. Cllr Stuart Wilson
  9. Craig McArdle - Corporate Director, Adults and Social Care
  10. Cllr Stuart Wilson
  11. Cllr Dominic Pinkney
  12. Craig McArdle - Corporate Director, Adults and Social Care
  13. Cllr Stuart Wilson
  14. David Munday - Director of Public Health
  15. Cllr Stuart Wilson
  16. Zoe McIintosh - Chief Executive, Healthwatch Bucks
  17. Craig McArdle - Corporate Director, Adults and Social Care
  18. Cllr Stuart Wilson
  19. Cllr Robin Stuchbury
  20. Cllr Stuart Wilson
  21. Cllr Robin Stuchbury
  22. Cllr Stuart Wilson
  23. Cllr Isobel Darby
  24. Craig McArdle - Corporate Director, Adults and Social Care
  25. Cllr Stuart Wilson
Share this agenda point
  1. Cllr Julia Wassell
  2. Cllr Stuart Wilson
  3. Cllr Frances Kneller
  4. Cllr Stuart Wilson
  5. Cllr Dominic Pinkney
  6. Cllr Stuart Wilson
Share this agenda point
  1. Webcast Finished

Zoe McIintosh - Chief Executive, Healthwatch Bucks - 0:00:05
Cllr Stuart Wilson - 0:00:09
Good morning, everybody, and welcome to the Health and Adult Social Care Select Committee
on Thursday, the 4th of December, 2025. My name is Stuart Wilson. I'm chairman of the
Health and Adult Social Care Select Committee, commonly known as HASC. For those that like
an abbreviation, I think we've got quite a few of those in the pack today, so I'm hoping
our experts will be able to walk us through all the three letter acronyms that we have.
Welcome to everybody. Welcome to the members of the committee and also to all our guests,
attendees who have come from all of our different parts of the health network. The meeting is
being webcast and recorded and by virtue of being here you are consenting to be part of
If anybody doesn't want to be part of that,
then please let officers know
and we'll try and find a convenient location
for you to hide somewhere in the room.
I'd ask everybody please to turn your mobile phones off
or to silent so that we're not disturbed through the meeting.
We don't have any fire alarms planned for this morning,
so if the fire alarm does go off,
please follow Sally and I out of the main doors
and congregating in the car park over to the left.
It is a long agenda today. We have a number of substantive items.
I'm not planning a break, but if people want to use the facilities, we have the cafeteria
next door, bathrooms over to the left there. So please use that to if you need a break
in the meeting. And I'm grateful for Sally Moore stepping in as our Senior Scrutiny Officer
Liz Wheaton who normally would be taking this meeting is away. So thank you Sally for pulling

1 Apologies for Absence

everything together for this meeting. So the first item on the agenda is apologies for absence or
changes in membership. Thank you Chairman we've had an apology from Councillor
Sally Moore - Senior Scrutiny Officer - 0:02:19
Leslie Clark today and Councillor Hope will be delayed due to traffic problems.
Cllr Stuart Wilson - 0:02:23
We haven't heard from Councillor Sherwell yet I understand and I
understand the cabinet member Isabelle Darby is on her way in so that's fine

2 Declarations of Interest

we'll note that. Members next item number two declarations of interest do members
of the committee have any items that they wish to declare? Thank you chair I'm
Cllr Julia Wassell - 0:02:52
a member of the Cigna PCN which I haven't registered yet but I will at the
Next meeting. Thank you. Yes, please do get that registered,
Cllr Stuart Wilson - 0:02:59
Councillor Wassell. If there are no other declarations of interest,
I'll move on to agenda item 3, minutes of the previous meeting.

3 Minutes of the Previous Meeting

Could I ask committee members to confirm the minutes of the meeting held on Thursday 2nd
of October as a correct record? Agreed.
Thank you. I'll sign those at the end of this meeting
Cllr Stuart Wilson - 0:03:23
to save time. Moving on to agenda item number four, public
questions. This is an opportunity for members of the public to submit questions to the committee.

4 Public Questions

We do welcome those. This is one of those committees where there are normally a few
questions from members of the public. This meeting is no different.
So Sally, perhaps if you would like to please take us through those questions. Thank you.
Thank you Chairman. The first question has been submitted by Rowena Reid. Buckinghamshire
Sally Moore - Senior Scrutiny Officer - 0:03:55
is approximately 68 miles long and 40 miles wide, excluding Milton Keynes. Please explain
how the decision was taken to reduce the overnight community nursing team to one team of two
nurses for the whole of Buckinghamshire. How is this an efficient use of time as the majority
of the shift can be spent travelling rather than with patients. An end of life cancer patient in
need of pain relief in the south had to wait an hour for the first and 90 minutes for the second
because both nurses were in the north. The call for the second medication was just two and a half
hours after the first dose. Travel time was 90 minutes to reach the patient. Thank you and I
Cllr Stuart Wilson - 0:04:38
believe either Raghu or Andrew you're going to verbally answer that question. A written
response will be included in the minutes. Thank you.
Mr Andrew McLaren - 0:04:49
Thank you, Chair. Would you mind introducing yourself as well?
Andrew McLaren, Chief Medical Officer at Buckinghamshire Healthcare. So Buckinghamshire Healthcare NHS
Trust provides community and adult nursing teams to support patients who live well at
home. In 2019 we noted that it was only possible due to a shortage of staff willing or able
to work night shifts to provide two teams across the patch 40 percent of the time.
As a result, after consultation, we reduced the service to a single team with a registered
nurse and healthcare assistant to visit patients and a second nurse to answer calls.
The team provide cover to a wide geographic area as is noted in the question, but it should
be remembered that the community nurses are only one component of out -of -hours care.
The team also signpost patients to alternate provision including 111 and ambulance services
if a delay in providing care directly is anticipated.
The committee should note that we will be enhancing our daytime services further but
also withdrawing the overnight element of the service between 11pm and 7am provisionally
from the 1st of February 2026 and will provide patients with appropriate guidance on how
to access care overnight if required along with an undertaking to visit promptly in the
morning if the need arises. Our patients and their experience of our services are a priority
for us and will be tracking the impact of this innovative way of providing the community
services going forward. Thank you.
Cllr Stuart Wilson - 0:06:26
Thank you, Mr McLaren. Do we have the next question please?
Sally Moore - Senior Scrutiny Officer - 0:06:32
The second question has also been submitted by Rowena Reid.
How are non -medically trained staff from doctor surgeries going to assess whether a patient
with complex medical needs who is non -verbal and disabled can see a doctor if a carer is
asking for help? Can the triage assessment be trusted given that no one past the age
of 18 has an open door. Thank you and I believe Dr Bartlett you're going to
Cllr Stuart Wilson - 0:06:56
answer this on behalf of the GPPA is that correct? Yeah do you want me to
Dr Amanda Bartlett - 0:07:04
introduce myself? Yes please. I'm Amanda Bartlett, GP in Buckinghamshire and
portfolio clinical lead for Bucks GP Provider Alliance and today I'm
deputising for George Gabriel. Dr Bartlett could you just pull the
a bit closer to you, it may be hidden behind the laptop, that might help people hear you.
Sometimes if you're away from these microphones, we can't quite hear you in the room, so if
members could, and guests, speak on the microphones so we can all hear you, that would be great,
thank you.
Yeah, so it's of course very important that patients with the most complex medical needs
can access care from their GP.
So in response to the question, since the 1st of October,
GP practises have been contractually obliged
to provide equal access via online, in person,
and via telephone.
And typically, these requests are fed through an online triage
tool where a GP or a clinician under the supervision of a GP triages the requests and then allocates
appointments according to clinical need. This is in contrast to sort of the previous
way of working where often appointments were allocated on a first come first serve basis
in the morning rush. In addition practises are able to use further information to guide
their decision making process including flags on records such as things like being a carer
or having a learning disability and there's also more and more use of segmentation tools
such as the John Hopkins, which allows patients
to be prioritised according to underlying health needs.
So in summary, this new way of working,
in this new way of working, triage
is designed to be clinically led.
And it should result in appointments
being more closely matched to clinical need
and also ensure that the most vulnerable are recognised and prioritised appropriately.
Cllr Stuart Wilson - 0:09:42
Thank you. I think we have a third question which you're going to read out.
Thank you, Chairman. This is a summary of the question which was submitted by Mike Etkin.
Sally Moore - Senior Scrutiny Officer - 0:09:50
The Buckinghamshire Strategic Update cites the need to empower residents to focus on prevention,
shift care from hospitals to communities, prioritise improvements in health outcomes while meeting financial obligations,
and adapt the focus for different areas according to needs.
In considering how to achieve these needs and the requirement to move to a neighbourhood health service,
can the Buckinghamshire Executive Partnership explain the following?
How will it comply with the 10 principles contained in NHS England Statutory Guidance,
working in partnership with people and communities?
Cllr Stuart Wilson - 0:10:33
Thank you. And I think Gemma, you're going to respond on that one on behalf of everybody.
Gemma Thomas - 0:10:46
Yes, thank you. Hi, I'm Gemma Thomas. I'm Director of Strategy for Buckinghamshire Healthcare
Our executive partnership is committed to ensuring that local people and communities
are at the heart of decision making and service transformation.
We involve residents, health watchbacks and the voluntary and community sector representatives
in our governance structures, including within our neighbourhood steering groups, so that
those with lived experience can help shape our priorities and actions.
Our approach is to engage with communities from the outset using a mixture of public
feedback, direct engagement and data to understand local needs.
And that data includes the joint strategic needs assessments as well as community insights.
We're particularly focused on trying to reach groups who experience health inequalities
through working with trusted leaders in those communities and supporting initiatives like
community researchers, which is led on by Health Bucks and Bucks Health and Social Care
Academy and the recent recruitment of community health and wellbeing workers in our most deprived
areas.
For those roles, we recruit and train people from these communities to understand their
experience needs and aspirations, as well as helping to develop that trust over time
with those communities, which we think is essential.
We work closely at BEP, which is Buckinghamshire Executive Partnership, works closely with
Health WatchBucks and the voluntary sector to broaden that involvement, and we're committed
to providing clear and accessible information regularly.
We're currently in the process of recruiting a communications and engagement manager, which
will help to further strengthen that work and support we support a range of
people to participate and build on existing assets and networks to empower
local voices. So for example we have close relationships with the community
boards. As we develop the six neighbourhoods across Buckinghamshire
we'll continue to review and improve our engagement processes ensuring that local
voices remain central to our transformation journey and this
commitment set out in the health and well -being strategy so the action plan
on our ways of working as a section on communities and we will continue to
review that and improve that to ensure that local voices remain at
the heart of that transformation journey and Zoe is helping us to lead on that.
Cllr Stuart Wilson - 0:12:55
Thank you, thank you for the public questions and for the responses. The
written responses will be included in the minutes. I would suggest that members
and those asking the questions might want to digest those responses.
And if we have any follow -ups, we might want to come back on some of those.
Certainly there were some points, I think, in the first question and response that I
think we might want to have a consideration of.
So I would just ask members to perhaps review the written responses as part of the minutes
and see whether or not we have any further follow -ups on those points.
Thank you.
Thank you for the answers. So moving on to agenda item 5, Chairman's

5 Chairman's update

update. So I have got a few points to update on since the last meeting. A working group
of HASC members met on two occasions to discuss and prepare a response to the Council's draught
local plan. The consultation ended on 29th of October. And we submitted a reasonably
detailed response I think and I'm grateful for those members that made themselves available
to contribute to that. I thought it was a good collective effort on that part. We will
be keeping a close eye on the key developments of the local plan and any opportunities to
feedback on any further proposals. I also received a letter from the Chief Executive
of Oxford Health requesting feedback on their strategy refresh to align with the NHS 10 -year
plan. Due to the tight timeframes for responding between our meetings, I prepared a response
which was submitted on behalf of the committee and that has been circulated to the committee
as was the response to the local plan. And I am grateful that we have got Zoe McIntosh
with us today on Health Watch Bucks. It is good to have you here Zoe and I understand
There's obviously a lot been going on in the Health Watch world and we kind of continue
to watch with interest on what happens on both the national and local landscape on that.
And there was a motion to Buckinghamshire full council last week, which occurred on
the 26th of November, regarding emergency care provision.
and that motion following a varying of that motion was passed I think
unanimously I couldn't quite see behind me but those pretty much behind I've put
a copy of the motion in its final form on everybody's table so you can all see
that and we'll come back to that and it relates to a question that will be
coming up shortly. But I think that's important, you know, when we have a motion at council
and that we have council support that we respond and it does call on this committee to do that.
I also have to offer some apologies to Councillor Wassell who sent an email in to Liz Wheaton
and Liz took it as a statement rather than a question. So I'm going to read it out if
I may, by way of an apology, it does have a couple of questions in it which health colleagues
may have not had any time to prepare but hopefully we can get you a written response. So it says
dear chair and members of the committee, we have recently met for the first time as the
health subgroup of the High Wycombe Town Committee. We would like to express our support for the
development of the new Wycombe Hospital to accommodate existing services. We would also
like clarification on what is the future of the old use of the old hospital site and wish
to ask that consideration be given to purchasing the formal Staples site for health -related
purposes. That's a question. Our group strongly supports the restoration of accident and emergency
services in High Wycombe. Withdrawal of A &E, maternity and children's and baby units have
in our experience disproportionately affected certain groups, including larger families,
at the elderly and particularly the frail elderly.
We also wish to acknowledge the excellence of the stroke and coronary care services currently
provided at Wickham Hospital and commend the dedication and achievements of the staff.
We welcome the forthcoming NHS initiative, Health on the High Street, located on the
ground floor of the Eden Library, and our group will be grateful for an invitation to
the opening event planned for December.
We have received information from Public Health regarding their activities, plus further information
about health inequalities in Wycombe, which we greatly appreciate. We thank the committee
for its continued work on behalf of residents and look forward to engaging further in the
future. So I don't know whether BHT want to respond on the particular question about the
Wycombe site first or whether you want to do it by a written response.
So I think we'll provide a detailed written response. We've looked quite carefully at
Raghuv Bhasin - 0:17:57
a staple site and is financially prohibitive,
but we can provide some of the details for doing that.
I'd be very happy, I'm sure colleagues would be very happy
to meet with the subgroup as well, if that would be useful.
And absolutely want to engage going forward
around our broader plans for WICM
and we're working with Amanda and GP colleagues
about how we can do that collectively.
But we'll provide a full written answer
to give them the detail of the questions,
but very keen to meet with the group
and engage as much as we can.
Thank you.
Thank you.
Cllr Stuart Wilson - 0:18:31
And I saw nodding from our ICB colleagues
about the Health on the High Street and invitation
going to the subgroup.
It has actually opened in a soft launch last week.
So you can go visit it.
Gemma Thomas - 0:18:43
And we are just planning a proper launch event in January.
So we'll make sure the dates are sent out via Craig and David.
Cllr Julia Wassell - 0:18:55
Okay thank you very much for that and apologies again Councillor Wassell that
Cllr Stuart Wilson - 0:19:01
we missed your email that came in to myself and the the officer. Okay we have
a member question so from a backbench member who's not a member of this
committee I'm going to take that question now and Councillor Snith
welcome to I think your first ask would you like to read your question and I
Cllr Trevor Snaith - 0:19:28
will give you the response on behalf of the committee thank you last week the
council approved a motion asking ask could you bring your microphone a bit
closer please Councillor Snith. You can move the microphone to you.
Last week, last week the council approved a motion asking HASC to consider review into
emergency care provision across Buckinghamshire. Now to date, and that was last week, 4 ,477
now over 4 ,800, Wickham residents have signed a petition calling for the restoration of
E &E services. Now that's a clear indication of the strength of local feeling. The people
of Wickham feel disadvantaged with no E &E and emergency services local. Will residents,
particularly those in High Wickham, be able to share their experiences, their concerns
and evidence as part of this inquiry. Will all the NHS health partners and Books Council
commit to playing a full role in supporting HASC's inquiry, particularly addressing the
significant concerns of Wycombe area's residents? So since the closure of Wycombe General Hospital
in 2025, they feel totally disenfranchised.
Thank you.
Cllr Stuart Wilson - 0:21:02
Okay, so my response, so the question from a member comes to the chairman of the committee.
So thank you to Councillor Sather for his question. Further to the motion approved by
Buckinghamshire Council concerning the provision of emergency care across
Buckinghamshire. His long -standing advocacy for residents of High Wycombe
and the support for the ongoing petition are noted. This motion was only passed
last Wednesday evening and asked the Health and Adult Social Care Select
committee to consider an inquiry into emergency care provision. The agenda for this meeting
had been set for a considerable amount of time and had been issued prior to conclusion
of the council meeting. However, the first substantive item will be considering the impact
of the wide -ranging changes across the NHS and wider health landscape in Buckinghamshire
which clearly includes the provision of emergency care as one facet of the much wider picture.
HASC will have the opportunity to consider the forward work programme at the end of this
meeting.
With regard to the specific points, should HASC agree to a review of emergency care provision
in the forward plan, we'll need to set up a working group and agree the terms of reference.
Given the scope of the motion, I would anticipate that an inquiry would seek to receive evidence
from a wide range of stakeholders across the county.
Clearly members of this committee would also wish to provide input at the various stages.
You will also note that Councillor Leslie Clark, who sadly is ill today, and Councillor
Julia Wassell are members of this committee and are strong advocates for Wickham residents
and services.
As with any select committee inquiry, it would hold Buckinghamshire Council and all parts
of the health system to account requiring all relevant evidence it deems to be necessary
to be shared with the inquiry relating to emergency care provision across
Buckinghamshire including Wickham and I'm sure as he looks down the line the
representatives of those bodies will be happy to confirm this is the case.
Just to comment on specifics, so as Buckinghamshire Health Care Trust will absolutely
Raghuv Bhasin - 0:22:59
engage in detail with the inquiry as I said to Julia happy to meet directly
with high -working councillors to hear and discuss this in parallel to inquiry
and as part of inquiry should that be deemed helpful. Thank you and presumably
Cllr Stuart Wilson - 0:23:21
on behalf of Buckinghamshire Council cabinet member and the director of adult
social services would agree with that and the director of public health. Absolutely
chair. Thank you. Thank You councillor Snaith for your question and the work
The programme is right at the end of the agenda but you are more than welcome to stay on or
you can rush home and watch us at the end of the meeting.

6 NHS 10 year plan, Buckinghamshire Healthcare NHS Trust's strategy and Buckinghamshire's Health & Wellbeing strategy

So we move on to agenda item number six which is the NHS 10 -year plan.
Buckinghamshire healthcare NHS trust strategy and Buckinghamshire health and wellbeing strategy
which are all various limbs as well as the reorganisation
of the integrated care boards and neighbourhood health hubs
being announced, launched, and successfully piloted.
So there are lots and lots of moving parts in our healthcare
landscape at the moment.
And I thought it was very useful given,
I think in our very first meeting,
I think the NHS were just doing their announcement
about the 10 -year plan.
And so a few months on, I thought it'd be helpful to get a sense of what does this all mean?
And in particular, what does all this mean for Buckinghamshire?
Because we're really interested to understand from a resident point of view and a patient point of view,
how's it going to feel different?
So I'd like to welcome everybody to the meeting.
And at this point, I think I will ask, because I think pretty much all of you may well contribute,
starting from the Cabinet member to introduce themselves going down the line, and then I'm
going to hand over to the presenters.
Thanks very much.
Cllr Isobel Darby - 0:25:09
My name is Isabelle Darby, and I'm Cabinet member for Health and Wellbeing at the Council.
You don't sound very healthy at the moment, Councillor Darby.
I have had two days off and I thought I ought to make the effort to come today.
We very much appreciate the efforts, thank you.
I will probably defer to my officers to do most of the talking today.
Cllr Carol Heap - 0:25:32
Thank you. I'm Councillor Carol Heap, I'm Deputy Cabinet Member for Health and Wellbeing.
Hello, I'm Craig McCardell, Corporate Director for Adults and Health at Buckinghamshire Council.
Craig McArdle - Corporate Director, Adults and Social Care - 0:25:39
David Munday - 0:25:42
David Munday, Director of Public Health at Buckinghamshire Council.
Mr Andrew McLaren - 0:25:46
Andrew McLaren, Chief Medical Officer at Buckinghamshire Healthcare.
Raghuv Bhasin - 0:25:49
Raghavasthi Bhasin, Chief Executive Officer Interim at Buckinghamshire Healthcare.
Nicola Newstone - 0:25:55
Nicola Newstone, Assistant Director of Buckinghamshire for BobICB.
Gemma Thomas, Director of Strategy at Buckinghamshire Healthcare Trust and Director for Integrated
Care for the Postbase Partnership.
Gemma Thomas - 0:26:04
Dr Amanda Bartlett - 0:26:08
Amanda Bartlett, Portfolio Lead for Bucks GP Provider Alliance.
Cllr Stuart Wilson - 0:26:13
Thank you very much. So we have an all -star line -up and I believe,
Gemma, you're going to be leading on this. So if you could give us an introduction, I
would presume that committee members have read the pack and they are ready to go with
lots and lots of questions. So that would be great. Thank you.
Gemma Thomas - 0:26:33
Thank you. I will take it as read, but just to give a little bit of background, we've
been working on some of this since December 2023
across all partners.
So all of us are kind of represented here,
but also Oxford Health, also the voluntary community sector,
and Health Watch Bucks, and Bucks Health and Social Care
Academy have been a key part of it.
We've done a significant piece of work
collecting kind of public feedback,
looking at all the data, including our joint strategic
needs assessment to decide what we believe
is the right thing to do for the population in Buckinghamshire. The joint local health
and wellbeing strategy was approved by the Health and Wellbeing Board in July and was
approved by the council in September. That sets our overarching picture for what we want
to achieve for Buckinghamshire for the next 10 years. There's some very ambitious targets
in there which is why it's 10 years. That also acts as the strategy for Buckinghamshire
executive partnership which kind of feeds in the delivery of that to the
Health and Wellbeing Board. The Buckinghamshire Healthcare
NHS Trust strategy then sets out how what Buckinghamshire Healthcare Trust
needs to do to deliver that strategy. We're all committed as partners and
believe the best thing to do is work together in that collaborative way to
make the biggest difference for our patients and residents in Buckinghamshire
which is why we've kind of come together. In parallel to the work that
we've done in Buckinghamshire, the government have also shared their 10 -year plan and that
kind of highlight summary of that is in here. Fortunately, it is quite similar and we're
working kind of along the same lines and within both of the national and local strategy, there's
a key focus on kind of neighbourhoods and Buckinghamshire has got a well -developed plan
and is one of kind of the national pilot sites in implementing that and getting some good
early feedback. Just to note, we are still waiting for further guidance nationally, particularly
around that neighbourhood health element and the various contracts within that. We're not
letting that stop us from getting on, we're continuing to do what is right for our residents
and continue to work with them to develop whilst we wait for that. Just kind of high
level I think to achieve all of our ambitions, they are ambitious, but we do need to work
together I think that's a really really key point of this and so I just want to
pull out kind of four key things I think we need to do across Buckinghamshire.
We need to further empower our residents to focus on prevention and
support their own health and well -being. We know we've got increasing demand
across all of our services some of that is we want to happen because populations
are ageing and we're identifying unmet need but a lot of that can be avoidable
through kind of healthier lifestyle choices such as having a healthy weight
or stopping smoking. These behaviour changes will obviously be supported by structural
changes by a programme such as the Healthy School Neighbourhoods and kind of evidence -based
interventions such as health coaching. But we do require support from residents to kind
of push that message and empower them, so we would really like support and commitment
from that. There is going to be a shift of healthcare from the hospital settings into
the communities. We believe that's the right place to support patients, that's where they
live and work and operate their lives.
So where appropriate and possible to do so,
there will be that shift from that hospital into community.
So an example of that is we're currently piloting
community same day emergency care
in Poplar Grove practise in Aylesbury.
So if that is successful, we'll look to expand that
across Buckinghamshire where it's needed.
With all of this as well,
there is still a financial challenge
and that we can't get away from
and we'll need to prioritise our focus to make sure that we're improving health outcomes
for the populations that most need it, so we can make the biggest difference for population
health across the whole of Buckinghamshire and meet our financial obligations of all
the organisations. And these different levels of focus and resource will be required for
different areas so that we can really focus on those areas that need it most. This will
build on the work within Opportunity Bucks so that we are targeting resources that are
personalise to that community and where they'll most need it so we can have the biggest impact.
I'm going to leave it there. I'll just ask Nicola if there's anything she wants to come
in with on the ICB commissioning intentions.
Nicola Newstone - 0:31:03
Thank you Gemma. So the Thames Valley ICB commissioning intentions were released a few
weeks ago obviously in advance of Thames Valley ICB becoming a formal ICB from April 1st,
I think, so there's some summary slides in the pack.
I think again we're seeing a lot of alignment along with both the ten year plan but also
what's coming out locally in terms of the priorities in Buckinghamshire.
So the plan was based on population health data, performance information, but also significant
amount of insight that's been gathered over the last few years and themes coming out again
as we saw in the health and wellbeing strategy around more timely focus, more focus on prevention
and timely access.
And then the strategic objectives, the three that have been highlighted in the commissioning
intentions around commissioning to maximise value, commissioning for integrated and proactive
neighbourhood health as we've just talked to, and also prioritising prevention.
And there are some particular areas of focus around CBD, obesity and diabetes, and children's
and young persons' mental health.
But the focus is obviously broader and there are other areas around a focus on the frailty
and our most vulnerable communities in there.
So the commissioning attention has been released now, but it's not intended to be a static
document.
It should evolve and further engagement plans over the coming months to further develop
the commissioning plans of the new Thames Valley ICD.
Cllr Stuart Wilson - 0:32:42
Thank you. Do any other people wish to speak at the moment in terms of I should
also mention we obviously had the Director of Public Health's report
published recently as well so I forgot to mention that apologies David for doing.
That's fine I won't say anything more about that but if there are questions
regarding that specifically obviously happy to pick those up chair.
Anything from no okay so I'll open it out to questions so I've got Councillor
Rouse, Councillor Stutchbury, Councillor Pinckney and Councillor Gaughan. So
Councillor Rouse would you like to kick us off and Russell. Thank you Chairman.
Cllr Simon Rouse - 0:33:23
Two, one observation for the question and then a follow -up so I think it's page
The inequalities by deprivation life course, I've never seen it like that before and I
thought it was incredibly powerful, quite stark in terms of some of the differences
that it's showing.
And I suppose my question on that is, how often are you able to refresh the data sitting
underneath this?
Because I think actually this would be a really powerful ongoing tool for us to understand
the impact of the strategy.
And yes, so just kind of how we intend to use this and I think personally I think this
to be really helpful to keep having at the committee.
And then the second bit, which you actually referred to
in your summary, which is under the strategic priorities,
you reference it including having a focus
on the wider determinants of health,
such as housing, employment, and education.
I suppose my question is, in practical terms,
given actually there is a huge amount
within your own ecosystem that you're trying to influence,
in practical terms, what does that mean?
What will you be doing?
And how well connected, how well supported you feel
from the parts of the wider system that own
and drive those elements, how well connected
and involved you feel they are in the strategy?
So I'll answer certainly the first part of that question,
if that's okay, regarding the inequalities data.
So that's drawn directly
David Munday - 0:34:44
from our Joint Strategic Needs Assessment we often just refer
to as the GSNA, and there's a collection,
as obviously you can see, of different indicators there.
Most of those are annual indicators that update annually.
Slightly unhelpfully, they update at different points over the course of the year.
But the way that we undertake JSNA now is that where those updates come through,
we will be updating those data at that point.
So if the Committee want to be viewing this going forward,
then that would be welcome from my point of view,
from that perspective of how important it is
to be addressing some of the inequalities
that they highlight and agree with the point
about how stark this looks.
David Munday - Director of Public Health - 0:35:30
My word of caution or piece of advice with that
would be that a lot of the indicators described here
won't change quickly in time.
So what we can't do, and we need to resist
almost the temptation to do, is to look at an indicator
one year down the line.
And if it hasn't shifted, assume that means that the strategies that we're talking about
today are not working because a lot of them will take many years to shift.
So the way we've built the performance reporting of the health and wellbeing strategy itself
and the metrics that go to the health and wellbeing board are designed to have some
long -term outcomes but also some of the kind of more immediate process things we're doing
to try and address.
So I think we need to be looking at this continually but with that long -term lens.
Cllr Stuart Wilson - 0:36:22
If I could just come back on the second point.
So with the wider determinants I see us as having two key things that we can do.
Gemma Thomas - 0:36:28
So when you put us all together we are large employers and large purchasers within the county anyway.
So it's how we use our influence in that to support employing people from the communities,
ensuring that our colleagues have access to support around housing, how can we ensure
social value in all of our procurement processes.
And then the other part is that influencing part with our colleagues from the other areas
that have influenced planning, housing and estates.
So we've got some good connexions in with Opportunity Bucks.
obviously with that being multi -partner and we're just working closely particularly with
other colleagues in the council to strengthen some of those agendas so trying to get health
in all policy and we're also looking to restart or refresh and re -kick off a One Public Estate
group to make sure we're reviewing that and obviously David and Craig and others are linked
into the local plan so we can influence there as well. But more support to push that agenda
in those to push the health and well -being agenda
and those wider determinants in all
of the other remits is always helpful.
Do you want to come back on any of those?
Cllr Stuart Wilson - 0:37:45
If I may just come back on the first point, I mean, again,
Cllr Simon Rouse - 0:37:49
I thought the infographic is terrific and, you know,
Cllr Stuart Wilson - 0:37:53
it's obviously a central part of the public health report.
My understanding is we have that sort of data
down to very granular level.
And I've previously seen it, I think,
down to a ward level or something like that.
So I think as members it's a kind of thing that we can really get our teeth into.
And I think it will be useful perhaps at some point in the future to have a session on public
health at the local what you call neighbourhoods is quite a wide area.
What we call neighbourhoods is parts of our wards.
And it will be quite useful I think to have a session maybe offline or as part of this
meeting in terms of how much granularity there is in that public health data that, you know,
Gemma talked about in terms of all the information that's been gathered.
So I think that will be useful for probably all, for this committee and perhaps all members
of the council.
Just make a quick comment on that, Chair.
So we'd be happy to provide the committee with further kind of insight on that.
David Munday - Director of Public Health - 0:38:56
I think that we absolutely do look at this at quite a granular level.
there'll always be some indicators that sit more across the county or do sit at
that kind of neighbourhood level, others are kind of clearer at ward level.
The smaller the geography you go the more kind of variance that you get and
and you have to kind of understand some of the kind of fragility of the data so
but we would be happy to provide kind of further insight to the committee if that
was of help. And if I may, sorry, just for a moment, on
the second part of that initial question, I think it's helpful for the Committee to
know we have, in terms of that wider determinants kind of agenda, kind of my team have provided
an evidence study into the local plan, which as everyone in the Committee will know, has
recently closed that consultation phase, to provide some of the insight regarding how
how that as an example can contribute positively to the wider terms of health
and improve well -being in the in the county. Thank you, thank you for
Cllr Stuart Wilson - 0:40:03
clarifying that and you are a statutory consultee of the local plan as well I
understand so I think also in response to Councillor Rous's question because
that the other infographic that he picked up I had noted clearly if you
feel that this committee needs to understand some aspect from your point
of view please feel free to propose how we may be able to help take that message
back into Buckinghamshire Council so I think it's a two -way door is is the
suggestion so thank you councillor else for raising those two in point
councillor Stutchbury
Cllr Robin Stuchbury - 0:40:44
yeah firstly thank you very much for the report and and also the referring back
to the life inequalities roadmap. I thought that was really enlightening and
actually a great graphic and which brings me to some questions. In pages six
of 39 you talk about how services bring services to the communities and that's a
big issue you need to grow facilities for that. At what stage will you be start
piloting discussions about where those health centres service is going to be delivered.
Obviously you can't do that now but you will be in the future.
And then if you go down to your outcomes page 12 or 39 there were some things in there which
interest me and maybe where the council will cut in.
The delivery of inequality is going back to your road map.
It's a big hill to climb when we're going to do health and social care
because we need a direction of travel and we need to plan that because how
people live life successfully. The start of your road map, there you go, because you'll
start from the point of hope because you start with young people which you're
starting with their health outcomes not determined. Of course on your road map
when you get to the end of it many of the people's health outcomes would already have
been determined by their life experiences so you're starting at a good point and at
the end you've got a point where you perhaps didn't want to be so how you balance that
out because resources need to be found for both. And lastly I didn't note in there some
of the interest in neurodiversity and is huge player in health outcomes people who are neurodiverse
don't make good choices because of their dispositions and they don't always make large health choices
and there was nothing I saw in there about that and a little bit on that would be useful
to me, thank you.
Thank you, so I think there were three questions in there.
Cllr Stuart Wilson - 0:42:54
So, Raghu.
So if I maybe do estates and a bit on neurodiversity, maybe Andrew could do a bit on end of life
and support.
Raghuv Bhasin - 0:43:03
So on estates, so in our six neighbourhoods,
we're working to look at where the right estate is
to deliver services.
So for example, in your area, Robin,
we know that Lace Hill is coming on stream.
That will enable some space to be decanted
and created with a swan practise
which is co -located with Buckingham Community Hospital.
So we're then thinking about how we can use that
to create more of a hub.
and that's been replicated across the patch.
I would say the biggest challenges are probably
in Wickham and Aylesbury in terms of a state,
but again, we're trying to work across the trust
and primary care partners with council
to look at opportunities.
I think our ambition is to have quite clear plans
by the middle of next year for states
in each of those areas.
Equally, quite a lot of this data
is providing more care in people's homes,
So for example, engage with the voluntary community sector
to think about how we can support people in their homes
or in their local communities in a different way.
I think neurodiversity and neurodivergence
is a really important area.
We've just recently had the send inspection
of our services for children.
We know there's more we need to do,
particularly around diagnosis and support
and support for those families.
But again, it's quite often I think families in those environments find our services quite
fragmented, so they speak to colleagues in the council, they speak to colleagues in health
care, in Buckinghamshire health care, primary care, Oxford Health, mental health.
So the key theme of our neighbourhood health work is to bring those services together so
that we can do better care coordination.
And I'll just give you an example of a patient storey
which I think illustrates some of this issue.
So I was in our A &E a couple of weeks ago.
A lady was in their mid 40s, had a number of seizures.
Why was she having seizures?
She didn't sleep.
Why was she not sleeping?
She had two children with neurodivergent needs
who weren't getting the support they needed.
So that's a really good example of,
We could have given her a pill to stop the seizures
for a couple of weeks, but actually what we need to do
is wrap services around that family in a different way
to enable, to ensure that they've got the support they need
so that we're not seeing the, we're addressing the cause
rather than the symptom of her presentation.
And that is sort of central to what we need to do
in neighbourhoods to combine our resources together
and do things.
And at the moment, we didn't have a service
to put that patient back and her family back into.
and that's what we're trying to deliver.
But Andrew, do you want to come in on the life?
Yeah, the life course issue is fascinating
and the graphic really illustrates the problem.
Your premise that everybody's born equal
and has equal opportunities at the start,
I think is slightly flawed
Mr Andrew McLaren - 0:46:02
because we know that those children born
into the more deprived communities have a greater chance
of poor health outcomes almost from the start.
And that starts to translate through,
you can start to see it in measures like overweight and obesity
which is much higher, there's been an increase in able -weight and obesity in the deprived
populations but we've not really seen that increasing in the wealthier populations. So
there are changes going on which we need to address and that speaks to getting care closer
to communities, getting more education into communities, getting more support into communities,
which this programme is designed to do, to start to try and address and understand at
the very local level where the support is going to be needed to nudge people, encourage
people, support people to live their lives differently. And you're right, some neurodivergent
people will struggle with that. But I go back to, if you look back to 30 years ago, there
were an awful lot more people smoking. But that journey to change smoking from something
that virtually everybody did to something that's now pretty uncommon has been a very
long one. And that's the kind of journey we're on with some of these health changes that
we're going to be needed. We need to get the population, our residents, the people who
work in our organisations to do things differently with their lives to improve their health outcomes.
That's the challenge and it's a really difficult one and we're all going to have to get engaged
in doing that.
Do you want to come back?
Cllr Stuart Wilson - 0:47:32
Cllr Robin Stuchbury - 0:47:34
Well firstly thank you for the responses and coming from an agricultural background as
I actually know the difference between the gate and the landowner and the experience financially.
I'm well aware of the out of life outcomes and I thank you for raising that Andrew and I think it's important that we remember it.
On the direction of choosing where sites might be, yes we are awfully fortunate in Buckingham that Dr. Gavriel and his team working with the Trust and Everyoneness delivery and the new health centre and we must pay credit to that.
Are you suggesting that within the health campus of the Buckingham Hospital that some
of the areas in there could be repurposed for the hub because they're already owned
by NHS England and they are paid for so they don't need to be bought or it's just a matter
of repurposing.
Is that what you're suggesting because that's very positive?
Yes, so I think we need to look at our existing estate to start with and that's not just the
existing estate.
Raghuv Bhasin - 0:48:31
the hospital, it's primary care, it's Oxford Health and also council. So for example, we've
recently, well, for the past 18 months, we've taken a lease on a building in Wickham, which
was a council, empty building, we've put children's therapy services in it. And that's a really
good example of using one public estate. And I think we've got to do that across the patch.
We're also linking with council colleagues on a growth agenda because there's an aspect
of regeneration as well as town centres that we can contribute to as part of this journey.
We offer guaranteed footfall through the health and care system, so thinking about particularly
for Wickham, Aylesbury and Cheshire and how that links in as well.
Cllr Stuart Wilson - 0:49:21
Thank you. And I think health on the high street is a perfect example of that for those
of us that have been to the one in Aylesbury but will be going to the one in Wickham I'm
sure in the next couple of weeks. So thank you very much for that.
Cllr Dominic Pinkney - 0:49:37
Councillor Pinckney. Thank you, chair. Thank you all for the information.
I have a serious concern with the plans, the things that are not in here. Although the
voluntary community sector is mentioned many times, the actual situation of the health
of the voluntary community sector is not sort of factored into this.
The current health of the voluntary community sector is extremely stretched and under -resourced.
And for all these plans, most of these plans to be successful over the next 10 years, you're
going to need a resourced voluntary community sector.
And that isn't here in address.
There isn't a plan to resource the voluntary community sector here.
And that is a real concern, because a lot of these things, we can talk about it, just
won't happen.
And it would create bigger problems.
I was at a meeting in a London local authority last night where the
cabinet member for communities, their data said that
for every one pound they invest in the voluntary community sector they get ten pounds back.
That's the council data. So that was a bank, we'd all put our money in it. So that
just highlights the multiplier effect of that kind of work. But the multiplier
effect works both positively and negatively. So if you reduce it we're
have much bigger problems. Last week at full council I asked the Buckinghamshire
cabinet member for communities if they could commit to even just the current
level of resources let alone increase it and they can't at this moment. So I'm
very concerned about these plans if we don't have a properly resourced
voluntary community sector. So I asked people in the room is there going to be a
commitment or a plan to properly resource because there's lots of things
about having conversations and engagement.
And I also want to stress,
because some Buckinghamshire organisations or groups
have said that it's great that you want to do engagement,
but to recognise that every time you go to do that
engagement, you're paid to be there.
For them, it is a cost.
So how are you going to overcome this?
So shall I maybe come into that and maybe Craig?
Raghuv Bhasin - 0:51:43
So you're completely right.
So my ambition and the ambition of the Trust
to seed a lot of our delivery into the voluntary community sector.
We cannot do that with the state the voluntary community sector is currently in after years
of reducing funding.
So we're having active conversations with Heart of Bucks, who I met Henry Alman last
week, meeting Kate Walker from Community Impact Bucks.
Next week Gemma, Nicola and team are engaged with them to think about how do we help build
up the infrastructure in the voluntary community sector so that we can seed more and more of
delivery and resources into the voluntary community sector.
And we need to get a firm plan about how we do that
and do that collectively across our partners.
But the intent is really there to do it.
And we know the gearing effect of a,
actually for a 700 million pound organisation,
which we are a relatively small amount of money,
moving from our organisation into the voluntary community
sector is really significant,
but it needs to be received
and have the infrastructure to receive it.
And so that's central to what we're doing.
And I'm very clear, we need a clear plan
about how we're going to build that up over time,
working with leaders in voluntary community sector.
We also need to recognise that the representation
of voluntary community sector is variable across the patch.
And so it's engaging with the full breadth
of the 5 ,000 plus organisations to think about,
well, what is right in Wicca might not be right in Buckingham
and might not be right in Missenden.
So thinking about the different aspects
of the voluntary community sector and how we use them.
We've got some really good examples
of working with Chilton Prostate Group
who ran prostate screening in Wickham.
Recently we're having conversations
with high net worth individuals
about them supporting philanthropy in certain areas
that support some of this work.
We are looking to develop a proposal around loneliness,
working with community sector organisations about loneliness, so really
thinking about how we can integrate those resources and those teams
into what we're doing, but we need to transfer some resource to create an
infrastructure to do that. I don't know, Craig, if you want to.
Craig McArdle - Corporate Director, Adults and Social Care - 0:54:00
Yeah, thanks for the question, Councillor. So I think there's a number of aspects.
One is involving the voluntary community sector in the planning of services as well.
So I think through the BEP, the Bucks Executive Partnership, and our delivery group there,
we have some strong representation from the VCS on there, including Community Impact Bucks
as well.
Having their voice at the table is really important.
You won't be surprised that they raise similar challenges to us as well.
Certainly that multi -year funding settlement is one which comes across very strongly as
well.
Wherever we can, when we're letting new contracts, we build that in.
So recently you'll be probably aware that we've been out for a prevention contract which will span financial years as well.
That's presently delivered by the VCS. It has a history of being delivered by the VCS and we hope will continue to be delivered by the VCS as well.
But clearly it's in the middle of a procurement at the moment.
That's really important. That is also really difficult for public sector bodies when we don't get multi -year funding settlements as well, often in this space as well.
that point needs to be made to central government in terms of that to give us some financial certainty.
Certainly when Buckinghamshire council is looking at fair funding reform as well as
councillors will note in this space. That's really important to us that we work with the
VCS increasingly though in that service delivery because we think they're really close to our
communities so we're building them to the integrated neighbourhood working in that space as well.
Now I also know a councillor is also a very strong advocate of volunteering as
well and I think that's another area which actually across Buckinghamshire
we're really good at in terms of that but I think as a City Council there's
more to do in that space and I know we'll be having conversations regarding
that. Do you want to come back? Yeah just quickly just to say so thank you for those
Cllr Stuart Wilson - 0:55:49
responses and I do appreciate there's a lot of good understanding in the room
and outside the room of that.
Cllr Dominic Pinkney - 0:55:54
And I know there's lots of good conversations
and there's involvement in voice,
but until that translates into actual action,
then that's not good enough.
So there will, I'm hoping to give you
some very positive news about actual action
Raghuv Bhasin - 0:56:10
very shortly and happy to sort of meet outside
to talk and get your input in that.
Thank you.
Is it possible to, maybe we next have a meeting
Cllr Dominic Pinkney - 0:56:19
to have a sort of an update specifically on that?
Is that okay?
Cllr Stuart Wilson - 0:56:24
I was going to suggest I think this is an important point and one that we can talk about
in terms of work programme and when we want to do it and put it in.
And I think this notion, you know, with the reduction in grant funding and moving to a
commissioning platform, it is really important that we do kind of go through these points.
And I'm aware, for example, talking to the Princess Centre in Bournend, that I say, well,
what's the difference between success and failure?
Well, another three council clients would make a world of difference for us if we could
do that.
They're on the margin right now of surviving.
And it's those sort of simple conversations, I think, that could make a difference.
So I think it is an important topic that we should come back to if we can have that as
an action point.
Whether it's the next meeting or a future meeting when we've, you know, we'll cheque
in with partners and I'll cheque in with Raghu and Craig and see when, you know, when are
we going to have some news that could allow us to kind of dive into this in a bit more
detail.
So did you want to come in on this point, particular point?
Yeah, thank you.
Cllr Shade Adoh - 0:57:41
I can see that Zoe you have your hands up. I don't know if something similar I'm going
to be talking about. I'm just thinking on the point that Councillor
Picnich has mentioned, it would be a good idea to involve health watching it.
I know they are going down but I do believe at the presentation in council meeting the
cabinet member mentioned about future work with health watch on taking things forward.
So I'm hoping that when this programme does come up,
would involve people like health watching it.
Thank you.
Thank you.
Were there any other points on,
Cllr Stuart Wilson - 0:58:19
so, Zoe, introduce yourself as well.
So I'm Zoe, Chief Executive of HealthWatchBucks, thank you.
Zoe McIintosh - Chief Executive, Healthwatch Bucks - 0:58:26
So I think you're absolutely right
that there are VCSE reps in the room at BEP
and we are in the room as well.
My personal view is that what's missing
is kind of active representation from commissioning,
because I think the specifications
as to what is being commissioned,
I think that's really important to get right
in terms of health inequalities
and what the sector is actually commissioned to deliver
and how that works together, et cetera.
That's just my view.
Cllr Stuart Wilson - 0:59:07
Thank you. Any other points on this point? We move on to the next question. But I think
it is a topic we do want to follow up on. And I will ask Sally if we can make a note
of that. So Councillor Gough. Thank you, Chairman. We are all a little bit
Cllr Phil Gomm - 0:59:21
croaky today. Glad we are at HASC. I am extremely lucky that I am quite an old experienced HASC
member and have learned over the years to make sure that we try to work ahead of schedule.
So listening to what you're saying about this new strategy, I'd like to say to make sure,
I haven't really got a question, I've got a recommendation, Chairman, is that to link
up hard with the community boards, I've chaired quite a few community boards and Zoe would
know we're always quite active to make sure that we promote health and wellbeing within
the area.
So on the community boards that I chair for West Bucks, we're now launching daycare centres
where we got older people, younger people joining in with activities.
So they would be a great way of learning when you come to your page 22 working with our communities that you know,
the community boards will work into your structure on that one.
So just making a recommendation, please link up because otherwise we just go around and round in a circle before we get back to A again.
So just a recommendation.
So you reference community boards when you were talking about this.
Cllr Stuart Wilson - 1:00:25
So we've obviously reorganised community boards from the council for this term.
So what is actually happening and how are,
who and how are you interfacing with those community boards right now?
Thank you. So yes, absolutely. We do want to do that.
Gemma Thomas - 1:00:44
So we've been linking in with, and I'm going to get the titles wrong,
but the officers that support the community boards,
they are members of the steering groups and we do know that we need to link in
more we've obviously waited for the reorganised or restructure of those
community boards so it will be our integration leads which we have one for
each neighbourhood that will be the key link in and then we'll link them in with
the clinical leads for each of those neighbourhoods as well which are
predominantly from primary general practise.
So chair if I could just come back please.
Cllr Phil Gomm - 1:01:15
So I'm not being disrespectful to officers, could you make sure that the
officers push that information to the chairs and the members of that group
because they are the driving force the officers are too but make sure that we
get to here yeah absolutely that we can get the
information needs to meet the councillors as well and make sure that
Gemma Thomas - 1:01:32
Cllr Stuart Wilson - 1:01:36
good thank you very much thank you thank you I was just going to ask my community
board chairman if we can make sure this is on the agenda for the next for the
January meeting
Cllr Phil Gomm - 1:01:50
but don't worry I do have the best community board in Bucks so I can teach
Cllr Stuart Wilson - 1:01:53
a little bit. And he wonders why I've put you on opposite sides of the table. Okay moving
on to Councillor Wessel your question please thank you. Thank you chair I'm pleased to
Cllr Julia Wassell - 1:02:09
see the spotlight on Wycombe developing. Regarding the neighbourhood this to my mind depends
on multidisciplinary team working, which of course we've all been trying to take part
in and study for many years. So what is the leadership of that multidisciplinary team
working or is it going to be cottage hospitals without walls? On health inequalities, 30
years we've been looking at this, what's going to be different? And finally, loneliness.
Let's encourage all the lonely people to go and do volunteering now, they are needed.
And people with chronic loneliness, which originates in childhood, possibly through
trauma and lack of trust in adults, chronic loneliness is going to be more
difficult to tackle. Thank you. Question mark.
Cllr Stuart Wilson - 1:03:16
Gemma Thomas - 1:03:21
I'll come in and then Amanda might want to come in. So the MDT working, so
that's kind of one element of kind of neighbourhood care and there are
different MDTs based on the conditions. So for example in Wickham there is a
children's MDT which is supported by general practise and paediatricians at
the acute trust and then there are other like frailty and different conditions as
well so that leadership is predominantly coming from general practise and then
bringing in specialists where appropriate to do that but there'll be
lots of elements to kind of neighbourhood working some of it will be MDTs a lot of
it will be kind of bringing kind of that volunteering community sector because we
know the impact that they can have if we bring them in earlier on as well as
moving services to those communities where possible but the leadership the
clinical leadership is within general practise for the neighbourhood as a whole
within Wickham. In terms of the difference this time in health inequalities
others may want to join in but I think we have a real commitment and we have
that aligned strategy across all of our partners to work to do this. I think from a Buckinghamshire
Health Care Trust perspective, this is the first time our strategy specifically sets
out that our number one priority is to reduce health inequalities for our population. I
think that's a very significant shift for an acute and community trust. So I think we
have really prioritised it. I think that the fact that we're all kind of working together
and we do have better data than we've ever had before to understand where these health inequalities are.
Mr Andrew McLaren - 1:05:09
Thanks for your question, Councillor Wassell. I think the health inequality point is crucial.
As Gemma said, it is integrated into our strategy and into our approach in all the way we deal with
our patients. We're also looking at it in our data in a way that's really different
And if I look back, I recently looked back at the various consultation exercises that
were done around the Wickham hospital changes that we've seen over the years, and they go
back a number of years now to 2012 and then 2014.
There was no mention of health inequalities in those documents, which I found quite interesting.
There was lots of mention of moving care into the community.
There was not a single word about health inequalities.
I think that just illustrates the shift over the last 15 years or so.
We have used the building block that the council set up of opportunity
bucks so we see data in our board reports which is split out by the
opportunity bucks wards and the rest of the population so we see that built in
we've seen our waiting lists normalise so there's no delay depending on where
you live and interesting things like that so we're tracking it as we go
through and of course the key point here is if you don't look at the data you're
you're never going to do anything about the data.
So we are looking at it in as many different ways
as we possibly can.
I think the data point's fascinating
because Dr. Bartlett's already mentioned
the John Hopkins stratification.
This is a way of looking at how
some an individual's health is
and then you can use that to adjust
how you apply the health services
and wrap health services around them.
And there's great work being done
in the Frimley and Wexham area using that data
which is both reduced GP activity,
because they do different things as a result
of looking at the data properly,
and also reduce hospital attendance and admissions
by big numbers.
So we're trying to bring that into Buckinghamshire
in a way that will help support people as well.
And maybe just to add two things onto that,
if that's okay.
So one on the inequalities
and one on the loneliness and volunteering points.
So on that inequalities part,
David Munday - Director of Public Health - 1:07:17
I won't repeat what colleagues have already said.
The additional point I would make is that I think
the evidence base and the understanding for what will work
to address inequalities is stronger now than it has been.
And I think that draws in an understanding
of kind of two elements which as I say,
I think is increasing now.
One is the importance of those building blocks of health
that we've kind of referenced in this discussion earlier
or the wider determinants of health
and the degree to which those are driving some of those stubborn inequalities that you
highlight. And then with that, I think as we've heard, the kind of commitment to take
action and I think also evidence that we need to just, we can't focus simply on kind of
an individual level. We need the right support for individuals. We also need some of the
right interventions at that more kind of societal kind of level to help do the change we want
to see and I think the strategy work that is included in the PAC and that we're describing
is trying to work at both of those levels.
On the loneliness point, I completely agree with the challenge of loneliness and within
the Opportunity Bucks framework we've done a specific deep dive on the challenges of
social isolation and loneliness to be looking at how we can best address those and I agree
there is definitely a connexion into that volunteering space.
And Craig earlier in the comments regarding kind of engagement and funding of the VCS
kind of just alluded to this. But we are looking at in Buckinghamshire how
we can best galvanise the kind of volunteering kind of effort across the system, so not just
a council piece of work. And I think there is absolutely a connexion
that can be made there between people that are lonely and isolated and that kind of volunteering
needs, so I agree with that connexion.
Can I just add also that the use of population health data is increasingly being used in
Dr Amanda Bartlett - 1:09:22
primary care, both as I said earlier to help us sort of allocating patients to appointments,
but also in the neighbourhood work that we're doing.
Cllr Stuart Wilson - 1:09:36
Cllr Julia Wassell - 1:09:38
When I trained as a social worker we were taught class analysis and that we should work
ourselves out of a job, get everybody affluentised. That clearly didn't work. So I do rather wonder
if class has been replaced by health inequalities in the terminology and the intersectionality
between working class and the different protected characteristics and geographic communities
and communities of special interest. So I think these issues of poverty, if you like,
or undertake up of health services have always been there and they've somehow just been rebadged
as demography changes have come in, would you agree?
I'll come on that one,
because I think we're straying into a different,
Cllr Stuart Wilson - 1:10:37
slightly different one.
My view is from what colleagues are saying
is that we're getting behind the drivers
of what may have been deemed to be social class.
And so income levels, housing,
all of those bits and pieces.
So I think it has gone to a deeper layer,
would be my interpretation,
beyond the historic social stratification that we had
in terms of the contributory factors,
things like housing and so on and so forth.
So I believe it's kind of gone to that point,
but if anybody wants to disagree with me,
or I'm happy to move on to the next point. Okay, thank you. So I had, did you want to ask a question?
Yeah, okay, Councillor Ado.
Thank you very much. I'm Councillor Shadi Ado and my apologies I would need to leave about
Cllr Shade Adoh - 1:11:41
10 past 12. My patients are needing me or not. So if I'm allowed I have three questions and
and they are related to pages 17, 18, and 19.
As chair of West Chilterns Community Board,
an area with elderly residents and in need
of additional youth provisions, I
see health inequalities such as loneliness in rural areas,
farming communities, and many more.
How does the neighbourhood health centres
cater for rural areas and young people
in these areas in light of the health inequalities,
and that is my page 17.
And on page 18, I have raised this prior,
on do we have the women centres focused for women?
Do we have that?
Do we intend to have that?
Because I know in other areas there are women health hubs.
How are we doing that?
Should we have that?
And we need a champion to lead on that, as other areas that I
know from my professional life have done.
On page 19, I've got on workforce.
It says, eliminate agency staffing.
I have to put that I've written here impossible.
How and why do we intend to do this?
Is that possible ever?
haven't been in healthcare for, you know, long enough,
it is impossible to eliminate.
And why should we intend to do that?
Why is that a point to focus on?
I'm thinking we should be focusing on, you know,
better staffing, working with our staff,
making sure they're comfortable to be there.
And there are people who may want to work part -time.
And if we say to ourselves, we don't,
we're going to eliminate,
We need to put more flesh on that bone.
So he's not saying we're getting rid of it,
because there will always be an avenue,
an opportunity for that to be necessary.
What we don't want is to rely, you know, make it a point of view,
rely solely on agency nursing.
So I just have an issue with that, you know, bullet point there,
and I would like to know why that was put there
and how it's, you know, how it's going to be made possible.
Thank you.
So several questions there.
Cllr Stuart Wilson - 1:14:11
Yes, should I come in and others might want to?
So I think, so neighbourhood health isn't just about
Raghuv Bhasin - 1:14:17
buildings and hubs.
So I think there's, we need to think about,
it's a way of bringing people together to link up care
of which some of which will be done in buildings and hubs.
So I think there's a, what we need to do is,
and part of what we're trying to do in neighbourhoods
is say, well what is the best fit for your population,
and your demographics, your rurality in that space.
We know that in the sort of market towns
of the West Chiltons, it'll look quite differently,
say from central Aylesbury.
And so that's what we need to develop.
Core to that is a focus on women's health.
And so we are working and looking at different models
for women's health, working with the GP Federation
to look at how we could look at bringing some of the services
out of trust into the community to be closer to women. So just on agency staffing, so agency
is an external agency to the organisation, so it's not our own colleagues working flexibly
or Buckinghamshire colleagues working flexibly on bank, it's about when effectively we might
need to go out to a quite often high cost agency and we could get a qualified colleague
but someone who doesn't know Buckinghamshire.
And so we know that where there is a, as you said,
where there's high levels of agency staffing
that does contribute to challenges
in terms of patient care and safety.
So eliminate is an ambition.
It isn't about reducing flexibility
or changing the diversity of our workforce.
It's about having to go out for that high cost
often late notice agency,
which doesn't deliver the care our residents deserve.
Okay does anybody else want to come in on any of those points?
Cllr Stuart Wilson - 1:16:10
No? Councillor Ata do you want to come back?
Cllr Shade Adoh - 1:16:17
Thank you very much for that response. So can I therefore make a request
that if there's a way that can be rewarded
the eliminating agency staffing so that it reflects you were talking about
external and we have the internal processes that can work better.
Maybe that should be rephrased.
And thank you on the health hubs and I do agree with your comment on it's not about
the siting, but for women it has to be about the siting because women want to go into a
place where they feel comfortable, where they feel safe.
So we need to look at that.
And I know you've said we are planning, we are planning.
We need to start doing.
And I know we are doing because I'm in there,
but we need to show that we are doing
so that people feel more reassured with what we're doing.
Thank you.
Yeah, you don't have a stronger support
than just get on with it, than me, Councillor Addo.
Raghuv Bhasin - 1:17:17
So we are, over the past 30 years,
we've built a system not to do what we're trying to do.
So it'll take quite a lot of time to unwind that
and change from the culture and the processes and the systems.
And one of our trauma and orthopaedic surgeons approached a local GP practise and said,
oh, I've got lots of patients in your practise. Why don't I come and run some outpatient clinics
there, kind of run alongside one of your practise nurses, do some upskilling. And the first question
he got was, how much are you going to pay for the room? And we do the same as a trust when
GPs want to come in. And so that's the lived reality of what we're trying to break down.
So yes, our foot is on the accelerator.
I think when I first met you and Mr. McDonald
Cllr Stuart Wilson - 1:18:02
to talk about all these changes in Wycombe,
I said your biggest challenge is culture.
It's gonna be culture changing a system
that's been entrenched for 70 years
in terms of ways of working.
So I think that's right.
Do you wanna come back on this point, Councillor Wesson?
Cllr Julia Wassell - 1:18:23
pick up on the women's health hub, I mean come round to my place, you know that's
got sort of the beginnings of a women's health hub in it and the ground floor of
the municipal offices and Queen Victoria Road is housing a lot of the women's
voluntary sector. But I do think that would be a great asset if you could set
up some kind of women's health hub. I mean, you know, women have been involved
with their own self -help from earliest times,
and there's a lot of voluntary sector women
are very into women's health,
and there are a lot of us in the caring professions
who are women.
So I'm sure the ingredients are there.
Thank you, and how much do you charge?
The room?
Cllr Stuart Wilson - 1:19:08
£42 an hour.
Okay, thank you.
Councillor Hogg, is this going to be about data and AI?
Cllr Thomas Hogg - 1:19:22
A little bit, yeah. The strategy that you put together, there are some really good parts
of it. The prevention, the screening, that's great. I like the data part, the single client
record, that's really good. There are some red flags as well. And the biggest red flag
for me is this absolute focus that you've all mentioned today on inequality.
I know the German healthcare system weirdly well,
for reasons I won't go into, but the quality of that whole healthcare
system, from the quality of care all the way to
the administration of it, to how quickly you get a diagnosis and
the treatment, it is so much higher than the NHS in this country.
And when I hear that the focus is going to be over the coming years on inequality, that
makes me very worried about moving forward with medical research, with getting cutting
edge technology in because you can't focus on both at the same time. Now you
can't, you can't focus on both at the same time. I look forward to disagreeing
with you when I cut them and the point comes. Because the reason you can't focus
on both at the same time is that the cutting -edge stuff going doing what
hasn't been done before is really expensive and firstly only the rich
people are able to afford it, and then it becomes mainstream.
I'm very, very concerned by this focus on inequality for an
organisation, the NHS, which is way behind in terms of the
quality of care that it gives against some of its
international equivalents.
So that's the first one which I'm keen to get a response on.
The second one is joined up services,
something that we've heard this time around.
There's nothing new.
I've been hearing since I was at university
studying social policy in which I was looking
at the NHS back then,
all about how joined up services are so important
and how we need to do more of it.
What makes this time different
to all of the previous times that I've heard about this?
The last one that I will just, the last question that I'll just bring up is on the client record.
So I love this client record.
It's absolutely key to high quality healthcare.
The concern obviously that always comes with it is data protection.
And patients should feel in control of their data and who they give it to.
That should be up to them.
That's how it works in Estonia, who have exactly this sort of thing.
And I'm keen to hear how you are planning on delivering this single client record.
Thank you.
So three questions, I think, now.
Who wants to come back on?
Cllr Stuart Wilson - 1:22:50
I think I took on the mantle.
So I fundamentally disagree with the point you made
Raghuv Bhasin - 1:22:57
about research inequality.
I think we need to do research innovation
to address inequality.
So as an organisation, Buckinghamshire Healthcare Trust
is really focused on research.
We are bringing in new AI technologies
and new treatments for our patients.
Equally, we're really focused about how do we get access
for the most deprived people in our community.
It's not acceptable there's a 12 year age gap
in life expectancy in this county.
Yeah, so I couldn't disagree more and we will do both.
On the what's different,
I think you've got the collective ownership of all partners
who are sitting in front of you to do something different.
You're completely right.
We've been talking about this for a long time.
You could probably take the NHS 10 year plan
and put a 1990s logo on it and it would read quite similarly
but I think you've got that collective ownership,
public commitment, we're setting a 10 year plan to do this.
Our board has signed up to work in a very different way
with our partners, and we are starting to move in that way.
But as I said to Councillor Adu,
I think there's a real challenge around the structures
and systems and the way they're built.
So at the moment, for example, the trust is paid for
doing a operation on an 85 -year -old frail person
who shouldn't have that operation.
We're not paid for the multiple conversations and support
we will provide that lady and pain support
to avoid the operation and achieve what they want to
in their lives.
So that's just an example of what we need to try
and break down.
I think the data protection is really, really important.
We know there's a number of our residents who've opted out
from some of the sharing of their details
and the use of the collective care system.
Quite a lot of that is about information and engagement
and what we're using this for.
I think partly quite a few of our residents would be surprised that the ambulance service
can't share data with the health service, with the NHS Trust, so we need to sort of
understand that, but show the data how it will be protected and put things into, and
give people the control over the data, like you say.
Segmentation, which a number of colleagues have mentioned, is really important.
We've got that system, it's called collective care in Buckinghamshire, we're really lucky
to have that.
We don't quite utilise that to deliver our services in a consistent way and that's one of the big areas we're going to push on
Cllr Thomas Hogg - 1:25:25
Thanks, thank you very much for that we'll agree to disagree on the inequality issue
It's not that I don't think it's important inequality is important
But I'm very concerned considering the where the NHS is as an organisation at the moment
And I've got one or two other questions for you
First of all, there was a report by the King's Fund a while back about innovation in the
NHS where you had doctors and nurses trying to innovate and they would make huge differences
in how A &E works, improve outcomes, and then it just gets cut off at the knees.
So there's quite a lot of funding for pilot schemes.
there's almost no funding for actually taking the pilot scheme and delivering it across
the whole hospital, a range of hospitals.
So how will you ensure that innovation does not get cut off at the knees as the King's
Fund has reported?
That's question number one.
Question number two is,
this plan, as I say, generally I'm actually quite in favour
of what you are putting forward.
How will residents and councillors monitor the progress?
Will there be public dashboards?
I noticed that the Centre for British Progress
has put a public dashboard on this nuclear programme
that the government mentioned coming out.
It keeps them to account.
I love it, and I'd love to do the same thing with your plan.
If you say there's going to be joined up services, let's have public dashboards that we can all
see.
So I think that would be that's probably.
One other thing is how is the required 2 percent annual productivity gain being delivered and
tracked?
We hear about it.
We saw it in the 10 -year NHS plan.
Again, tracking is important.
Thank you.
George, come back on the productivity one.
Cllr Stuart Wilson - 1:27:25
Raghuv Bhasin - 1:27:28
So, should I come back on, so our plan will be really open and transparent about through
this committee, through the Health and Well -being Board.
We've set a number of metrics in the plan and we'll be reporting on those quarterly.
Very happy to show our both implementation plans as we held to account.
It's really important we do that for our public as well because we are asking our public to
do things differently.
So, part of that is also showing the impact of that difference.
On the productivity, that's a key challenge
for all of our sales and organisation.
We get set annual budgets,
there's inbuilt productivity in that.
So do we meet our budget includes,
are we meeting our productivity challenge?
There's a lot of very publicly available data,
for example, for the trust on things like
theatre utilisation, the productivity
of individual commissions as well,
and happy to provide more detail offline
if that would be useful.
Maybe Andrew wants to come in on some of the innovation.
Innovation piece is fascinating and you're right there's a concept of pilots that come in and then don't get fully funded and don't move forwards.
I think the best way to look at this is to kind of look back down the mountain at what has changed and what has been delivered.
Mr Andrew McLaren - 1:28:34
And there are huge innovations going on throughout the whole range of healthcare.
We've got a robot now supporting prostate cancer surgery, we've got a robot now
supporting gynaecology surgery and colorectal surgery, we've got people
having hysterectomies who are going home the same day because they're using that
innovative technology. That is radically different. We've got a same -day
emergency care unit that's been set up within our emergency space footprint and
we've gone from 20 % of people who attend the emergency department being admitted
to under 9 % because we're dealing with people in a different way. So where innovation works,
where the teams on the ground manage to make a success of it, we back it. And we back successful
teams. And we've just done a huge project funded by the Getting It Right First Time
money to put £5 million into our eye department at State Mandeville to renovate the interior
of the building because they've done a project over in Amersham relating to macular degeneration
where they've increased number of patients they see threefold with no more people just by changing
the way they see people. So we put the estate in, spending that money we got from the centre
to back that team to deliver that in the state Mandeville site as well. So we will support
innovation, the NHS supports innovation, but it's got to be running for money.
Cllr Stuart Wilson - 1:30:00
Thank you. A couple of points on that. There are some extraordinary amounts of detail on
key performance indicators that I've seen on, I think,
ICB documents that go into a huge amount of detail.
And the other point is those of us that attended the visit,
the HASC visit to Stoke Mandeville,
we actually were hosted in the Innovation Centre.
And I think it was extraordinary to hear about
the kind of pragmatic translation of not what's happening
in some university somewhere, but what's actually happening
and being sponsored locally and being translated.
So maybe that's something that you might want to separately set up a visit
and see that sent of Stoke Mandeville.
It's really interesting.
And I think it's kind of a homegrown innovation hub of practical learning.
So I think that's well worth seeing.
So I'm going to take one more question, Councillor Nella,
and then I think we need to draw this item to a close.
Cllr Frances Kneller - 1:31:03
Thank you, Chair. I want to first thank you for a really interesting and helpful scene -setting
report and I'd like to particularly commend the Director of Public Health's annual report
which I found really useful, helpful and interesting. I had two questions. The second one I think
in part has been raised by Councillor Pinckie but can I just say that I echo his concerns
as somebody in the room who is forever trying to encourage and recruit volunteers. I am
very concerned that some of the most commendable ideas that you're bringing forward are dependent
on voluntary sector and it would be a real shame that your plans are scuppered
by the fact that these groups have not supported and encouraged and are there.
But my main question was really looking at the health streams that are brought to
our communities through Health in the High Street, the neighbourhood health provisions
and the Beth Stark Family Centres and all of those with those health streams are going to
instrumental in ensuring that what you want to deliver by 2035 actually happens. So I'm
interested and to some extent concerned about the approach that's being taken to draw those
three concepts together. We've had one -stop shops in the past but it is very important
that we have a joint approach and particularly in areas of high need because this coordination
and this engagement really should be about people coming to one place to pick up all
of those elements rather than it being sort of scattered across an area. So I'm particularly
concerned obviously for Chesham but I know Aylesbury and Wickham have similar issues
to do with inequalities and needs. So I would be very interested to see or hear about what
you're looking to do in relation to having this combined service through the
Health in the High Street, the neighbourhood health
provision and the Best Start family centres. Thank you. So thank you for that
question I think it's really important the core premise of neighbourhood health
Gemma Thomas - 1:33:33
is no wrong front door because it's very difficult to access those services so we
are trying to connect them up as much as possible and how I see Health on the High
Street as a core part of the current neighbourhood health services so
integrated to that. There is an estates challenge on the High Street so they're
not going to be able to provide everything we need from a health service
perspective but a core element of Health on the High Street is signposting,
directing and being able to understand the health and care, by that I mean social
and the voluntary community sector landscape, so it's enabling people to access that.
So they're very linked together and we'll make sure they're very complimentary offers
and with that kind of community engagement, that question that we had at the beginning,
we'll work closely with communities to understand what they want and need.
Health on the High Street in Aylesbury has been very, very responsive to that local need
and that local need for people coming through, as we might not access them through other
means so they will be very aligned. Nicola has been working very closely with colleagues
at the council with the Best Starts Hub so that we can align them and link them together
so that health services are together in one place with the other services with the council
so that people are going to one place as much as possible and if it's not possible they've
got really clear guidance and are not being pushed off to go to another door, they know
where to go they've got that phone number or however they want to contact
those services. So very, neighbourhood health centres and Health and High Street
very aligned, Best Start hubs, we are doing that linking to make sure it as
soon as possible. I appreciate your problem about finding the right buildings but do
Cllr Frances Kneller - 1:35:22
come and have a look at Chesham High Street I think we've got a couple of
buildings along there that will do just the right thing for you. Thank you.
Cllr Stuart Wilson - 1:35:33
Councillor Heaps, did you want to come in on the topic?
Cllr Carol Heap - 1:35:41
Thank you very much. If I'd just like to ask how you are going to be publicising all of these changes that are coming through the system,
because my experience working with residents is that a lot of them are very confused about health services generally now
due to huge change, particularly in primary care, but also in secondary care now that's coming down the track.
And people don't know how to access the services they need, and that is a big concern, I think.
And I don't know how you're going to, I'd like to know how you're going to engage with the actual residents.
That's the first question. And I do, I note that you have mentioned launch events in the six neighbourhoods in the pack.
Now those events I know have taken place in the past but local members,
councillors don't generally ever get to hear about them so can you please make
sure that whatever communications you are doing that you include local members
and I mean that the people in this room here not not just community board
managers because some of that information I'm afraid it doesn't get
fed down to us and we're the people dealing with residents all the time.
Thank you. Councillor Heape is an honorary member of this committee so she was
Cllr Stuart Wilson - 1:36:59
allowed a question. Yeah I don't rely on community board managers if you want to
pass the message on to local ward members is something we would all say
time and time and time again. So but communication I think is going to be
really important so I would take this as the last point.
Gemma Thomas - 1:37:23
Yes, thank you. So that engagement with residents is happening hyper locally, so we get to the
right people. It's happening in conjunction with Health Watch Bucks and ZOE. It's happening
in conjunction with the voluntary community sector because they access services differently.
We've got a communication and engagement manager who will be linked in to all the comms teams
of the statutory organisations to help that and take your point on the comms. It's always
helpful to know how we can reach people better.
Thank you.
Okay, I'm going to draw this item to a close.
Cllr Stuart Wilson - 1:37:49
We've had, I think, a good discussion.
Everybody's had an opportunity for questions.
I think there's a few points to follow up on public health data,
whether we do that as a separate offline workshop as a HASS group
or bring it back as an item.
Discussion on voluntary sector and how that's going to be
engaged going forwards.
And I think we're all probably slightly itching to understand,
well what's it going to look like in our area?
You know, I looked at it and I went,
yeah, but what I want is a map
which shows me what's going to be where on Buckinghamshire,
both physically in bricks and mortar,
but also virtually,
and how's it going to be different from each area?
So it's very much work in progress.
I think we have to accept that.
And it's going to take a period of time
to get some change built into the system.
But thank you everybody for coming in
and taking the questions.
and our members happy to note the report. Thank you. Thank you for your time. You
will be back. You are welcome to stay for the next item and beyond but I
understand if you if you do need to move on.
Some people are being a bit cold. Is there a way to increase the heating?
We have a perennial problem in this room that it's driven by the wider heating in the building.
So if the rest of the building is hot, this room gets cold.
What? But the rest of the room gets hot, this gets
cold. Yeah, because it's driven by what's going
on out there. So it's... but unless Paul can... okay yeah Paul's gonna try and
manage it. Yeah it does it it does immediately go to from from freezing to
boiling in a short space of time. Okay right whilst we're settling back down

7 Dementia services

can we move on to agenda item 7. I was going to say Councillor Heapers and this
okay so I will wait a couple of minutes because I do want her to come back so
I'm not sure the cold has helped people's ability to wait.
you
you
Okay, thank you. We thought we'd better wait for you, Councillor Heap, because you're central
to this item on every side of the discussion. So item number seven on the agenda is dementia
services. This was a rapid review that was undertaken by HASC some two years ago. And
it had its first reappearance for a six month review but then due to a variety of reasons
it's been delayed or deferred.
And both Liz and I felt that we couldn't put it off anymore.
It's a very important item.
And so we wanted to bring it back and make sure we included it within this term.
So I'm going to hand over to the cabinet member, deputy cabinet member,
and welcome Comrade Eidman, who also I think is joining us for this item.
So perhaps if you'd introduce those who are going to be presenting
and then give us an update. Thank you.
Yes, excuse me. Thank you very much, Chairman.
Cllr Isobel Darby - 1:43:26
So I am going to take a very backseat role in this because, as you have already said,
a lot of the work was done by Carol.
She knows all about this review because she was involved in it when she was a member of HASC
and we're bringing it back to you today.
We have with us Conrad who's not been with the Council very long
But he has hit the road running and I'm going to hand over to Carol now to take this forward.
Cllr Carol Heap - 1:43:58
Thank you. Thank you. Welcome everyone. I hope you've all had a chance to read the update
report on the dementia review. A tremendous amount of work has happened since February
23 when we looked at the dementia pathway across Bux and made a whole
series of recommendations for improvements that concerned all of our
all of our partners actually in the health system because it included the
Health Trust, it included primary care, it included the ambulance service, the
voluntary sector. We reached out to just about everybody for this for this review
So, as I say, a lot of work has been done and a lot of progress has been made, and that's
reflected in the report.
There is still work to do.
I think there always will be, and there are some challenges around this.
The voluntary sector is really important in dementia support, and that's something that
we are quite fortunate to have in Buckinghamshire,
but it is not, um, evenly spread around the County.
So in some places we're really well served and in others,
we don't really have anything, but, um, that's just one, one aspect.
Um, I think one of the, um,
the big gains from the review was that we did actually manage to secure a
considerable amount of additional funding from the better care fund.
and that has enabled us to recommission the dementia support service that Bucks Council
provide and hopefully that's only recently happened, that was launched in July I think,
so we're waiting to see how that's going to progress but that should certainly help quite
a lot going forward and meeting some of these other recommendations in due course.
Thank you.
Anything anybody else wants to add before we get into questions? No? Okay, great. Thank
you. Okay. And I note Councillor Addo, Councillor Gough and Councillor Stutchbury were also
Cllr Stuart Wilson - 1:46:16
part of that Rapid Review Group that worked on this report. So you'll all be very much
very familiar with the background and the importance of it so thank you to you
for your support on this two and a half years ago so with that I will open it up
to questions please so I've got councillor Wassell
councillor Nella sorry did you put your hand up yeah and councillor Pinckney and
Councillor Gormley. Sorry. So Councillor Wasser would you like to start?
Cllr Julia Wassell - 1:46:58
Thank you. I know that dementia diagnosis is increasing which is felt to be a good
thing but do you think that we are over diagnosing older people and some
dementia diagnosis is a natural part of ageing as we're all living longer. I mean
I was thinking this this morning hearing the debate about AHDH and over -diagnosed
were we putting labels on people who didn't need to have that and
particularly where the carers of people with dementia and young people are very
keen to have a diagnosis so they know there will be a treatment plan and care.
But you know where is this going to end in fact that if we all apart from those
experiencing severe inequalities are going to be living longer then we will
be affected by dementia, delirium and some of the unfortunate mental health
issues of old age? I won't give a technical answer,
Craig McArdle - Corporate Director, Adults and Social Care - 1:48:20
Councillor Russell, but I think getting an assessment is really important for
the families as well in terms of that. If I speak by personal experience, my mum
thought my late father had dementia for a number of years and actually he wasn't
assessed for having dementia but she had spotted the signs before that as well
and when he was then diagnosed it just helped her to manage the
condition far better in terms of that as well. So it's really important that if
people are experiencing symptoms they do go and get an assessment. I can't say I
can't encourage that more in terms of that. I don't think I look at our rates
we are over diagnosing within this county would be my sort of sense.
We're still below the national average in terms of that.
So my plea is, you know, do that because you can then access a range of service,
including carer support as well.
It's really important that you learn how you manage this condition around that as well.
You're right, it will be increasing part of it.
Some of it is part of ageing, undoubtedly regarding that as well,
but it is important and that would be my key message.
David Munday - Director of Public Health - 1:49:30
And then just a quick note on that kind of ageing process, I mean absolutely we see that
dementia becomes more prevalent as people age and I think we all understand that pattern.
There are things that can be done that prevent dementia, so whilst we, clearly we aren't
going to prevent all cases of dementia in the county, we can reduce prevalence of dementia
and when you look at the evidence base on what those risk factors for dementia
are about about 45 % of the risk factors for dementia are modifiable that doesn't
mean that we'll prevent 45 % of all cases in Buckinghamshire but it does mean that
we can reduce we can reduce the prevention work that the the prevalence
sorry through the right preventative actions and I think the report provides
some of the context as of what we've been what we've been trying to do there
So whilst it does become more common in ageing,
it's not an inevitability.
Thanks very much.
I'll just take your point generally.
Cllr Isobel Darby - 1:50:32
You mentioned ADHD and things like that as well,
and diagnosis, and I think if people are able
to ask the question, and it is loved ones generally,
who do see these changes, and if they at least
have got access to where to go to get a diagnosis
or get a non -diagnosis as soon as possible,
and even if it is a non -diagnosis there may be another issue which can be
addressed and action can be taken, self -help in a lot of cases, different
ways of doing things to help that that loved one be they're young or old
through their life course.
I'm not criticising, I'm asking a question about are we
Cllr Julia Wassell - 1:51:11
facing you know so much more demand and issues like hearing loss and so on so I
had with my own parents, you know, can be misdiagnosis or whatever.
Dr Amanda Bartlett - 1:51:32
Can I just add to the points already made, the diagnosis of dementia, as I'm sure you're
aware, happens in a specialist clinic and even prior to referring patients to the specialist
clinic in primary care they will have a sort of a series of tests to look for
other causes of their symptoms so I mean there are you know there is this kind of
thorough process of assessing somebody and and looking at why they might be
having different issues before they get referred and before they get assessed to
try and sort of prevent people being misdiagnosed. I think from my point of
view the not knowing is worse than the knowing and that's why nine months for
Cllr Stuart Wilson - 1:52:12
me still feels like an awful long time for those caring for people who are starting to
show the symptoms is the mental anguish behind that is almost worse than, well I think it
is worse than knowing. And the other thing I think from raising this, and we've had,
you know, like whatever it was called, dementia bustle, whatever, as part of our community
boards, it's just raising awareness of how people deal with people.
And my wife's a practise nurse, as I've said before, and she went to experience
the dementia bus and she said it just made her think very differently about how
she would treat patients now, so, you know, on a day -to -day basis.
So I think it's an interesting question.
Obviously, it's a very topical matter at the moment and one that we need to keep
an eye on, but yeah, I'd probably err on the side of caution rather than ease off the
gas at the moment. Okay, thank you. Councillor Nella.
Microphone, please.
Cllr Frances Kneller - 1:53:19
Sorry. Just saying, I think the diagnosis aspect is very interesting and is very helpful.
Just from my background, my mother's family had incidents, a number of my aunts had multi -infarct
dementia, so we recognised it very early on and realised how to work with that and support
them. My bigger concern regarding dementia support and care is to do with carers. I've
had two examples in Chesham of people who've come to me who have had problems in accessing
support with a partner who have very serious implications from their dementia, their behaviours
and such like. And in both those instances these people were asking for help which wasn't
really forthcoming for whatever reason and it was only when they exhibited extreme violence
in a healthcare setting that both these people were admitted to care support, to residential,
although those carers had been asking for months, I need help, I need support
and it was not forthcoming and I kind of feel that that's an area that
doesn't seem to be met in the extent that we need in terms of picking up on
the ground. It's almost as if well you've got a partner, you're living in your home,
get on with it. I think there's also possibly a bit of stigma as well for
some of those carers not being seen to be able to cope in those extreme
situations and they were extreme situations so I think I welcome the
diagnosis but I do think we need to recognise that the tail end of the
dementia in terms of when it becomes quite extreme and quite unmanageable for
the families is not being supported adequately and I'd really like to see
what we could do to improve that.
Do you want to come back on that?
Cllr Stuart Wilson - 1:55:18
So I'll hand over to Conrad in a moment, but a couple of general points around that.
Craig McArdle - Corporate Director, Adults and Social Care - 1:55:22
I think firstly getting people access to timely information is really important.
So I would encourage you all to look at the Dementia Toolkit on our website as well.
That's a really helpful resource as well for anybody there.
Casework coming through, always forward it on as well because we sometimes have to learn through
these real life cases as well. So it's really important that they keep coming through to
me and my officers. I would encourage everyone who's in that situation as well while I've
got the floor to reach out to Idle Social Care, ask for a carers assessment. I think
carers books also play a great role in this space. We always can do more, absolutely,
in terms of that. And then within the new service offer, we're trying to look at the
whole family approach in terms of that new support offer, which Conrad will probably
just talk about briefly.
Conrad Eydmann - 1:56:10
Thank you. So my first committee is Connor Diamond. I'm head of conditioning for Older
People Services. So yes, the new dementia support service offer went live in July. That
service has been designed with a very dedicated focus on carers and dedicated outcomes and
performance measures relating to carer support as well. So I think right from the outset
it's been recognised the fact that in many ways that service predominantly
supports those caring for people with dementia as opposed to the clinical
offer which is there to provide the medical treatment intervention and
support. Alongside that we also have our carer support offer that's more
generic rather than being dementia specific and those two are absolutely
interwoven with each other so there is complete consistent working across
the partner agencies responsible for delivering both and taking advantage of
what each can bring to the table,
the carer's specialist and expertise in carer's bucks
and the dementia expertise within Age UK Bucks
Conrad Eydmann - Head of Strategic Commissioning - OP - 1:57:12
who have got the dementia support contract.
And I suppose as well, it does lead to the question
that from a commissioning point of view,
we do need to think about things like respite capacity
and the availability of residential services,
albeit sometimes temporary,
for people with very complex dementias
and my kind of commissioning team for older peoples residential has very much got that
in focus as well at the moment.
Just on that, could I suggest I talk to the two people involved and see whether they'd
Cllr Frances Kneller - 1:57:46
be prepared to talk to your team about their experiences on the ground because perhaps
it's from the real life situations that you can understand. It may be a problem for Chesham
but it might be Buckinghamshire -wide that could be picked up on and there may well have
points along that journey that could have helped the carers and the
individuals themselves. Absolutely welcome that, yeah. Thank you, I'll do that.
Cllr Stuart Wilson - 1:58:11
You mentioned respite and I think one of the recommendations in the original
paper was about using existing council facilities where we do provide respite
and things like that. Is that still part of the considered, as I read the report
it said it was an ongoing thought process, but obviously one of the things we discussed
with the short breaks project was the fact that we need to ensure full utilisation of
those resources wherever possible. So is that still being factored into the mix, recognising
that they are serving very different needs and different client basis?
So I think that conversation has moved on, Chair, in terms of that and I think our focus
Craig McArdle - Corporate Director, Adults and Social Care - 1:58:54
is really making those community opportunities focus on 18 to 64 specialists as well, just
so that we get the balance right in terms of that as well. And then working with, as
Conrad says, and some reference in the report to working with our care providers more generally
feels the best approach to really addressing that need as well. And then working with those
homes who are dementia specialists to make sure that we've got adequate respite. I would
say councillor Nella again feed those storeys through because we can we learn
quite a lot from that reports coming through to us.
Cllr Stuart Wilson - 1:59:31
Zoe McIintosh - Chief Executive, Healthwatch Bucks - 1:59:34
Zoe. Thank you. The rapid review looked at our young the HealthWatch
box young onset dementia report that we had done around the same time. One of the
report was a need for more tailored support for people with young onset
dementia. I noticed that this has been built into the current service back
which is great to see. I just wondered as a result of that had have you seen an
increase in the number of people that you're working with living with young
onset and their carers? So I think by default the likely answer will be yes
Conrad Eydmann - Head of Strategic Commissioning - OP - 2:00:18
but that service is still very much, I wouldn't describe it as an interim offer, but they're
still trying to get to capacity with staff recruitment, et cetera. So there is a slight
risk in terms of advertising what the service is going to be able to provide when you're
not quite in the position to be able to provide it, but that is absolutely one of the longer -term
intentions is addressing that very specific and a very tailored approach to young onset dementia.
just in terms of general activity. When the service started it inherited a caseload of 80 individuals.
They're now taking on a new caseload of 60 to 70 individuals a month.
So they're almost doubling their activity in the terms of the number of people contacted, identified and supported
per month that they inherited from the previous offer.
So I suspect that within that we would expect to see, because given the Young Law Accepted Venture
is always a proportion of those referrals, the numbers to go up, yeah.
Councillor Pinckney.
Cllr Stuart Wilson - 2:01:18
Cllr Dominic Pinkney - 2:01:21
Yeah, I just want to say thank you for everyone who's been involved in producing this work
and this report over time that it has sort of taken.
It's a really good report, it's got loads of great recommendations and I really feel
that focus on sort of dementia and having a strategy for it I think is really, really
important. Councillor Heath mentioned that the sort of the needs of the voluntary
community sector so I won't make the point I made earlier and also the
point around respite, carers respite, I think is really important and I wanted to give a
quick shout out to a local charity to me called Dementia Carers Respite which is
a new one that does really really good really good work. I was thinking about
the point about raising awareness of dementia because I think all of us you know
something that's important is has it been sort of thought about engaging with
sort of town and parish councils and perhaps their role in having to kind of
raise awareness sort of locally because obviously there's been the community
boards but also those of those councils will be doing kind of work and engage
community that's something perhaps they could they could get involved with so I
know an Amersham town council they they probably would
Conrad Eydmann - Head of Strategic Commissioning - OP - 2:02:32
yeah absolutely I mean I think Craig's reference to the toolkit is obviously a
starting point and making sure that all of our town and parish councils have got
that information, got the links to it and are able to identify not only what they
could do themselves individually but opportunities to engage further fully
Cllr Stuart Wilson - 2:02:53
welcome that. One of the challenges of for local members is we're not always
aware of what tools and collateral and information and I say this repeatedly
you know we do two community markets every month with a thousand people
passing through and if we had an opportunity to hand out a few leaflets
and dare I say it tends that they tend to be visited by the older residents you
know so I think every member probably has plenty of opportunities to promote
this alongside town and parish councils but we don't always aware of what what
available so I think there's always opportunities for that. Councillor Heap.
Cllr Carol Heap - 2:03:38
Yeah certainly we did promote dementia support through the community board in
what was South West Chilterns when I was chairing that and we supported our local
Dementia Action Marlowe and helped them through you know getting that getting
set up with some funding here and there for different things so I think there's
definitely a role for local members whether or not it's a role for parish
councils depends on their capacity and interest but certainly it worked through
the community board and I don't think we're the only board that supported that
because we've got dementia groups and cafes in quite a number of different
places and I'm pretty sure that members have been involved in the setting up of
those. In fact one I think has opened recently in Wendover I saw which is
which is a new it's one of the newer ones so yes I think that work is
Cllr Stuart Wilson - 2:04:43
is going on. I think it's a fair point but we do have a whole new raft of
councillors as well who may not have had that exposure since joining the council
in May so there's not a new opportunity to relaunch. Okay, Councillor Gaughan.
Cllr Phil Gomm - 2:04:59
I'm glad you continue to mention community boards because that's where
the Dementia project fired up and I'm gonna blow my trumpet maybe as me and
the Winslow area that we tried them out because they did work and they were
extremely good but we continue to still do that. So on the new community board
with these daycare centres we're launching to make sure that all of these
things get mentioned. I'm really glad that we're picking up on a working tool
for carers because again going back in the day from my experience is that was
part of my project leading it forward working with social care sadly it seemed
that I got missed off of the circles went round and round delivering that so
I should look at that toolkit but so I was made Buckinghamshire Council's
champion carer so you know but but anyway as we move forward so it is
great that this is this is going forward and for our new members yeah I think a
session their chairman would be good for everyone to understand that a little bit
more and be introduced to dementia where it goes I lost my mother last year
Cllr Stuart Wilson - 2:06:18
it's not nice. So it's good. Thank you and sympathism and there isn't
anybody that this doesn't touch quite frankly. I think we've all share your
your your thoughts. Yeah. Councillor Adder.
Cllr Shade Adoh - 2:06:37
My dear friend, yeah, it is a tough thing, dementia, and every condition that has to
do with any deterioration in one's capability and ability to actually think, work properly,
it is difficult.
So, I'm sure everybody on here will do, give their support in any areas that we can.
To my question, and I really want to thank Councillor Heap for her work that she did
prior to being in this role, the continued interest and passion in this area of care
and need.
Yes, as a part of agency process, particularly as we are living longer, and I know it's been
alluded to by everybody, as said by Mr. Munday, we can mitigate these processes and what's
happening to everybody.
Education, the way we run our lives, the way we live our lives, identifying and supporting
the carers.
And it's not just adult carers, it's children, because we have a lot of children who are
carers as well. So he's been aware of that and we as selected representatives actually
taking the information out there in our surgeries, every encounter we have and I think that is
a very important thing to do. Mr Edyman, I hope I've pronounced that right, please do
forgive me if I've not. I'm sure there is a way that we as a council to the projects
that we're doing are able to link into the GP practises,
to be able to look at how are people presenting,
because I always feel that GP practises are just
a good spot where you can pick up information,
and also opportunity for them to share about the dementia care,
every other thing that we're looking at.
But that's where carers go for support instantly.
their first port of call when they're struggling at home.
So is there something that we're doing
to work with GP practises on how we can mitigate these instances?
My other question that I think, and Zoe did try to go into,
is I'm very particular about early onset dementia,
because I've had the experiences of this in my role,
where you have a 35 -year -old.
Because usually we're thinking dementia 60 plus,
and people come up, oh, it's just a memory thing.
I'm getting older, so that's why I can't remember this name.
That's why I don't know where my car is or I forgot my parking space.
We need to be honing in on it.
And looking at this report, which I really do think there's so much in here,
but the early onset dementia aspect, I can't, I did not feel was zoning on,
because now 50, 60 is young.
Before 50 was younger, 40 was old, 50 was old.
Now 60 is young and we're having this situation where we're looking at people with dementia
at 70, 70 plus.
There are people now who are 40s but they just keep living and we just allow them.
So I'm not feeling that there's much in here that addresses that point and bring it to the focus.
So my questions are all on 2 .3 .7, 2 .4 .3, 2 .5 .1, and 3 .2 .2.
So I would just summarise and say that everything that I have looked at,
the pathway we've seen involved in designing,
how the cohort is sourced, prevention strategies,
and also on the 3 .2 .2,
How are we reaching out to secondary schools, to universities, in order to start this mitigation
that we want to do, you know, on health prevention, how you look after yourself, stress levels,
and why is, you know, why would be not included or cited in the next steps? Because next steps
speech 61 and that is my 3 .2 .2 question. Why is it not cited there as part of the next steps?
Thank you. I hope you're all taking notes on those points.
Cllr Stuart Wilson - 2:11:07
I'm so sorry I don't have to leave this one.
Yeah I know. Amanda do you want to come back on the GP point first of all and then maybe colleagues
can also follow up because I know you need to leave as well. Sure. Yeah I mean it sounds like
Dr Amanda Bartlett - 2:11:27
a really good opportunity and I'm sure if councillors want to link in with like
local practises or even with the neighbourhood work that's
going on at the moment they would be more than happy to you know my
colleagues in primary care I'm sure would be very happy to link in with any
of the councillors on that.
I had to David admit just to build on some of the answers around health cheques in particular
Craig McArdle - Corporate Director, Adults and Social Care - 2:11:54
and how we can use that as an opportunity.
I'm really keen that we build the dementia work into the integrated neighbourhood teams
because that's where it needs to happen as well to make sure that those services are
delivered around primary care.
That's the reason that we've actually gone down that route so we can really get care
closer to people's home including dementia.
So as we go forward with the integrated neighbourhood working, we've got to make sure that adult
social care is wrapped around it, as you would community healthcare services, but also the
voluntary sector services as well, including dementia support services and carers, etc.
That feels a really important ask for me in terms of that.
So that's our commitment really is to build it in.
I think that sort of big conversation point is really important to say, actually, there
are factors here that you're living your life today Mr. McArdle that will have an
impact later is really important and I'd reference back to David's excellent
report Tomorrow's World for those of you haven't seen it DPH which really
references that life course and some of those factors in our lifestyles today
which if we tackle it will have an impact on on this horrible disease later
and I think our public health messaging has got to support this agenda if I'm
being honest with you as well to really get those messages out because people
don't see the connexion between hearing loss as it might well be or alcohol use etc and
dementia as well. And so we've got to keep that conversation alive. I've really welcomed
some of the thoughts today about how we really make Buckinghamshire County a really dementia
friendly county as well and I think that's a challenge back to us as commissioners and
local authorities to see a bit of reflective space about how we can really accelerate that.
But I do think it starts with prevention and the work that David's doing as well. So I'll
touch on that and also the health cheques if that's okay.
Yes, so just I'll be brief but just to kind of but I think it is important to
David Munday - Director of Public Health - 2:13:47
touch this and it builds on how we work with primary care so all GP surgeries in
Buckinghamshire offer an NHS health cheque to their registered patients
that's offered every five years between the ages of 40 and 74 to pick up on
those risk factors that we think we all kind of touched on in different bits of
conversation that will increase the risk of dementia. And as Craig
highlights the reason we start doing that at the age of 40 is because
it isn't about thinking about this just at that kind of later
point in life it's about what's happening in the kind of
mid course of life that we can be addressing. In addition to that when
people are aged 65 and over within that kind of five yearly cheque there's a
specific dementia screening question that's built in as well to
pick up any of those early signs that may not have been apparent to the
individual or to family, friends and loved ones. So I think that is a
really important part of that working through the system,
connecting primary care into that prevention agenda and that reaching
to our residents. On the point regarding connexion in with schools, so we
do reference within the report a particular piece of work regarding
kind of dementia friendly school resources and that specifically is about raising awareness
among children about what dementia kind of is and some of the kind of triggers for it.
The data suggests that one in three children know someone who has dementia, often a relative
maybe an uncle, a grandparent could be a parent. The broader thing about what children themselves
are being educated on and how we're supporting them to be healthy and to build in healthy
lifestyles then fits more broadly within the work we're doing with our school nursing
service that we commission from the council that the NHS provide into all of our schools
in Buckinghamshire. We have a healthy school award that schools can sign up to to be doing
a range of actions that help that whole school environment be healthy and then we've also
got, we've been piloting it but we'll be looking to roll it out further a healthy school neighbourhood
programme which is about what's happening outside of the four walls of the school but in the
immediate community around that again can be enabling health. So those bits added together
Cllr Stuart Wilson - 2:16:15
I think help us then in that preventative kind of push. I'm quite happy to take up the young onset
Conrad Eydmann - Head of Strategic Commissioning - OP - 2:16:19
dementia issue as well. Is it you know such an emotive topic because given how cruel dementia
is for it to kick in at 35 or 40 is even more so. We certainly in commissioning have got a
responsibility to work across some of these silos. So we've got working age
adults, we've got older people etc and actually if we're going to go for a very
personalised approach the duties on me to work with my colleagues who are
looking at adult mental health and working age adults as well to make sure
that we can come up with a seamless and integrated offer that meets the needs
for people with young onset dementia. For me as well critically the fact that
we've made a very specific reference and carved out some capacity in the new
dementia support service for young onset gives us a window of opportunity to
engage with those affected both individuals with the diagnosis and their
carers so that we can co -design the solutions because I actually we're
better off listening to people with young onset dementia and the people
caring for them to find out what would work for them and how they can be best
supported in the community and taking our heads out of the what age are you
space and actually sitting down with a person and their carer in front of you
saying what what are your needs what are you able to provide self from a
self -sufficiency point of view for support and where can we step in and
provide some additionality to help you.
Councillor Stutchbury.
Cllr Robin Stuchbury - 2:17:46
Firstly thank you chair for bringing this forward it's been a long time and
I give credit to Carol and colleagues who worked on it time this time a long
time ago 2023 doesn't it. Can I ask in your new role working with your cabinet
member taking some ownership over the recommendations that at some point you
can come back to us and give us an update on how you feel those
recommendations have been taken forward and whether some of them haven't been
taken forward. I don't think that's right to get you to answer each question now it's
inappropriate but just come back with an update where you think they've gone
forward and on reflection after time one of the things which is clearly a big
burden to us all is isolation. Isolation can break down into many many different
aspects. You can live in an urban area and be isolated and no one notices you
and you don't get picked up, your needs don't get noticed. You can be in a rural
area and be even more isolated because people think well they've got the
countryside it must be alright so you don't get picked up. One of the things
listening to the Chief Executive of Bucks Health Trust and the Chief Executive of
the other of medical officer and when we talked about the health roadmap the
biggest burden to everybody getting the care they want and can be a big burden
is economic isolation because you have not got the resources or have never had
resources, be able to make contact with all the other things, you are definitely
isolated and that affects your health outcomes. So those things about
isolation, if anything I think I've picked up since then, is it's isolation of
people which affects them getting the support they need, the early onset
diagnosis and that's not a criticism it's just an observation. You've
done something a few years ago you still carry on watching don't you? So if we can
go and look at isolation in our community without a prejudice. Isolation
could be anything. I think that would be somewhere where we need to go. Thank you.
I think your first question we are here to kind of go through the the the review
Cllr Stuart Wilson - 2:20:06
of where things have progressed and where they haven't. I think the the fact
that this has only in the relative recent past been set up as a dementia
support service probably means we're not as far down the track as we would have
liked to have been when the report was first done and you know is my sense of
it. One of the things I think is quite interesting with the fact that we
haven't seen this report for some time is there's been new actions being added
to it because as new people have come in as we've had an opportunity to review it
I suspect it's raised a series of other,
it's matured a bit.
And I wonder actually, and it's probably a general point
for scrutiny in general, is sometimes some things
are gonna take a bit longer to come to fruition
and there may be some benefit of actually it raises
a whole set of topics that maybe we move on
from a rapid review too quickly.
And here I was pleased to see that actually
there's some new actions been brought by the service voluntarily to do that.
So I do think that's the point.
Let's pick up on the point of isolation, if we may.
Yeah, thank you, Robin, for flagging that.
I think that is something that we are very much aware of,
Cllr Carol Heap - 2:21:30
and it is a really difficult issue to tackle,
but I will certainly make sure that that gets raised in the forum
where we're discussing the services that we are providing.
Yeah, it's difficult isn't it?
In rural communities people are very spaced out,
but there is support available in those communities
and it generally centres around the local towns
and I've seen that in a lot of cases,
Wendover, Winslow, you know, they're both,
well, Winslow is north of the county,
went over, not so much so, but it does exist and it's really just the game is linking those
people into the services that are actually there and I think if we can do that then there's
hope for that.
Come back on that.
David Munday - Director of Public Health - 2:22:32
Sorry, just a quick additional comment if that's okay. So we do, I agree with the point
regarding the importance of social isolation, that does figure as a risk factor for dementia,
as you've correctly highlighted, and one of those risk factors that we can take action on
in terms of the comment I made earlier. Two bits of action to reference, because I think
we're doing a range of things on social isolation and we don't always badge them under the dementia,
in the dementia space specifically. So within the opportunity box work, and I touched on this just
earlier, there has been some specific deep dive piece of work on social isolation, what we know
that's happening and how we can be addressing that.
But I appreciate that this is an issue
not just in opportunity box areas.
And we are, and Craig referenced,
the Tenders Live at the moment
re -procuring the Adult Social Care Prevention Service,
which is referencing in the context of that being delivered
for a number of years by VCS organisations.
Centre to that specification,
to the service that they say is the Tenders Live on,
is a model of providing social connexion and addressing isolation as a key part of
how we prevent people needing the kind of statutory care element keeping people independent
and healthy at home. So there will be significant part of how that service runs will be addressing
social isolation. Now we don't always capture that as a this is a specific dementia kind
preventative action but I think it is about weaving together these different parts that
are happening that help us.
Thank you for the responses.
Cllr Robin Stuchbury - 2:24:15
If one thing which I think the chair made a very good point about we've got a different
set of people in the council now than we did before and the fact that empowering councillors
to be able to be advocates for their community. I think what we really need I
think is a simple card. What I mean is a card that we can all have in our wallet,
our purse, a handbag or whatever you choose to carry your ring around, which says this
information. You meet someone in the street and you say what you're doing. You
have to think, well can you drop me an email such and such, a number, a telephone
number when that person's very vulnerable and actually discloses to you
about something that is the point that you need to be able to take action
they're not going to take an email they're not going to do that. If you've got
a number and say ring this number that person at the end of this number will
get back to you and give you help because there's a sense of embarrassment
around dementia unfairly and there's a sense of people tend to feel vulnerable
So I think that in anything we do as elected members a card with important numbers on it would be valuable
So you can be we could be proactive and put that person instantly in touch with the person who's qualified to help them
Isn't always yourself the counsellor and that would be really good. I think collection of numbers
I think and in South explanatory members who aren't on this select committee will meet people as well
Thank you. Maybe an idea for public health in general there, rather than purely being
restricted to dementia.
Cllr Stuart Wilson - 2:25:54
David Munday - Director of Public Health - 2:25:58
No, I agree that we need to be using councillors and as much as we possibly can to signpost
and help people get into services and that we have put together, it's I think kind of
a one -sider kind of infographic which has got for all of the public health services
the range of things. Now there's probably more hyperlinks and phone numbers on there
just in terms of the way that the world is,
but provided that for exactly the reason that you describe.
Thank you.
But happy to recirculate that so that the colleagues can see.
Thank you, that would be helpful.
Cllr Stuart Wilson - 2:26:25
Councillor Hogg.
Cllr Thomas Hogg - 2:26:31
At the risk of sounding like a bit of a broken record,
I'm going to be talking about metrics.
I was, this report that we saw today, it partly premised on the dementia diagnosis rate.
And it's talking about it being a target, you've got the national target, we're not
doing as well as that, we need to do better, makes sense.
So I looked into how it's calculated, and that made me a bit worried, because it's calculated
based on the estimated number of expected people with dementia.
But we are measuring this in decimal points.
So we're talking about an estimate, and I'm not entirely sure why we're putting decimal
points to this at all.
It's clearly just a, like a vague, um, look at this.
And I, and I, that, that, that's worrying me about trying to reach a target when
part of the calculation is actually quite vague and are we absolutely sure that we've,
we've, we get that estimate right.
Um, secondly, it being a target at all, I'm sure lots of you will, you will be
aware of, you know, as soon as you turn a metric into a target, it's
it can skew the numbers and it can change people's behaviour just to reach the targets they're trying
to get. So I'm just keen to hear about your thoughts on that risk. Sticking on the diagnosis
just for a moment, the other thing I mean I can say that personally with the NHS I've had a few
very seriously bad misdiagnoses of something that I've had in the past.
So poor that it could have led to a very bad situation.
I have a slight lack of trust that
the NHS will provide the right diagnosis. And when it comes to this issue of dementia,
there are things which can look like dementia, which definitely are not.
especially things to do with gut.
And so I'm interested, when I look through the part of the rapid review
which is about correct diagnosis,
I didn't see anything about misdiagnosis.
And that was something which I noted. The last question I have is,
of the recommendations that you put forward from the 23 review,
which of these is
the furthest from completion in your view and why?
I'll maybe make a quick comment on the data side if that's okay so you're
David Munday - Director of Public Health - 2:29:35
absolutely right Councillor it is a synthetic estimate and it's taken
on the population number adjusted by age and by sex to
to calculate an assumed dementia prevalence.
It doesn't take into account more subtle variation
within each place.
So for example, I've touched already on some of the risk
factors for dementia.
It doesn't calculate in smoking prevalence,
alcohol use, and so forth.
So it is meant to be there as an indicator and as a guide.
And I think what it does do is focus the activity that's
needed to happen in terms of supporting diagnosis.
I think what matters more locally is then,
and Conrad will have more detail in terms of people waiting
for within that kind of specialist clinic
to get the diagnosis.
And I think that's where we,
and understanding that is what needs to drive activity
more than hitting what you're absolutely right
is an actual absolute kind of absolute level.
So I think that is important.
Unfortunately, our clinical colleague is not here now,
but there is clear guidelines from NICE,
National Institute for Care and Health Excellence on how on diagnosing
dementia and that is something that's implemented within primary care
services and then is what informs how the secondary care can
support in terms of diagnosis happens so there is clinical
guidance that is used also. Yeah happy to pick up so I mean obviously you
Conrad Eydmann - Head of Strategic Commissioning - OP - 2:31:10
can never eliminate the risk of any misdiagnosis but the Adam Brooks
cognitive exam is pretty robust and used internationally as a means of detecting
dementia and is the tool that we would expect memory services to at least make
an initial assessment but that would then be followed up with fairly
prolonged testing certainly before any kind of pharmacological intervention
was applied. I think the important thing is this the the early state stage
of diagnosis because when we had some feedback from our GP practitioners locally in terms
of the current state of play with dementia, we got great reports on the new support service,
they were seeing more people going in, getting supported, but it's this barrier to a rapid
diagnosis which still remains quite challenging. The reason being that if you leave it too
late you go past the point at which certain medications are viable and in many cases those
would be medications that could foresaw or delay deterioration.
So for us, yes, there is a figure, there's a target, but actually trying to get as many
people as possible through an early stage is the critical point because that's where
we can have the most effect, both in terms of support to them, the families, and the
clinical intervention.
Cllr Thomas Hogg - 2:32:28
Just a brief note on that, the survey, it's not a survey, it's like the questionnaire
that someone fills out to test their memory. I've actually seen that test and what it does
is it tests memory but it doesn't test the cause of why someone's memory might be poor,
doesn't necessarily mean dementia.
And that's my big concern there.
I just, I don't, that's not a question,
it's just a comment.
I think we just need to be a little bit careful about that
and I would definitely, just because there are clinical
guidelines around this doesn't mean they shouldn't be
reviewed, doesn't mean they shouldn't be
forensically checked.
I just want to come back to my last question,
just ask it again.
Which recommendation from the 23 review is still
furthest from completion and why.
Craig McArdle - Corporate Director, Adults and Social Care - 2:33:27
I mean I'm happy to take that. Like Raghu earlier, I don't actually
agree with what you're saying around diagnosis in terms of that. I think there
is a really strong evidence base, it's really robust. I get the point that the
target isn't an absolute target in terms of base, it's not a perfect metric at the
tall in the total sense, but I would strongly encourage people to get
diagnosed, I really would in terms of that.
And that's my key message, so I don't agree with that.
The more interesting metric in there, actually,
is the area where I think we're struggling most,
which is waiting times.
And that's the thing we absolutely need to focus on.
That would be my answer to.
What hasn't shifted as quickly as we wanted,
so within that data path there,
that we haven't moved the waiting times enough
in terms of that.
Okay, thank you.
Cllr Stuart Wilson - 2:34:13
If I might just add to that,
Cllr Carol Heap - 2:34:18
Yeah, I actually met with some of the team from Whiteleaf recently and had the opportunity
to speak to them about waiting times and how everything was going and actually the reason
the waiting times are still at nine months, it's not moved, is because they are putting
so many more people through the system because there are more referrals. There are more referrals
coming through now it's really grown and that's partly to do with
more awareness I think and also you know since lockdown everything you know took
a while to get back to normal so I think we're at the point now
where we're getting a lot more people through so more people are being
diagnosed so and most of those referrals actually come from GPs and as Amanda
explained, she's not here now. You know when the GP does that assessment they're
not relying on the test that you're referring to because that is just one
sort of very basic indicator that there might be a memory issue. That's kind of
the starting point and then the GP will do a full history and will do blood
tests and whatever is necessary to actually make sure that you know that is
what their you know dementia is is the diagnosis. But at the end of the day the
The memory clinic does that and they do the diagnosis.
So there's a lot of stages that people go through.
Okay.
So I think everybody's had a good opportunity
to ask any questions.
Cllr Stuart Wilson - 2:35:55
That, the waiting time bit for me,
and I mentioned it earlier on,
is the piece that is more concerning than a number,
quite frankly.
And as I read the report, it talked about capacity
as being the limiting factor.
So building on Councillor Hogg's question is,
so if there are more referrals,
what are we going to do to de -bottleneck the bottleneck?
Because as we said early on,
it's the not knowing that is worse than the knowing.
And having the correct diagnosis for both the individual
and the carer or loved one.
And in the same way that we've decided to put more money
into send evaluations,
because we've got to de -bottleneck that process,
I think we have to look at doing the same thing here.
And so my question, and you don't need to answer it now,
but I'd like a response on it,
is what would it take to de -bottleneck this capacity problem
so that we can relieve the problem,
And if we were to review this in 12 months' time, we wouldn't be seeing exactly the same situation.
And I'm going to add to the compounding factor on that is how much confidence do you have,
given the funding from the Better Care Fund, that the funding for this service is going to be there
in the future at all. And so we've got a capacity problem and reliance on a funding stream that I
think is at risk right now and so we potentially have a perfect storm. So my
question is how we're going to resolve those two potentially conflicting issues?
Craig McArdle - Corporate Director, Adults and Social Care - 2:37:55
Clearly chair leaving the most challenging questions to last in terms
of that. So how much will it take that is an active conversation between Conrad
and Nicola and that's so that's the question we're trying to answer as well
so that is a work in progress so I can't give you an answer today but that's a
really important question for us as well because if we if we can actually unlock
that by and I think the paper refers to non -recurrent funding then then we might
just have a chance to get back on an even keel so you're absolutely right to
put that challenge down unfortunately we can't give the answer today
Is that my colleagues?
The support service, not the backlog, is funded by the Better Care Fund.
Like you, I'm concerned about the governments announcements on the Better Care Fund.
They're saying it's going to be a reformed Better Care Fund, etc.
And I'm not quite clear what that means.
So that is a risk for us as a local authority.
I think this would be an area we would want to continue to prioritise though.
because we made the difficult decision at the time
to actually free up money on the Better Care Fund
to prioritise it.
So it would be an area that we continue to prioritise.
The whole Better Care Fund though is wrapped up
in the wider local government funding settlement
as you well know.
So that remains an unknown at the moment,
but I think this would be a service we'd continue to fund.
I'd probably like this down as a matter of rising
Cllr Stuart Wilson - 2:39:20
in the minutes in terms of when we come back
to the next meeting.
and having an update if you don't have the final answers and hopefully by that
time we'll have the government's settlement and will have been through
budget scrutiny and but I do think this is an important for me it's the burning
platform of this report. I would hope certainly with the better care fund that
we're in a position by budget scrutiny chair so again for those on budget
Craig McArdle - Corporate Director, Adults and Social Care - 2:39:51
that might be an area of focus. You know I'll be there.
Cllr Stuart Wilson - 2:39:56
Councillor Wassell you wanted to come in on this point.
Yeah sorry Councillor Hogg isn't here because when he mentioned the German
Cllr Julia Wassell - 2:40:06
healthcare system I felt a bit indignant at first but of course they do
spend three times more of their per capita of their GDP on healthcare and
The whole issue really is underfunding in health and social care.
If we were to find an issue such as the bottleneck that you're referring to, then I think there
would be a lot of candidates for extra funding. It seems to me the government is trying to
target child poverty to some degree, which is possibly quite sensible to target in the
younger area, but also we don't want to discriminate as people get older. So whether you would
want to particularly single out dementia is the issue that we try to get extra funding
for? I'm not sure. Is that something, should we consider a lot of areas or is that an area
we should...
Cllr Stuart Wilson - 2:41:20
Well I was picking up on the fact that we've got this report in front of us today and it
was drawing particular attention to the capacity limitations. And so I take your point, which
is why I was quite keen that we didn't get into a whole discussion about political economy
and fiscal policies and the rest of it that are perhaps beyond the scope of this committee
or at least beyond the scope of the Council and indeed our local NHS partners.
But I take your point that there are many mouths to feed in the process and Craig will
be very – and Isabel will know that when it comes to budget scrutiny, we'll be asking
for all the mouths to be fed from the same amount of resources.
And the same with public health.
I mean, we could all suggest that David directs his funding,
but he is directed from above in terms of his priorities as well.
But I think that they're all topics, and we have to, at the end of the day,
decide which of those are going to have the significant impact.
So thank you for raising that.
So with that, I thank you very much again for bringing the report.
Comrade, I hope that wasn't too bad for your first hask.
And I look forward to your response on my questions as to how you're going
to solve the intractable problem of service delivery and funding simultaneously.
OK. Is the committee happy to note the report?
Thank you.
So we'll move on to the key performance indicators.

8 Q2 performance - Health & Wellbeing portfolio

So quarter two performance, we gave the cabinet member a free ride last time
because it was so long since we'd, since they were published.
But perhaps you'd like to introduce them and perhaps in the interest of time,
we can focus on those areas where you would like to see the greatest progress made.
And I'll let you have one or two success factors as well.
Cllr Isobel Darby - 2:43:28
Thank you very much, Chairman. Well, obviously we can see we have two reds, so we have got
the adult social care assessments where we are below the target to complete these before
their 18th birthday. It is a very, very small number. It's at 18 in the quarter, and we
only managed to do 13. Had we done another couple we would have reached the target. But
I would say that I would like it to be 18 out of 18 because we need to make sure this
works. We obviously have the new transition board which is looking at preparing for adulthood.
We know that this is an area where we have to improve and we are doing all we can to
make sure that that doesn't continue to stay in the red. Moving on to the
quit smoking, again we are below but actually we've we actually
had a much larger cohort than we could have done and so we had a lower success
rate but I can tell you now that the next quarter we're looking at a good
turn on that which I'm really pleased about but there are lots of lots of
things in there I think it was hitting a lot of people quite quickly and I guess
the argument is should you hit should you hit everybody who wants to give up
smoking or just the ones you think are going to are going to hit smoking go to
quit smoking so we are looking at a new drug which is and I can never pronounce
it properly I'm gonna ask for in a Klein in fact I was talking to somebody about
it only yesterday, which actually reduces the craving rather than being nicotine replacement
and that is showing some very exciting results. So we're very hopeful on that one. And then
looking at and looking for a green one to pick up now. So I think we'll probably both
the admissions to care homes for the 100 ,000 population, we're very pleased with those.
And, you know, that does actually come into line with our strategy of trying to keep people
out of residential care for longer, keeping people independent.
It's all part of how we are going to address this big budget challenge.
So I'll leave it at that.
Thank you.
Cllr Stuart Wilson - 2:46:01
I'm not sure your voice would have sustained for another plaudit on that one.
Craig, is there anything else you want to add to any of those points?
Craig McArdle - Corporate Director, Adults and Social Care - 2:46:12
I mean of those two red I actually think the Public Health one as Isabelle probably referenced
is we're doing quite well in terms of that one. The one which does concern me is the
transitions one. It was the area of focus as you remember from the last meeting that
CQC picked up good overall. I always like to say that but that was an area for improvement.
The transitions board is one thing and having Steve Bambrick chair that but with additional
support wrapped in to get those projects moving is really important. But there's another
one which we've just talked about really we need some short -term tactical stuff
to really get on top of this so we've as a director at Lookware we could free
resources internally which does mean pulling people off doing some work to
other areas but this is an area of focus so we're moving some of our social work
staff around just to focus on this area to get back on track whilst we do the
longer -term piece of work but it's the transitions one more than anything
that worries me. The amber one there is about safeguarding outcomes expressed that if you
go into the detail is around making sure that our practitioners make sure we record the
outcomes on our paperwork in the first place because we have a better return rate when
we actually record that and then understanding the reasons. So that's one that we're trying
to work through overall, slightly below the target but one we're focused on.
Cllr Stuart Wilson - 2:47:28
Thank you. Questions? Julia and Dominic and Zoe.
Cllr Julia Wassell - 2:47:31
Seems to me the one that's on Amber is a very high achievement, whether it met the target or not.
To get people's personal outcomes fully or partially achieved when expressed, that seems a massive achievement to me as a social worker myself.
because people who are the subject of safeguarding inquiries could have so many barriers to achieving
that with the help of the Council. So well done on that one.
As you know, I have a specialist interest in hoarding at the moment. Often letters are
Then I make the safeguarding referral often for self -neglect
and then let us assent to the person experiencing
self -neglect.
And they don't open their envelopes,
so I don't know that they've had an appointment sent to them.
So I find that slightly problematic.
But where there is connexion is made,
I would agree that the case is seen through to some kind of satisfactory conclusion or
handover and mine is not an easy project to find anyone to pick up and follow through.
That is a very good achievement there I think. I haven't got a question really about it but
you know if that could be, if you could get that kind of outcome across more indicators in respect to safeguarding that would be very good wouldn't it?
Cllr Isobel Darby - 2:49:30
Thank you very much Councillor Russell and I think we should pass that back to the team because it's not something that happens just like that, it's a lot of work goes into it.
Craig McArdle - Corporate Director, Adults and Social Care - 2:49:43
Yeah, it's a lot of effort by the team, a lot of work by the team, but making safeguarding personal is really important because during those difficult conversations we need to keep the person at the centre.
The self -neglect one's a really important point. As a safeguarding adults partnership board it's one of our priority areas to really make sure that that pathway is working better, Councillor Vassell.
So offline I'm happy to pick up your thoughts on that because it is probably our main area
for focus as a secondary and adult sport.
Thank you.
Cllr Stuart Wilson - 2:50:10
And I thought the point about sending people letters and envelopes that they're not going
to open up was a very good point as well.
Yeah and it's another one of self -regretting in particular and hoarding and things like
Craig McArdle - Corporate Director, Adults and Social Care - 2:50:21
that where you need multi -agency work really at its best, environmental health, housing,
directorates really coming around the person as well so we've got to keep the
person at the centre of everything we do in those cases.
Okay, Councillor Pinkney.
Cllr Stuart Wilson - 2:50:33
Thank you, yeah I'll be quick over the time.
Cllr Dominic Pinkney - 2:50:42
The same question for both REDD issues is how confident are you that the
actions you're taking are going to change things? I mean particularly for
the transition and what Craig Hughes was saying about that sort of focus.
I was thinking, you know, saying about repurposing resources internally.
Is that going to meet the capacity gap and is that going to be sustainable?
Craig McArdle - Corporate Director, Adults and Social Care - 2:51:02
So I think short term it's a fix, but long term it's not the fix.
The fix is to really re -engineer the pathway,
making sure that our children's and adults teams are far more integrated.
And if that means we have to join them up, that's something we have to consider
as part of this process, as part of the board.
I'm not making a pronouncement today, just so everyone's clear on that.
is something we need to consider. We've got to move that one. CQC will be background,
Ofsted will be background, they will look at that areas and quite rightly too, but more
importantly I think as a council it's an area, that interface between children and
adults that we really want to push on. So I think short term we want to get over this
bump, but longer term we've got to get transitions on a firmer footing and make sure that those
assessment start at age 14 as best we can.
Cllr Stuart Wilson - 2:51:55
And I suspect it may or may not be an issue that comes back in the recent children's services
send inspections as well in terms of transitions for those particular individuals. So, you
know, we may see further emphasis being put behind that. So I think so.
Just on the, because the other red is the quitting one, is the extent to which we have
confidence both in the smoking and alcohol in terms of people staying stopped because,
you know, four weeks is no time at all in the lifetime of a smoker. And I don't know
what the alcohol programme is, maybe two months or something like that with one recovery box,
but how do you ensure that people stay so – are we measuring the right thing?
Yeah, thank you. It's a really important question. So – and stopping smoking for
David Munday - Director of Public Health - 2:52:45
people that smoke is the single best thing they can do to improve their health and well -being
and we do focus a lot of time and energy into that service for that very reason. And we
are required to report nationally on our four -week quick rate. So that's the reason that we have
it here specifically as an indicator and that goes through to Cabinet and so forth. And
that's in the public domain on the public health outcome framework. But you're absolutely
right we do need to track longer term we work closely with our provider Maximus
who provides the Be Healthy Bucks service to ensure we're getting that
longitudinal look. It won't surprise you to know that people do relapse while
they've stopped smoking particularly and it's often people take
two, three, sometimes more quit attempts and we have to have a service that is
supportive of that so we have to be kind of realistic but we do track them on
kind of up to a six month kind of follow -up process to see what's happening.
We're also expanding the use of carbon monoxide validation which is a way that
we can cheque people truly are smoke -free and that's a way of helping kind of
you like validate the quality of the service that we're providing that people
are truly becoming kind of smoke -free so we definitely kind of have that as well
work with the service. On the alcohol side again they will see
readmissions into the service. What we've tried to do is and we've worked hard
with them to reduce the number of unplanned exits so that's not people
getting to the end but then relaxing as people not getting to the end at all to
ensure that we're kind of supporting people as effectively as possible and
again they will do that longer term kind of follow -up piece as well. So that's
always come through the Cabinet reports but is very much part of the work we we
are doing with those providers.
Zoe, you had a question.
Cllr Stuart Wilson - 2:54:32
Zoe McIintosh - Chief Executive, Healthwatch Bucks - 2:54:37
I think Craig has probably already answered it but I think my question was it talks the
adult social care assessment talks about a small number of late referrals and I think
you've addressed it by needing closer working between children and adults because I just
don't understand how if someone is within children's services those referrals unless
they're moving into County or they're being identified post post you know
they're in new needs being identified how someone can be in children's social
care and then have a late referral to adult social care but you talked about
case of working between the two and if I'm missing something about the referral
process. No and the reality is there has to be a push and a pull model between
Craig McArdle - Corporate Director, Adults and Social Care - 2:55:21
children's and adults as well in terms of we can't just wait for people come
over we've got to be actively working with our children and colleagues much
sooner in terms of that space as well. Often the reality is like lots of things
is where if someone's safe in their package for example our focus is on
the new thing that's come in in terms of that and so that's often the reality of
the situation but on these small number of cases we just need to be in reaching
far sooner and as I said part of that solution may well be a joint team going
forwards as well that could well be the solution but again I've got to reiterate
that decision has been made certainly without my DCS in the room.
Cllr Stuart Wilson - 2:56:03
It's an obvious question. How on earth does this happen to people we already know about?
Okay Robin did you have a new question?
Cllr Robin Stuchbury - 2:56:13
Yes it's positive the outcomes on what you're doing I just wonder whether it'd be
Some things are high risk, some things aren't low risk and to record some things you know they do have bigger outcomes.
Have that against it and another thing is we do keep reviewing the same things whether we ought to look for some other things to review that we're not reviewing.
So these are the reports that are agreed by cabinets in terms of the key performance indicators.
Cllr Stuart Wilson - 2:56:50
I know, I mean you keep assessing the same things continuously.
Well until we get them right we're going to keep looking at them.
Cllr Robin Stuchbury - 2:56:57
Cllr Stuart Wilson - 2:56:59
Absolutely, we've got the key performance indicators, each portfolio holder has them,
Cllr Isobel Darby - 2:57:06
but if there's anything that anybody feels that our service is slipping on, which are
not part of these key performance indicators, then please, we'd like to hear about it.
Craig McArdle - Corporate Director, Adults and Social Care - 2:57:24
In terms of risk, that's part of another committee as well who will focus on that as well, and
they're historically, they've been through our risk registers just to make sure that
We're absolutely actively monitoring those as well.
But always happy to share documents.
And I have the joy of being on that risk management group as well.
I do know that.
Cllr Stuart Wilson - 2:57:41
What a lucky man. OK. I'm going to bring that item to a close.
Members happy to note the quarter to performance tracking report.
Thank you.
So we move on to work programme agenda item number nine.

9 Work programme

Suggested items for the next meeting in 26th of February is women's health hubs, south
central ambulance service and the quarter three performance review.
Are members happy to note those as items?
So I'm going to come to the rapid review in a minute.
Cllr Julia Wassell - 2:58:19
Cllr Stuart Wilson - 2:58:22
Can I just ask, as a new Councillor seeing women's health hubs here, I don't know what
Cllr Frances Kneller - 2:58:29
the background is to this, whether this is a review, whether it's a proposal. I have
views on women's health hubs, but again, I would be interested to know a bit more about
what is being proposed or not proposed. Thank you.
I think this is something that committee members, particularly Councillor Addo and Councillor
Cllr Stuart Wilson - 2:58:49
Wassel have been trying to get focused on the agenda for some period of time.
And perhaps Councillor Heap in her day as well. So I think it's something that's been
kicking around the work programme for a period of time. So we're trying to get the things
on the programme that members have wanted to see like the dementia review and like this
particular topic. So it's part and parcel and it's something
that committee members have been requesting. So now on the rapid review, sorry.
We've got report women help out with allowing the means on our website.
Excellent. Well then I can put you the other side of the table and you can make a note.
So perhaps you could send that to Liz and Sally as a follow up. So on the rapid review
on emergency care. I had a conversation with the chief executive at Bucks Health Trust
before the meeting. And obviously I asked the question in terms of commitment. And he
felt that they are in a position to contribute. I asked him whether or not they were ready
given everything else that's going on. He said absolutely we're ready. So I think we
should crack on given that council has asked us to consider it. My view would be we should
given the overwhelming support of Council and the cabinet member.
And so I'd be looking for people to volunteer to be part of that emergency care rapid review
if they wish to do so.
So given that we're now a small but beautifully formed part of the committee,
who would like to be part of that?
Otherwise I'm then going to need to take it out to the rest.
So, okay, so we've got, yeah, well, I've asked Sade if she would like to chair it as a vice
chair of HASC, because typically I think we try to get the vice chairs to chair meetings.
And obviously she said she was involved way back when in A &E at the time. So, yeah, so
I think probably reach out to Councillor Clark as well.
Anybody else?
I'm a bit concerned about availability.
Cllr Dominic Pinkney - 3:01:09
I'm interested.
It operates in a similar way to the way we did the local plan.
Cllr Stuart Wilson - 3:01:17
You have a series of meetings in between meetings, if you like.
There is evidence gathering days and then a process of report writing.
It's reasonably flexible around availability.
But clearly having a good cohort as we saw with the dementia review, having a good cohort
of people to work on it is important.
We should make a note to write out to the other members of the committee who aren't
here and ask if that, but we probably have enough. But I would like somebody from the
conservative group to be part of that in addition to Councillor Addo as well. Leslie, of course.
You're not in eligible these days. So we have a note for that. And we will need to work
up a terms of reference for that session. Okay. Thank you.
Yes, she is. So that's fine. I'd forgotten Leslie. You'd mentioned Leslie. So I was just
trying to get appropriate balance. Okay. Well, with that in mind, we come to date of the

10 Date of Next Meeting

next meeting, which is Thursday, 26th of February at 10 a .m. Perhaps in the Oculus or perhaps
in the fridge. So thank you, everybody, for participating. And we're just a couple of
minutes over, but that's not too bad. Thank you. Bye.
Thank you.