Health & Adult Social Care Select Committee - Thursday 26 February 2026, 10:00am - Buckinghamshire Council Webcasting

Health & Adult Social Care Select Committee
Thursday, 26th February 2026 at 10:00am 

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  1. Cllr Shade Adoh
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  1. Wheaton
  2. Cllr Shade Adoh
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  1. Cllrs Gomm/Hussain
  2. Cllrs Stuchbury/Pinkney
  3. Watson
  4. Cllrs Stuchbury/Pinkney
  5. Cllr Shade Adoh
  6. Cllrs Stuchbury/Pinkney
  7. Cllr Shade Adoh
  8. Cllrs Wassell/Sherwell
  9. Cllr Shade Adoh
  10. Watson
  11. Cllrs Wassell/Sherwell
  12. Cllr Shade Adoh
  13. Watson
  14. Cllrs Wassell/Sherwell
  15. Watson
  16. Cllrs Wassell/Sherwell
  17. Watson
  18. Cllrs Wassell/Sherwell
  19. Cllr Shade Adoh
  20. Watson
  21. Cllrs Wassell/Sherwell
  22. Cllr Shade Adoh
  23. Watson
  24. Cllrs Wassell/Sherwell
  25. Cllr Shade Adoh
  26. Watson
  27. Cllrs Wassell/Sherwell
  28. Cllr Shade Adoh
  29. Watson
  30. Cllr Shade Adoh
  31. Watson
  32. Cllrs Wassell/Sherwell
  33. Watson
  34. Cllrs Stuchbury/Pinkney
  35. Watson
  36. Cllr Shade Adoh
  37. Watson
  38. Glenn Watson - Democratic Services
  39. Cllrs Stuchbury/Pinkney
  40. Cllr Shade Adoh
  41. Glenn Watson - Democratic Services
  42. Glenn Watson - Democratic Services
  43. Cllr Shade Adoh
  44. Glenn Watson - Democratic Services
  45. Cllr Clarke
  46. Cllr Darby/McArdle
  47. McIntosh/ Cllr Kneller
  48. Cllr Shade Adoh
  49. Cllr Shade Adoh
  50. Cllr Stuchbury/Cllr Pinkney
  51. Cllr Shade Adoh
  52. Cllr Shade Adoh
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  1. Mark Ainsworth/Sam Burrows
  2. Cllr Shade Adoh
  3. Cllr Stuchbury/Cllr Pinkney
  4. Cllr Shade Adoh
  5. Mark Ainsworth/Sam Burrows
  6. Cllr Stuchbury/Cllr Pinkney
  7. Cllr Moore/Cllr Hussain
  8. Mark Begley
  9. Cllr Shade Adoh
  10. Zoe McIntosh/ Cllr Kneller
  11. Mark Ainsworth/Sam Burrows
  12. Cllr Shade Adoh
  13. Cllr Clarke
  14. Mark Ainsworth/Sam Burrows
  15. Cllr Shade Adoh
  16. Cllr Wassell/Cllr Sherwell
  17. Mark Begley
  18. Cllr Wassell/Cllr Sherwell
  19. Mark Begley
  20. Cllr Shade Adoh
  21. Cllr Gomm/Cllr Hussain OBE
  22. Mark Ainsworth/Sam Burrows
  23. Cllr Gomm/Cllr Hussain OBE
  24. Mark Ainsworth/Sam Burrows
  25. Cllr Shade Adoh
  26. Cllr Shade Adoh
  27. Mark Begley
  28. Cllr Shade Adoh
  29. Mark Begley
  30. Cllr Shade Adoh
  31. Zoe McIntosh/ Cllr Kneller
  32. Mark Ainsworth/Sam Burrows
  33. Cllr Shade Adoh
  34. McArdle/Adonis-French
  35. Cllr Shade Adoh
  36. Cllr Stuchbury/Cllr Pinkney
  37. Mark Ainsworth/Sam Burrows
  38. Cllr Stuchbury/Cllr Pinkney
  39. Mark Ainsworth/Sam Burrows
  40. Cllr Shade Adoh
  41. Cllr Clarke
  42. Mark Ainsworth/Sam Burrows
  43. Cllr Clarke
  44. Mark Ainsworth/Sam Burrows
  45. Cllr Shade Adoh
  46. Cllr Shade Adoh
  47. Cllr Stuchbury/Cllr Pinkney
  48. Mark Ainsworth/Sam Burrows
  49. Cllr Stuchbury/Cllr Pinkney
  50. Mark Ainsworth/Sam Burrows
  51. Cllr Shade Adoh
  52. Cllr Gomm/Cllr Hussain OBE
  53. Mark Ainsworth/Sam Burrows
  54. Cllr Shade Adoh
  55. Cllr Shade Adoh
  56. Zoe McIntosh/ Cllr Kneller
  57. Cllr Shade Adoh
  58. Mark Ainsworth/Sam Burrows
  59. Cllr Shade Adoh
  60. Cllr Gomm/Cllr Hussain OBE
  61. Cllr Shade Adoh
  62. Cllr Moore/Cllr Hussain
  63. Cllr Shade Adoh
  64. Mark Begley
  65. Cllr Shade Adoh
  66. Cllr Shade Adoh
  67. Cllr Shade Adoh
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  1. /Sam Burrows
  2. Dr Iyer/Gemma Thomas
  3. /Sam Burrows
  4. Cllr Shade Adoh
  5. /Sam Burrows
  6. Dr Iyer/Gemma Thomas
  7. Cllr Moore/Cllr Hussain
  8. Dr Iyer/Gemma Thomas
  9. /Sam Burrows
  10. Dr Iyer/Gemma Thomas
  11. Cllr Moore/Cllr Hussain
  12. Cllr Shade Adoh
  13. Cllr Stuchbury/Cllr Pinkney
  14. Dr Iyer/Gemma Thomas
  15. Cllr Shade Adoh
  16. Cllr Stuchbury/Cllr Pinkney
  17. Cllr Shade Adoh
  18. /Sam Burrows
  19. Dr Iyer/Gemma Thomas
  20. Cllr Shade Adoh
  21. Dr Iyer/Gemma Thomas
  22. Cllr Shade Adoh
  23. Cllr Clarke
  24. /Sam Burrows
  25. Dr Iyer/Gemma Thomas
  26. Cllr Clarke
  27. Dr Iyer/Gemma Thomas
  28. /Sam Burrows
  29. Cllr Shade Adoh
  30. Dr Iyer/Gemma Thomas
  31. Cllr Clarke
  32. Cllr Shade Adoh
  33. Cllr Gomm/Cllr Hussain OBE
  34. /Sam Burrows
  35. Cllr Shade Adoh
  36. Cllr Shade Adoh
  37. Cllr Wassell/Cllr Sherwell
  38. Cllr Shade Adoh
  39. Dr Iyer/Gemma Thomas
  40. Cllr Shade Adoh
  41. Dr Iyer/Gemma Thomas
  42. Cllr Shade Adoh
  43. Cllr Gomm/Cllr Hussain OBE
  44. Dr Iyer/Gemma Thomas
  45. /Cllr Darby
  46. /Sam Burrows
  47. Cllr Shade Adoh
  48. /Cllr Darby
  49. /Sam Burrows
  50. Cllr Shade Adoh
  51. Cllr Shade Adoh
  52. Cllr Shade Adoh
  53. Zoe McIntosh/ Cllr Kneller
  54. /Sam Burrows
  55. Dr Iyer/Gemma Thomas
  56. Cllr Shade Adoh
  57. Zoe McIntosh/ Cllr Kneller
  58. Cllr Shade Adoh
  59. Dr Iyer/Gemma Thomas
  60. Cllr Shade Adoh
  61. Zoe McIntosh/ Cllr Kneller
  62. Cllr Shade Adoh
  63. Cllr Shade Adoh
  64. Cllr Wassell/Cllr Sherwell
  65. /Sam Burrows
  66. Dr Iyer/Gemma Thomas
  67. /Sam Burrows
  68. Cllr Wassell/Cllr Sherwell
  69. Dr Iyer/Gemma Thomas
  70. Cllr Shade Adoh
  71. /Sam Burrows
  72. Cllr Shade Adoh
  73. Cllr Shade Adoh
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  1. Cllr Wassell/Cllr Sherwell
  2. Cllr Shade Adoh
  3. /Cllr Darby
  4. Cllr Shade Adoh
  5. /Cllr Darby
  6. McArdle/Adonis-French
  7. /Cllr Darby
  8. McArdle/Adonis-French
  9. Cllr Shade Adoh
  10. McArdle/Adonis-French
  11. Cllr Shade Adoh
  12. Cllr Wassell/Cllr Sherwell
  13. McArdle/Adonis-French
  14. Cllr Wassell/Cllr Sherwell
  15. McArdle/Adonis-French
  16. Cllr Wassell/Cllr Sherwell
  17. Cllr Shade Adoh
  18. Cllr Stuchbury/Cllr Pinkney
  19. /Cllr Darby
  20. Cllr Shade Adoh
  21. Cllr Shade Adoh
  22. Cllr Stuchbury/Cllr Pinkney
  23. /Cllr Darby
  24. Cllr Shade Adoh
  25. Cllr Stuchbury/Cllr Pinkney
  26. McArdle/Adonis-French
  27. Cllr Shade Adoh
  28. Cllr Shade Adoh
  29. Cllr Clarke
  30. McArdle/Adonis-French
  31. Cllr Clarke
  32. Cllr Shade Adoh
  33. /Cllr Darby
  34. Cllr Shade Adoh
  35. McArdle/Adonis-French
  36. Cllr Shade Adoh
  37. Cllr Gomm/Cllr Hussain OBE
  38. Cllr Shade Adoh
  39. /Cllr Darby
  40. Cllr Shade Adoh
  41. /Cllr Darby
  42. Cllr Shade Adoh
  43. Zoe McIntosh/ Cllr Kneller
  44. /Cllr Darby
  45. Cllr Shade Adoh
  46. Cllr Shade Adoh
  47. /Cllr Darby
  48. Cllr Shade Adoh
  49. Cllr Shade Adoh
  50. Cllr Shade Adoh
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  1. Cllr Shade Adoh
  2. Cllr Clarke
  3. Cllr Shade Adoh
  4. Cllr Shade Adoh
  5. Cllr Stuchbury/Cllr Pinkney
  6. Cllr Shade Adoh
  7. Zoe McIntosh/ Cllr Kneller
  8. Cllr Shade Adoh
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  1. Cllr Shade Adoh
  2. Webcast Finished

Cllr Shade Adoh - 0:00:11
Good morning everyone and good morning Julia and welcome to this morning's session.
I've got to let you know that Councillor Stuart Wilson has asked me to step in the chair today
as advice because he's got other concerns going on at the moment.
So if I may, can I ask you so please for any apologies please.

1 Apologies for Absence/Changes in Membership

Thank you Chairman. Yes we've had apologies from Councillor Simon Rous,
Wheaton - 0:00:44
Councillor Stuart Wilson and Councillor Thomas Hogg.
Councillor David Moore is substituting for Simon Rous, Councillor Robin Stutchbury is substituting for Stuart Wilson
and Councillor Maz Hussein is substituting for Councillor Thomas Hogg.
and in terms of changes in membership, Councillor Robin Stutchbury is no longer a member of
this committee, although he is here today as a substitute, and we have Councillor Mamoub
Hussein is a new member on HASC, so welcome.

2 Declarations of Interest

Cllr Shade Adoh - 0:01:18
Welcome Councillor Mabou. So any declarations of interest from members please?
Thank you very much. Right on the items we have.

3 Minutes of the Previous Meeting

Sorry, sorry Chairman before you go on to item three the minutes I'd like to put a proposal in please if you could bear with me for one second.
It's to do with a motion please Chairman following yesterday's full council with the change membership proportionality I'd like to propose in this motion.
Cllrs Gomm/Hussain - 0:02:14
Select Committee Procedure Rule 2 .64 allows me to submit a motion without notice to the Select Committee.
It does so by engaging the council procedure rules under the council
procedure rule 3 .41. I propose that 1. The select committee procedure rule 2 .12 .4
be suspended so as I so to disapply the length of service of the chairman and
that 2. The committee elects a new chairman with immediate effect for the
of the current council year. That's the proposal of the motion, please, Chairman.
Is that motion seconded?
Cllrs Stuchbury/Pinkney - 0:03:23
The motion has been proposed and seconded so it is on the table.
Watson - 0:03:25
So Chairman, you are allowed to allow any member to speak before we then vote on whether
that motion is carried on up.
Cllrs Stuchbury/Pinkney - 0:03:34
Cllr Shade Adoh - 0:03:49
Well I've been at the advice of the legal officer which all you did before
the meeting I'm surprised that that this is being put forward to the motion. We
have a very important meeting today we have a vice chair and and we're now
Cllrs Stuchbury/Pinkney - 0:04:01
spending time discussing a motion about personal people chairing a meeting. I think
that's a miss I think it's a bad odour and if this was going to do surely
Cllr Shade Adoh - 0:04:15
there was enough time between those papers being published yesterday that
members could have been circulated with the intention of it. I'm sure what the
legal officers given advice before the meeting is correct but it is not exactly
how we should be conducting ourselves in a civilised business like community or council.
Thank you very much Councillor Stogbury. It is a proposal and we've got the monitoring
officer here for advice. We've got our officer here for advice. So if I can go to Councillor
I'm sure she's probably going to talk on the motion as well. Over to you.
Thank you, Councillor. I'd like to propose an amendment to the motion.
Cllrs Wassell/Sherwell - 0:05:01
I'd like to propose an amendment to the motion. This matter is deferred until we've heard the very important business of the ambulance service and then we take a break so we don't do that while we've got guests waiting.
I'll second that.
Cllr Shade Adoh - 0:05:28
So your proposal is that this initial phase is amended, then we bring it back after having the SCAT session.
Yeah, I think we should get on with the meeting while we have the guests waiting and then introduce this business in a gap.
you know have our little say about it and then have the next guests and seems
much better I wouldn't expect to go to a health meeting.
I don't see why we kind of just do it and get it over with and then we get our guests to do what they need to do rather than us having this conversation with our guests.
Watson - 0:06:04
The order of the agenda items is for yourself chair would not need an amendment to do that so you can determine just to proceed as has been proposed by Councillor Gough.
Cllrs Wassell/Sherwell - 0:06:14
Cllr Shade Adoh - 0:06:19
I think we should proceed Councillor Wessel. We'll take the vote and we'll finish with that and we then get our guests to interview room.
Just to add to courtesy, I intend to amend the motion and would want to have a discussion about it.
Watson - 0:06:31
Can we just take a vote on the amendment then, if that helps? Is that ok?
Cllrs Wassell/Sherwell - 0:06:36
No, I want to propose an amendment to this motion then.
Watson - 0:06:41
You just did, Councillor. That is on the table. It's been proposed and seconded.
I'm seconded by Councillor Stojbray. So can we take a vote on the proposal of the amendment?
Just to delay it until we haven't got guests.
So can we take a...
So what is now before you is a proposed amendment to the motion proposed by Councillor Gough.
You are now in a position where you can just vote on whether to accept the amendment that is now being put forward.
So I would say chair you just call for those for and against that amendment.
Okay. All those for the amendment please.
One, two, three.
That's three members.
Three members for the amendment.
Those against.
Cllrs Wassell/Sherwell - 0:07:24
I will list them.
Watson - 0:07:25
Okay.
Councillor Stogbea you can.
No I won't again.
Okay.
Either way, that amendment has been lost. So we are now back to the proposal that Councillor
GOM had on the table and therefore as the debate has now occurred you are able to take
a vote on whether to accept the proposal that Councillor GOM has put forward.
Cllrs Wassell/Sherwell - 0:07:49
We want to speak on the motion now. Why do we need to speak on the motion, Councillor
It's been the motion is that it's not carried, it's not agreed, so we move to the next one.
Cllr Shade Adoh - 0:08:06
Other points not related to the amendment which I want to raise.
Watson - 0:08:13
Cllrs Wassell/Sherwell - 0:08:14
You've raised that by saying there should be a delay so that we can get our guests to speak.
Yes, but I can speak again now because we're on the main motion.
Councillor Wessel, if you please allow me, we are taking a long time on this process
Cllr Shade Adoh - 0:08:27
and we can just do what we need to do and move to where we need to go.
So the proposal you've made for an amendment to delay, which is your reason, has not been carried.
If you don't allow me to speak, then I will suggest that the thing is null and void.
I'm entitled to speak on the main motion.
Watson - 0:08:43
If I may say, Chair Boonas, to advise you, you are able to determine as chair whether a matter has been debated enough.
and if your judgement is that you want to move to a vote you can do that.
Cllrs Wassell/Sherwell - 0:08:56
Cllr Shade Adoh - 0:08:58
Hasn't been debated at all, I put an amendment separately from what I want to say.
Councillor Wosu, I do appreciate what you're saying and I think the idea is the fact that you believe that there should be a delay because you haven't had time.
The motion is we need to actually, you know, move for us to proceed and I'll be asking you to please let us do what we need to do and we take it from there.
I say no, I want to have my say on the proposed motion.
Alright, then I will be, you know, kindly saying we are going to move ahead.
Yeah, please, we're going to move ahead.
I say the motion is now in void then.
Please, thank you.
Right, so...
Watson - 0:09:46
You are now voting for or against the motion.
So you can now call for those for Councillor Gomes motion.
Cllrs Wassell/Sherwell - 0:09:54
So if I can please call for those in favour of Councillor Councillor Gomes motion.
Cllr Shade Adoh - 0:09:57
Am I allowed to go?
Okay.
Against.
And those against.
Watson - 0:10:08
Cllr Shade Adoh - 0:10:11
Any abstentions?
Any abstentions?
That motion is carried.
Watson - 0:10:19
The effect of that is therefore that there needs now to be an election by this committee for a chairman of it.
Cllrs Wassell/Sherwell - 0:10:32
Can I have it minuted that I'm making a complaint later today that I wasn't allowed to speak on the motion?
Watson - 0:10:36
Cllrs Stuchbury/Pinkney - 0:10:39
And I'd like it recorded that I also would have liked to have spoke on the motion, being
as you determined that it had been debated enough when there was no debate.
Watson - 0:10:44
I think the Chairman has made her ruling. If you wish to make any comments about the
conduct of the meeting you can refer them to the monitoring officer afterwards.
Cllr Shade Adoh - 0:10:54
Yes, there are two points. There is the Councillor also.
Watson - 0:10:55
What? The next step. Thank you, Chairman. As Deputy Monitoring Officer, I can now set
out the process for the election of a new chair. The process is that I will ask if there
are any nominations for chair that would need to be seconded each nomination would
need to be seconded one cannot nominate oneself but when it comes to any vote
Glenn Watson - Democratic Services - 0:11:31
one can vote for oneself so are there any nominations for chair
uh well it stops a chairman well sorry you're not the vote well i'd like to propose uh shaadi
adik please take over from the vice chair over to chairman is that seconded it is so that is a valid
nomination now are there any other nominations for chair of the meeting councillor stotchbury
Cllrs Stuchbury/Pinkney - 0:12:04
I'd like to propose Councillor Julia Wassell, long standing member of the House, has been here for a very, very long time
and has conducted herself with sheer dignity at the start and we're going to meet inside to propose Julia Wassell. Thank you.
Cllr Shade Adoh - 0:12:18
Glenn Watson - Democratic Services - 0:12:19
And is that nomination seconded? Thank you, it is. Therefore we have two nominations at the moment, Councillor Ardo and Councillor Wassell.
Are there any other nominations? No. Okay. So we will now vote on each candidate.
As a member of the committee at this stage you are only voting for one of the candidates.
You can't vote multiple times at the moment.
So I'm now going to call for the first valid nominated candidate, Councillor Sade, those in favour of Councillor Sade -Ardol being chair.
and Councillor Ardern you can vote for yourself.
One, two, three, four, five, sorry.
One, two, three, four, five, six, seven.
For the record, any against?
No? Well, I don't need to do that. My apologies.
We have seven.
That is a majority of the committee.
It is a requirement that any person that's validly nominated and then elected
would get a majority of members of the committee.
that has happened and therefore we do not need to vote on the other nominee
Glenn Watson - Democratic Services - 0:13:22
because we now have a majority of the committee in favour of the chair and
therefore I can say that Councillor Arday is now the formal chairman of the
committee. I'd like a vote to be held if that's okay. It isn't okay because the
rule for electing a chair is that it's a majority of the committee and therefore
the first nominee had the outright majority and it would therefore be no
Cllr Shade Adoh - 0:13:52
need to move to that second vote. So Councillor Ardo as you are now chair of the committee
Glenn Watson - Democratic Services - 0:13:56
and you were formerly vice chair of the committee there is no vice chair of the committee and under
the rules in the constitution you are able to appoint a vice chair of this committee so you
might want to do that as your next business. Thank you very much and thanks for the time
and the opportunity and I'm sure we will work well together once we've gone through this
initial phase. But that's what we're here for, for our community, for our residents
and the projects we want to do in order to support them. So now I'm no longer advice
and we need advice. I would like to appoint a long -standing member who has been doing
a lot of work on health and social care. We've got a lot to do on the rapid review so I would
like to appoint a Councillor Leslie Clark and hope you will say yes.
Oh come on. Thank you. Thank you.
Thank you very much. Chairman, may I just bring a point please.
Just going back to the point of motion that we put through.
Just as a note, a complaint is going to go to the monitoring officer of some that didn't
quite agree with that process. Although they took it upon themselves to name themselves
to go forward on that process. So that's a bit controversial when it comes to that. So
I would like that noted by the monitoring officer please.
All right. So that we can proceed. Sorry. I have to thank you very much for your time
and thanks for helping us out. Thank you. So to the agenda item 3 which is the minutes
of the last meeting. So looking at what I have on page six of the minutes. There were
some updates from ask members were invited to the official launch of Health on the High
Street in Wacom. Can I ask if anybody went to that?
Cllr Clarke - 0:16:30
I wasn't around when it was launched but I went in to have a look and spoke to the
two people who were running it. Very interesting. I had my blood pressure taken
and I was told that my blood pressure was wrong. So I said well it must be because it was two o 'clock
and somebody said you know I had to be somewhere else so um but it was really
good very very friendly and I do hope that people will use it you know it's a
quick in and a quick out.
Anybody else? Oh thank you.
Thank you chair I'd just like to say that
Cllr Darby/McArdle - 0:17:05
Councillor Heap and myself attended and it was an amazing event it really was
the place was buzzing and I think this is a huge asset to High Wycombe and to
the people of High Wycombe. It was also great because we met some of the new
community health workers who are going to be working in the
opportunity bucks wards who are actually going to be going out into the
community and knocking on the door so that they weren't part of the help on
the High Street but we met them and it was really exciting to hear
at what they're going to be doing as well.
So I felt it was very positive.
I don't know, Carol, if you want to add anything.
Yeah, it was really good actually.
And there were a large number of patient groups represented
there with,
this one, this one.
Large number of patient groups represented there
for different organisations that we were able to speak to
as well, so yeah, a good start.
That's good, thank you very much.
Councillor Neill.
I was able to attend however I do look forward to having a health in a high street arriving
McIntosh/ Cllr Kneller - 0:18:12
in Cheshire high street before too long.
Thank you very much thanks a lot.
And then on page 8 the committee requested for the inequalities data that underpins the
Cllr Shade Adoh - 0:18:30
JSN in Brackett snake infographic showing health inequalities in box across the life
course.
David Munday, Director of Public Health. Is he here? He's not here. He's not here yet.
So he's not, this has not been completed yet, but he's going to be sending us the paperwork
or reports on this for everyone to read and give feedback. Am I correct?
Yes, yes. The data link is going live in March.
In March?
Yeah, okay.
And on page nine, there's a report from Health Watch box on women's health hops that have
been circulated to all members.
And on page 12, the dementia diagnosis waiting times, that response is due shortly and this
will also be circulated to members.
Thank you.
I can see a cancer or hip nodding.
I know that's your pet project.
yeah thank you. So are we all in agreement with the minutes? Thank you.
I'm so sorry guests protocol and processes so do bear with us. So as
Yes, Councillor Wilson, I want to say chair, with his updates, the chairman's updates.
So there was a launch, public question, an opportunity for members of the public to submit
questions but there were no questions received.
The Chairman, there was a launch event on the 28th of January for the Health and the High Street Facility.
He couldn't go, but we've had reports and feedback from most people in the room, which is quite good.
There will be a Mount Vernon Cancer Centre, a public consultation currently on the way for a proposed relocation of services to Watford.
The meeting is taking place on Friday the 13th of March.
And it would be good for us to have members here, too.
We need two representatives that will be able to sit on that and represent us, take our
views forward because it's a boundary, a project our residents do attend.
So please do liaise with Liz on this for your intentions.
We need two people.
and like I said it would be good to have us in that room. There will be a Buckinghamshire,
Cllr Shade Adoh - 0:21:14
Oxford and Berkshire West Joint Health and Overdose Criteria Committee meeting taking place on
Tuesday the 17th of March. Members of the Bob J. Husk would have received the meeting invite
and that would be the chair well okay he's in Oxford.
He's in Oxfordshire, he will be there.
Councillor Wilson at that last meeting and in between,
due to the outbreak of measles in the country, he made requests to our officers in box to find
out how we as a county are doing. And so the response from the council's public health team
states that as many will be aware, the UK recently lost its measles elimination status
as a result of the disease being shown to have been circulating continuously for more than a year.
The public health team works closely with UKHSA, NHS England, the local school age immunisation team,
and other partners to promote routine vaccination and make it as accessible as possible for
historically undeserved communities.
What's undeserved?
Undeserved.
Undeserved, yeah.
Stuart.
When the data has, what the data has shown that particular Buckinghamshire GP practises
have low MMRI uptake, they engage with nearby community and faith settings to emphasise
the safety and effectiveness of the vaccine and the regional immunisation team provide
extra resources to enable the practise to expand their vaccination offer. We are also increasing
our outreach to nurseries and other early year settings and have worked with comes to run
starting school back to school campaigns and this includes the importance of vaccination
to prevent outbreaks during the summer months. So that's the report from the Chair, Councillor
Wilson. So that's why he's asked me to read that to everyone. So back to us. Apologies
again. Sorry Councillor Stogbert.
Cllr Stuchbury/Cllr Pinkney - 0:23:39
Yeah I'd just like it recorded in the minutes that the immense thanks that we have to Councillor
Stuart Wilson for the independent nature that he chaired this as, the hard work that he put into
this, the professionalism that he brought to the role and the report that he's presented to you to
present today. I think it's important that we recognise that commitment, we recognise that
whenever because it was not mentioned at the start of the flurry into the new positions. I think it
was most courteous of us to do that, if we can't be courteous to each other we can't be anything.
So I'd like to have it recorded that our thanks in the minutes and those words accompanying
in that because if not we are nothing more than in Curtis.
Thank you.
Cllr Shade Adoh - 0:24:21
Okay.
So prior to us going through and I'm sure from the times you've been here you have
met the now past chair.
And I think my colleague has already
alluded to how passionate Stuart is in my discussions with him
and Liz about because we're going to be having a rapid
review as well.
And the relevance of your service to the community,
to emergency care is quite vital.
So it is an opportunity for me at this time.
I know my colleague has already said a lot of that to express our gratitude, having had
discussion with the officer as well for the work that Stuart has done in the service,
not just since it's been unasked, but we've looked at rapid women's health, housing,
as it affects health and healthcare provision.
Cllr Shade Adoh - 0:25:24
So we are very keen on that and would like to take that forward and see how far we can
I join Councillor Stodgeberry in saying thank you to Councillor Wilson for the work he has
done. He has acted fairly.
I would say as a partner because he has made efforts to bring everybody together to work
and we will continue the project that he is passionate about with the support of experienced
members that are sitting in here.
So, I would like to welcome Mark and Mark. That took me a while. I kept saying Mark and
Mark until, you know, Liz said no, it's Mark and Mark, to give us an outline on the work
that you're doing and how far you've gone to this committee. We had an email that was
sent, so if I'm allowed, if I can give a background, so now therefore opening to members
to ask questions. I know we've taken your time. We're writing to you today, that was
on Wednesday, the 29th of October, to update you on an important development in ambulance
services across the Southeast. South Central Ambulance Service, SCAS, and South East Coast
Ambulance Service, CCAM, are joining forces to form the South Central and Southeast Ambulance
group, the first group model of its kind in England.

6 South Central Ambulance Service - move to Group model

This initiative has been fully supported by NHS England in
Brackett, Southeast, and is in line with the NHS long -term
plan, which is a 10 -year plan, which aims to deliver high
quality, sustainable, and equitable care across the country.
The new group model represents a proactive move to strengthen
in patient care, improve staff support, and ensure ambulance services remain safe and
resilient in the face of increasing demand. Both SCAS and CCAM will continue to operate
as independent trusts, maintaining local accountability and flexibility while collaborating more closely
on shared priorities such as clinical excellence, digital innovation, and workforce development.
A shared leadership model with a single chief executive and chair will provide strategic
alignment and coordination across both trusts, enabling more effective use of resources while
preserving each organization's local identity.
The key benefits you've set to us are more consistent, high -quality ambulance care across
the Southeast, stronger collaboration to share expertise, data, and best practise, greater
resilience and operational efficiency to meet rising demand, improve staff development opportunities
and support, enhance value for money and alignment with national NHS priorities. Over to you.
Based on what we have said, because I have said the outline, I have laid out any updates
for us and then we will be open to questions.
Mark Ainsworth/Sam Burrows - 0:28:46
Is that on with the green light is it? Yeah where is his mic?
Thank you I'm Mark Haynesworth I'm the Executive Director of Operations at PSCAS and Mark
Begley you probably know because Mark comes to these meetings quite regularly. So if we
cover off the collaboration work around the group model first and then Mark can do any
further updates on the performance. I believe all the councillors have got the performance
charts that were circulated by Mark earlier. So the current position with the
group model is we've been out to recruit a chair and chief executive. We are still
in that process so there's been one round of interviews and there wasn't a
chair appointed so we are working with an agency to secure a chairperson still.
We've got a number of applicants for the chief executive role, but the chairperson
appoints the chief executive.
So the chief executive appointments are again paused until we recruit a chairperson.
That said, both trusts are working collaboratively on a number of work areas, as we highlighted
in the letter.
For example, our mean computer aided dispatch systems, that's the system we use for the
999 calls and dispatching ambulances to patients and we'll be going out to do a joint tender
for that so we'll have the same system operating across the region. It is obviously a very
complex procurement process but it will enable us to provide resilience across the whole
of the region and will enable us to review where our contact centres are, how we operate
our contact centres and provide that resilience. If we lost a contact centre through a power
failure or anything, we can immediately move to another contact centre across
anywhere across the southeast and there currently as an example there's currently
five contact centres across the region and we have three, Seachem have two with
Milton Keynes for us just being the one -on -one contact centre for our Thames
Valley area. From an operational and patient services side of things we've
been working closely for the last 12 months to review each other's services,
what works well, where we need to make improvements and again a couple of
examples. We have a really good service from specialist practitioners. You go
out and see our category 3 and category 4 patients, provide a really high level
of see and treat so of the patients they attend 80 % of those patients are left at
home. CCAM don't operate that model in the same way so they're looking at how
they adopt that provision within their area.
And in reverse, from a critical care side of things,
so these are patients who are in cardiac arrest
or serious trauma, CCAM have a critical care paramedic role
which South Central don't have.
We rely on the air ambulance provisions
to provide that critical care cover,
both by air without two air ambulances and also cars,
and they put two cars out across the Thames Valley for us.
So those sort of things, bringing those together,
and then looking at our clinical model.
So how does a patient in Kent get the same treatment
as a patient does in Aylesbury?
And there's a lot of work there to do.
We're working with our chief paramedics,
our chief medical officers, to really understand
what is the best service we can provide for those patients.
That work can continue without a chief exec
and chair in post.
So we have committed both organisations,
both our independent boards have committed
to that work continuing.
My personal thoughts are I don't think
a chief executive chair are gonna change that strategy.
This is about doing the best care we can
for the population of Southeast.
And we can only do that in collaboration.
As part of the change,
there is a commissioning change as well.
So SCAS are currently commissioned
by Hampshire and Isle of Wight ICB.
Clearly Bob Frimley, Milton Keynes
to contribute to our funding, but that will change from April. We will move to a single
commissioner for the whole of the south -east region and that will be Surrey and Sussex
ICB. So again, that is a new ICB coming together. They were two independents coming together
as one ICB. Surrey were previously the commissioner for CCAM and they will now provide commissioning
for all of our services for 999.
They won't provide single commissioning
for 111 at this stage,
so they are still procured independently.
So we're working with Thames Valley,
as it will be from April,
around our 111 contract to secure that
for the next 12 months,
and then look at how we deliver
the 111 provision moving forward.
From an operational staff perspective,
I think there's a lot of enthusiasm because it will lead to further development opportunities
for our staff, particularly if we're looking at developing critical care, paramedics, advanced
practise, again, as a clinician, Mark and I are both paramedics, but it's gone very
wrong if we're seeing patients every day.
But, you know, as a professional, you want to enhance your career, and we can do that
in collaboration, learning from each other.
that we can use each other's training
and education facilities to develop our workforce further.
So operational staff, while they're thinking
it won't be affecting them at the minute,
in the future it will lead to those opportunities
and at the end of the day, patients will receive
that standard and improved care across the region.
So I'm happy to take any questions on the group model
ahead of doing any performance questions.
Firstly, thank you, thank you for coming. I hope your selection of chair and by everything
Cllr Shade Adoh - 0:34:46
Cllr Stuchbury/Cllr Pinkney - 0:34:49
that's not smoother than the ones this morning, I'm sure it will be. The point which really
to make is I'd be interested in the changes. We have Wexham and we have Milton Keynes Hospital,
you'd be aware that both of those places effectively serve Buckinghamshire, the county, not the
ceremonial county, are you assured that the changes that take place, that continuity of
understanding will remain because many patients in my ward and constituency will automatically
because of time be taken to Milton Keynes Hospital because it's the quickest place to
get to so they can get the best treatment quickly. Though we are, if you're further
towards Winslow you'll probably go to Stone Mandeville because ambulance always choose the
place which is going to be the best place to get them to. So will the changes affect that in any
way? I don't believe they will and with the introduction of a new party in it what work's
being done to work with the other blue light services that being fire and police to make sure
that there's an understanding between all those services that turn up to
emergencies that what's going on and what the model would be so there's no
miscommunication and people not turning up to places they need to be to make
sure that's our doubt at the onset because you could get a situation that
they didn't believe it was theirs because it wasn't once to ensure that
actually taking place and that patient care is not impeding.
Cllr Shade Adoh - 0:36:29
Mark Ainsworth/Sam Burrows - 0:36:31
So our geographical boundary as SCAS won't alter. We are moving our internal
boundaries as of the 1st of April to go to a county -based model
which will make life a lot easier. So our footprint will be Buckinghamshire. So
Mark as head of operations will be taking in the south Bucks area of High
Wickham. So the geographical footprint for Buckinghamshire from Milton Keynes
down to just below sort down to the M4 below South, below High Wycombe, will come under
Mark's jurisdiction as head of operations. So Thames Valley we will split into the three
counties and we'll have Oxfordshire, Buckinghamshire and Berkshire as our operating areas. There
will be a slight change there. With regards to where patients get taken to, again we'll
take patients to where the best facilities for their care. So we will
still take stroke patients to High Wycombe if that is the closest stroke
unit for their care. As we develop other pathways, again working with
South East Coast, we've identified a number of pathways that we have got that
they don't have, so we're going to support them to develop those pathways
but also they've got a few that we need to embed in our operation as well. With
regards to your point around emergency services working, all emergency services
buy into Jessup which is the Joint Emergency Services Interoperability
Programme which is basically how we communicate at the scene of an incident
and all three services train and exercise that together. So at the scene
of any significant incident where all three services are present, all the
commanders and all the staff know exactly how each area operates and what
the priorities is whether it be fire, police or ambulance takes command, if
there's serious injured patients we take command and the other services support
us. So that is well embedded across our organisations across the Thames Valley
and we've just had a recent inspection where they've inspected each of the blue
light services and that's come out very favourable at how we're working together.
Cllr Stuchbury/Cllr Pinkney - 0:38:42
Follow up then. Well if I ask it now it'll be in context.
Cllr Moore/Cllr Hussain - 0:38:53
Thank you Chairman. Firstly I just want to say Mr Ainsworth, Mr Bokely, thank you for
your service and the amazing work that paramedics do. Very inspiring work indeed. I know how
much work in terms of, because my ward's next to Wexham Park Hospital, we see the day and
ambulance drivers and all the support staff are keeping everyone safe and
making sure they are taken back into good health and transported them to the
appropriate hospital. My question is regarding specifically Wexham Park
Hospital. With this new group model how will this affect the conveyancing
decisions across the ICPS because obviously Wexham Park Hospital which
serves a lot of my ward, Farnes and Stoke Pogges ward, was in the
friendly health area and I appreciate the ICP boundaries do not necessarily reflect
the geography and Buckinghamshire is a long county and is there any risk that this change
might risk the regional, well regional standardisation could reduce the flexibility in taking patients
to the nearest hospital. How can we ensure we have that, as you mentioned, local autonomy?
Thank you very much.
Mark Begley - 0:40:00
Good morning everyone. So to answer your question, all ambulance services certainly are SCAS.
We take our patients to the nearest most appropriate receiving unit. So that may not be the closest.
To give you an example, if you were to have a cardiac event in Aylesbury, you wouldn't
normally go to Stoke Mandible, you would go to High Wycombe, because that is where the
cardiac specialists are.
So in terms of Wexham, patients that are already
receiving treatment at Wexham Park would automatically
go to Wexham Park anyway.
If we have a new patient that's never been to Wexham Park
or Stoke Mandeville, the judgement is there
where their location is and where we will take them.
And again, going back to the most appropriate
receiving unit.
So there are certain areas of expertise and we were to take that into consideration with
all patients.
And that's not just Wexham Park, that's throughout the whole of SCAS, including Thames Valley.
Thank you very much.
Zoe, please.
Cllr Shade Adoh - 0:41:12
Thank you, Chair.
Zoe McIntosh/ Cllr Kneller - 0:41:14
So Zoe from HealthWatchBucks.
I was interested in the communication and engagement work you've done with patients
and residents about this new model and how you'll be using patient experience
and feedback across the geographical footprint to in your decision -making and delivery of services.
Mark Ainsworth/Sam Burrows - 0:41:41
So we have a patient panel, both trusts have patient panels with very good representation on
so we'll be using them as our point of contact to any change in service.
Currently there is no change in service, so both trusts will continue to deliver as they
are.
We will continue to work as independent trusts.
Now that may well change in the future, but at the minute the intention is that we collaborate
where we can.
What we haven't done yet is get the two patient panels together, so I think that's one step
for us.
We started to bring some groups together, so union colleagues for example, bringing
those together to understand how we work. Obviously communication wise going out to
the public has very much been in the media. Both of our chief execs have done local media
releases. There's been joint media releases from NHS England region, south east as well.
So at the current stage our engagement with patients will continue through patient panels,
through patient experience feedback, so patient surveys.
Some good news for us is that our compliments
far outweigh our complaints.
So learning from those compliments, what's going well,
how we embed those, but also learning just importantly
from the complaints.
And we do that through both written complaints,
verbal complaints.
We also do, we've embedded PSERF,
so the patient safety area where we monitor every day
any patient safety incidents and we've now embedded duty of candour into that
process so if we identify we have failed a patient we will notify them of that
failing and we'll work with them so they understand the learning that we've taken
from that. Those processes will stay embedded within both organisations. What
happens in 12 months time around public engagement I don't know yet but it
certainly would only improve it's not going to deteriorate from where it
currently is.
Cllr Shade Adoh - 0:43:43
Cllr Clarke - 0:43:47
I have a couple of questions. The NHS in Bucks is moving and changing the
trust and we also now take it from me. So will your new organisation cover that area?
If you switch yours off it might work properly. So that is the first question.
The second one is that we're all very well aware that you end up being backed
up at A &E. With this new organisation will you have enough vehicles to cover
that problem because it is a huge area that you're now going to cover. And you
know the air ambulance is a charity and will they be included and financed with
this new reorganisation. My last question is about recruitment. We're all very well
aware that it is incredibly difficult to recruit people in the South East because
of the cost of housing and living. Are you finding that and do you see any way
that property could particularly we call it a certain housing do you see
working with the council to actually provide perhaps housing for ambulance
Mark Ainsworth/Sam Burrows - 0:45:23
drivers or firemen or that sort of thing thank you. So the first one around air
ambulances they remain independent charities there is no funding through
the AHS through to the air ambulances.
That doesn't change by this group model.
The geographical footprint we cover,
so we currently cover Frimley North from the old ICB,
and we cover a little bit of Frimley South,
and Seachem provide the rest of Frimley South.
With Frimley coming into Thames Valley ICB,
both organisations will continue to cover
the footprints they were covering originally.
What it does allow us to do is to share resources
across what becomes an invisible border.
So if South East Coast Ambulance have got an ambulance
that's closer to Crowthorne, for example,
then we can deploy them into our patch or vice versa.
With regards to the affordable housing and recruitment,
Last year we actually stopped recruiting in June because for the first time, I mean I've
been in the Trust 35 years, it's the first time I have known that we have reached our
establishment level.
So we had enough staff to run our service.
Now that is enough staff within our budget.
So clearly if more money was available we could improve our service.
But we had 2 ,000 operational staff and we reached that level.
So we actually stopped recruiting. We are now actively recruiting again because
the performance standards have currently been 30 minutes for CAT 2. They moved to
25 minutes from April and then we're getting back down to the constitutional
standard of 18 minutes by the end of 28 -29. So to do that we have to become
more efficient. We also have to increase our staffing levels, vehicles and
infrastructure to support that. So we are bringing in new staff now, so we've got
new staff starting February and March and then through the first quarter of
the next financial year we're increasing our establishment and the majority of
those staff are coming into the Thames Valley area. So whilst we stopped
recruiting we had over staffing in Hampshire, under staffing in Thames
Valley and every day we are moving ambulances from Hampshire into Thames
value to support that service delivery. So there is a number of newly qualified
paramedics about University that are joining us. We are not, I think we've come
before and talked about international recruitment where we've been bringing
paramedics across from Australia, New Zealand, South Africa and we have stopped
that because there are now more paramedics coming out of University than
there are roles available for them. So there is an abundance of workforce out
We knew there would be this sort of drop
as the three year degree programme embedded.
This is year three of the bulk of them coming out.
And unfortunately there will be paramedics coming out
that won't be able to get a job in the NHS.
But we will continue to recruit.
With regards to your question around affordable housing,
then definitely yes.
The Thames Valley is an expense,
well our whole geography is an expensive area
for our staff to live.
So we do look at what opportunities are available.
we do try and support staff as best we can. At the end of the day, you know, a
paramedic wage whilst it's going up is not significant enough to secure a
decent mortgage to get a house in this area, so a lot of our staff do rent
properties rather than buy, so if there are opportunities for a further
discussion on affordable housing then we would definitely be interested to have
those discussions, particularly around areas where our ambulance stations are
so High Wycombe, Wexham, Stoke Mandeville sort of areas.
Thank you very much.
Cllr Shade Adoh - 0:49:13
Cllr Wassell/Cllr Sherwell - 0:49:18
Thank you Councillor O 'Doow and welcome today with your innovative pioneering
organisation with its new model. When I heard about it I was concerned because of getting
away from localism and the need for new leadership and this sort of thing. Staff morale can dip
when this changes. So I hope you're getting on alright. In the document you kindly published
recently you talk about urgent treatment centres at Stoke, Mandeville and Milton Keynes. Do
you refer to Wickham as an urgent treatment centre as well? Okay. And do you find any
difficulty with the new organisation covering Wickham as you used to do, or is it exactly
Mark Begley - 0:50:25
the same? So as Mark said earlier, locally nothing's
changed, absolutely nothing's changed. We are still doing the same thing as we did before
and we will continue to do so, so we won't lose that local element. Some of you have
seen me here a few times as the head of operations, I remain as the head of operations. So I'm
really excited by expanding my area, which takes over South Bucks, High Wycombe. I have
a lot of interest locally anyway. I lived in the local area for many, many years. I've
worked in the local area, so not quite as many years as Mark, but I've done 29 years
and day one was based at Stoke Manhall, Culverie, High Wycombe, Chesham, all of those areas.
So I have a vested interest to make sure that we do the best that we can in our area
That's really good to answer your question. You won't see any different your your community will not see any different the
Standard of care we strive to provide gold standard care
And we will continue to do so good. So just got a question about
safeguarding training so when you receive when
Cllr Wassell/Cllr Sherwell - 0:51:39
paramedics want to make a referral do they have a designated safeguarding lead
and how easy is it to for them to know when to refer to adult social care care
Mark Begley - 0:51:59
safeguarding team how's that going so we've been doing safeguarding referrals
for many years now and it's all done online and when Mark and I first started
we had a great big piece of paper and we started at the top and ended up down the bottom.
Now we have a digital platform which our staff use, so all our patient records are kept on an electronic platform
such as it's similar to an iPad.
So our staff are well versed in doing safeguarding referrals.
They go centralised and then go out to the right appropriate area that they should do.
Bearing in mind whether you're in Milton Keynes or Portsmouth we use the same safeguarding
form because it's part of South Central Ambulance Service.
So yes there is a central area that we make sure that the right information goes to the
right people every time.
And who is your safeguarding lead?
Sorry, it was just I did ask that question.
Shall I do a bit of data?
Cllr Shade Adoh - 0:53:20
Cllr Gomm/Cllr Hussain OBE - 0:53:31
My question is first of all getting this opportunity to thank you for the amazing work you people
do. We are always proud of our services. I think you can see the concern from our council
is for the welfare of our people and our areas that are there being sort of because my concern
would be the quicker that the ambulance get there. I think surely we are going to see
some data that how fast, but the question was
changing the position or new areas or new strategy,
would that make any different to arriving the ambulance
any quicker or any less, because that would be the main
concern of the people, that how quickly they can get there.
The other question which I had was when you were making
your presentation, you mentioned that somebody had
a cardiac arrest in Stoke -Manuel,
and you would take it to High Wycombe.
I understand that High Wycombe is specialised,
but I'm sure the person need urgent attention
soon as possible, wouldn't be taken to Stoke -Manmore.
Why would he go to High Wycombe?
Thank you very much.
So I think Mark was referring to a cardiac incident,
Mark Ainsworth/Sam Burrows - 0:54:32
so somebody having a heart attack
rather than a cardiac arrest.
Cardiac arrest would definitely go to Stoke.
So cardiac arrest, closest hospital to the
that's got a resus department, whereas cardiac,
so somebody having a heart attack that needs
intervention therapy would go to High Wycombe.
So that's why we used the specialities.
So what was the first part of your question?
I would just say the changes to the area,
Cllr Gomm/Cllr Hussain OBE - 0:55:02
would that make any different?
I mean, I think I understand that the body language.
Mark Ainsworth/Sam Burrows - 0:55:08
So both South Central and Seachem
currently have different commissioners, as I explained.
And we're commissioned for different levels of service.
So this year we were commissioned to deliver 30 Minutes,
which was the national standard for CAT 2.
South East Coast were commissioned to deliver 25 minutes.
So arguably patients resident in that area
of our new group model are getting a faster response.
Part of this is around levelling up and levelling out.
So we will not worsen services across any area,
but we need to bring services up to the best we can.
And working with the new Surrey and Sussex commissioners,
we're looking already at how we invest in areas within South Central to bring
us to the 25 -minute standard that CCAM are currently delivering at.
Cllr Shade Adoh - 0:56:02
So I know we've been talking about Councillor Wosler has gone into data already so
Cllr Shade Adoh - 0:56:07
would you mind giving us you know take us through the performance data please
Mark Begley - 0:56:14
Mike Beagle. Yeah my pleasure. So hopefully you've had time to absorb a lot of the data
that I've put in front of you and this is what was requested from you, from you
chair, chairman. Just a couple of things really to note. You mentioned Councillor
Clark regarding the handover delays at the hospitals and how they're getting
and sort of blocked up and things.
So those of you that were here,
I think it was last year I spoke about RTR45,
which is Release to Respond in 45 Minutes.
And at the time it was discussing
what we perceived to be the improvement
and how we saw this going on.
Now in the presentation,
there's quite a few charts there that support this.
And you can see from December of last year
when we put RTR45 that there's been the continued improvement.
Now forgive me for putting all of our acute hospitals throughout the SCAS
footprint but I wanted to demonstrate the importance of RTR45 across the whole
of the SCAS footprint and how all of the acute hospitals had
improved to no end. So why is that you're asking?
So when you think about if we have handover delays at let's say Royal Berkshire Hospital.
Now because we are one service we won't see Royal Berkshire Hospital or Royal Berkshire people community left without some sort of response from us.
So we will start shifting additional resources towards that area.
Equally so, if Stoke Manville starts choking up, then again more and more vehicles will come from outside of the area to support us.
So it's quite a dynamic thing that we have to do, our control room have to do, in order to make sure no matter what is thrown at us, we provide a good response as soon as possible.
And that's how we move our vehicles about.
But as you can see the RTR45 has been really really good for us. It showed the
improvement in handover delays. Yeah we've hit winter and we have got a bit
of a sticky point at the moment but when you look at how how ill people are you
would have seen on TV the respiratory issues and things like that and when you
speak to the hospitals you can see the pressures that they're under. So we're
communication with our hospitals, working with them.
We don't work in isolation, we work with each other
to minimise any impact that that may have on our patients.
So the other thing that part of what we had to do
was to make sure that we get the right people
to the hospital and not just everyone going to the hospital.
So we've invested heavily in additional clinicians
to hear, it's called Hear and Treat.
So these additional clinicians that are within the control room and we have
remote clinicians as well that can look at the stack. Now what they do is
individually look at that call that's come in and see what else can be
done. Now this is the lower acuity so these are your cat 3s and 4s that
they will be looking at rather than the cat 1s and 2s. So with this they're
to look at the look at the incident see what they can do and see whether we can
provide a more appropriate resource rather than just an ambulance and
directing patients to where they need to go rather than the hospital and as you
can see in the charts our Here and Treat has been gradually going up and up and
up which is a really good improvement to have and what that's demonstrating is
we're taking less and less to the hospital enabling the hospital to
concentrate more on the patients that they need to concentrate on. Mark has
spoken about the national agreement for the 30 minutes and that was obviously
because the 18 minute was, it was, we were unable to achieve that across
nationally and that's why they brought in the 30 minutes and that is now
changing as we're getting better and better. So the last thing really to speak
to you is about the roadworks. Now as we know...
Do you know what? I left that on purpose to the last point. I've got to be
honest I knew I'd get that reaction. You've heard me talk about this before
and I did a presentation to you about the roadworks.
Now, Bucks is still as rural as it was before when I first come here,
and that hasn't changed.
So that does make it slightly different,
and I'm not talking just about the potholes, that's a different storey.
But it's still a very rural area,
we still have country roads that we have to navigate to,
and we still have the roadworks.
So we still get the new internet cables going through the waters
all those sort of things. But we also have East West Railway which is at the top end,
Councillor Stuck, more at your end. And then as we go down south into Chesham, Hammersham
through to Aylesbury we have HS2. So those real road works do happen, the diversions are still in
place. I think the difference is nowadays we have a much closer tie with HS2. I attend a lot of the
meetings fortnightly and we get a lot more information than we ever did before. So that's
a really positive and I think that was a support from the last time we came. In terms of what
I do is if there is a long diversion and when we talk about long diversion we're talking
20 plus miles for a diversion and you can imagine the impact that that may have on our
patients. So I will get to that diverse and see if we can do it. Now what they are doing,
they are listening to us, which is really good and this is what I wanted to come on
to. What they're doing is they're opening up what's called blue light routes. So where
we used to have to do all the way round, they've now taken on board what we're saying and they're
allowing us to go through on blue lights only. You can't just put your blue lights on and
and think, oh, I'm going to be late, so I'll put my blue lights, that's not allowed, and we don't do
that at all. Although we go through, we have to go through very slowly. At times we have to have
someone with us that takes us through, but it's far better than the long journey that we had before.
So that's probably the highlights. I was asked to keep it down to five minutes, but I think I've
failed miserably, so I do apologise, but obviously there's an awful lot of data in there.
Thank you very much.
Cllr Shade Adoh - 1:03:39
Thank you very much, Mark Bingley. That's very, very good. And I mean, it shows what
work goes into not just getting the patients to the place where their needs can be met
and they receive the appropriate treatment, it's what the ambulance drivers, the crew,
actually encounters in making that happen. And hopefully, like Councillor Clark said,
It's about working in partnership.
We all working together and seeing how we can make life for residents and the crew to
be able to work together.
So you've answered in part one of the questions I have.
You've mentioned about the blue light transfers and you've mentioned about the handover times.
And both questions I'm going to ask is around that.
So I just want more detail about the blue light transfer that takes place between Stock
Annover and Wakeham. On average how many take place on a daily basis and how does this impact
delays in Annover time at both hospitals. The second one, if you look at your slide, slide 21,
this is about the Thames Valley Annover times. Why do the Annover times consistently
remain lower at Wexham Park. Why are they doing differently to the other hospitals?
Milton Keynes. I think it was Milton Keynes.
Wexham Park is the green one.
Oh right, sorry, I'm looking at something completely different.
So this is the additional info. Oh no, I've got it here, these different numbers.
Mark Begley - 1:05:29
So in part, if I answer your Wexham Park question, so Wexham Park have had a massive increase in funding in terms of rearranging their ED, their emergency department and have been able to improve their handover delays.
they weren't always down the bottom. So what we're doing, we're looking at what is Wexham Park doing
and how can we replicate that, certainly in Aylesbury as well. Now Aylesbury has for some
time been quite an exemplar for handover delays and bearing in mind when you look outside of the
Scas footprint or outside of Tender Valley, our handover delays are a lot more favourable
than other areas, Norfolk and Norwich and that's the different parts of the
country. So we're doing exceptionally well here but certainly with Wexham Park
they did have I think it was a 60 million pound increase to rearrange or
re -modernise and it did need modernising their ED and that again that supported
how we can move patients through quicker.
So it's probably up to five a day in a 24 -hour period so that's not that many.
Now the studies have proved that if you take patients that are having a cardiac event such
as a heart attack to specialists, the outcome is far better than if you go to the local
hospital.
So for argument's sake, if you were having a heart attack and we took you to Stoke Mandeville,
yes they could see you, they could stabilise you, but the expertise is in High Wycombe.
So the additional time that it takes us to go to High Wycombe, the patient outcome is significantly
better. They have the experts there, they can do absolutely everything where Stoke Mandeville can't.
So hopefully that answers your question and it is the cardiac event, it's not the cardiac
arrest.
If it's cardiac arrest it goes to the nearest emergency department.
Thank you very much Mark.
Zoe.
Cllr Shade Adoh - 1:07:45
Thank you.
Zoe McIntosh/ Cllr Kneller - 1:07:49
I just wanted to pick up on Councillor Wasser's point about safeguarding.
So you talked about the process of safeguarding referrals.
I think when you were here a couple of years ago there were quite a high number of inappropriate
that were being made, has that improved and what are the numbers looking like now?
Mark Ainsworth/Sam Burrows - 1:08:08
So I think you're referring back to around 2022 when our CQC report came out. So that's
when we were rated as inadequate and that was the biggest area they found was our safeguarding
processes and failings within that. So our safeguarding team, we now have an adult safeguarding,
child safeguarding lead. We've also got an interim head of safeguarding at the minute
So come back to your question around who that is.
A lady called Sarah Thompson is our interim at the minute.
And this is one of the areas we're looking at
how we collaborate jointly with CCAM
because we could have a head of safeguarding
across both trusts.
So that's why we've got an interim post holder.
The focus was on around education of our staff,
around appropriate safeguarding referrals.
So every member of staff now does level one, level two,
level three safeguarding, e -learning.
They do a face -to -face seven hour session.
and this year we've brought in a four hour supervised session as well.
That's more difficult to become compliant with because it needs to be supervised by a safeguarding specialist
and we don't have many of them.
But our compliance with eLearning, funnily enough we reviewed the Executive Committee on Tuesday,
we're at 94 % compliant with our staff for doing the eLearning.
And what we've seen with getting the education where it needs to be, there's fewer inappropriate referrals.
There's still some that go through where staff are over cautious but I think our actual referral
rate is more appropriate now than what it was back in 2022.
And we've just had CQC have done an inspection late last year on our emergency operations
centre that moved from requires improvement to good and our operations teams removed from
inadequate to requires improvement they've then just completed their
well -led inspection and we're just waiting the outcome from that report
which we're due by the end of April but the verbal feedback was they've seen
Cllr Shade Adoh - 1:10:08
significant improvement in our safeguarding process. Thank you. Can I just quickly come to you.
I hope I'm not putting you on the spot. Great. You know do you see this in our
appropriate referral from your perspective in your role in adult social care?
McArdle/Adonis-French - 1:10:25
Thank you, Chair. As a safeguarding system we still receive a lot of concerns, safeguarding
concerns, so nationally we are top quartile in terms of the number of safeguarding concerns
that we receive. Now that's not just through SCAS, I need to be clear with you because
get safeguarding referrals in from concerns from a number of places. What
we've done with SCAS in particular, that's the question, is work very closely
with them to say what's a safeguarding concern and what's a welfare cheque as
well and so that's really helping the process. It's absolutely a work in
progress and we're building locally stronger links with SCAS around
our multi -agency safeguarding hub and things like that. So we have seen the
quality the referrals improve, the volumes are still there as well and it'll be a work
in progress. I know you're doing more on your safeguarding referral forms, electronic to
update it as well and some of the challenges that SCAS and others have is each local authority
is slightly different as well so we have to work within those parameters as well. So it's
a work in progress I would say Chair but definitely progress.
Cllr Shade Adoh - 1:11:32
Thank you very much. It shows we're all working together which is quite good. So if I can
to Councillor Stogbury opportunity for your follow -on question as well.
Cllr Stuchbury/Cllr Pinkney - 1:11:45
Thank you, thank you. We cast ourselves back to where I was. I was going to come to the point that in North
Buckinghamshire quite often at that point we often have people which I picked up from hospital, they
can end up in Bedford, in Banbury at the Holton and they can end up at Keynes. One of the things
which in North Buckinghamshire and I suppose it's in other extrenths of the
county is this inability for people when they get there to know how to get home
because they're vulnerable that's why they phoned someone like me to come and
find them. Not that it's a very good journey for them but they you know
this is one of the things what works being done to make sure the general
practise know where they are, who might know where their parents or responsible person is.
Lastly one of the things which is being undertaken is the 10 -year health plan,
which might in some way change the way that you operate and it might impact, because like in
Buckingham there's every likelihood there'll be a health hub in Buckingham, which means people
may be circulating around the health slightly different than they were before. They may
not necessarily be going straight off to a major or various things, they might come there.
What provision is there within the service to assist people to get to these health hubs
to receive the treatment where they are going to be because it won't all be emergency treatment,
it'll be social care with outpatients and stuff like that. Because there is an
issue in rural areas and there's an issue financially for people, their
inability to get appointments sometimes. There's always the hospital car
appointment but you've got to have the money to be able to help contribute to
that. So if people can't get care they won't recover and if they miss their
appointments that costs the NHS money it also affects their outcomes of their
their treatment. So in the 10 -year health plan is there likely to be anything looking at that?
Because otherwise we'll do something really good but no one will be able to use it type thing.
Mark Ainsworth/Sam Burrows - 1:14:06
So we don't provide patient transport services that's now provided by eMed as a private company.
So getting patients home from hospital or between hospitals if they are mobile themselves
would normally be done by patient transport services.
What we've started to do is look at if a patient, if we take a 909 call and the patient needs
to go to a treatment centre but they don't need an ambulance, we will always say have
you got a relative or a neighbour that can take you.
If the answer is no, we would have previously still sent an ambulance to go and take them in as a very expensive resource.
We are now using accredited taxi companies to take those patients on our behalf.
So they will have a medical assessment over the phone by one of our paramedics or nurses.
If they are deemed suitable, we will send them a taxi and we pay for that taxi.
It's cheaper for us to do that than it is to send an ambulance.
And it means the ambulance is then available for a category 1 or category 2 call.
We're looking at how we do that for 111 as well.
Now the risk is if the public gets a here, phone 111 or 999, you're guaranteed to get a tax and you won't have to pay for it,
we need to be really careful because that could become out of control.
With regards to notifying other healthcare professionals and families where patients have gone,
our crews will always try and notify next of kin as to where the patient's being conveyed to.
If they don't have a next of kin, they will try and tell a neighbour or somebody else who's close by us where they've gone.
Once we've conveyed the patient, the electronic patient record that the paramedics complete is sent to the hospital, but it's also sent to the GP.
So the following day, the GP surgery, we get electronic version, they'll see Mrs Smith has gone into State Mandeville Hospital by ambulance and they'll get a full report of what they've gone in for.
As we move forward with community hubs, our focus is very much on the left shift.
What else can we do to keep patients treated in the community?
So whether that be through Hear and Treat on the telephone or face -to -face,
we're looking at how we support those patients to stay at home,
and if they need to go to treatment centres, go to those local treatment centres.
So if there are additional urgent treatment centres that are established,
that are closer to the patient,
then we would convey them there,
rather than conveying them to the emergency department.
And one of the things we're really keen to do
is work with each of the community areas
so that the place -based care, we're embedded within that,
so we can look at how our clinicians can be utilised
in the services, but also making sure
that any clinical pathway that's developed,
all of our staff know about them,
so we can make sure we utilise them.
Cllr Stuchbury/Cllr Pinkney - 1:17:05
Lastly when we've gone through all these, one of the things which everybody gets confused about NHS services
and every time there's always a change coming, there's always an alteration.
At the end of the process, during the process, quite often if the information that could be placed in an appropriate place
like the taxi service and that. Would that be a place with the GP practise commission people
who might be better placed to make a judgement and assist in that rather than me wanting you to pick me up
because I'm coming out of the pub on a Saturday night. You know because you've got a free taxi
which I think you alluded that sometimes the things might be inappropriately used.
but if that can be sort of communicated because I didn't know that and I think
the GP practise probably the best place to know that.
Mark Ainsworth/Sam Burrows - 1:18:03
Thank you. So we're not going to openly publicise that we're moving patients by taxes.
We will triage every call on its own merit and if it's appropriate to send an ambulance then we'll do so.
If it's appropriate for them to make their own way, you know, nine out of ten residents can hopefully get a relative to take them and then we'll do that.
we've got no intention to notify GP's that you can use us to book a taxi
because we'll be inundated. Thank you very much. Mark.
Cllr Shade Adoh - 1:18:33
Cllr Clarke - 1:18:37
Councillor Black. Thank you Chairman. A question in High Wycombe you have an
ambulance station which quite frankly needs to be knocked down and built again
and that's been like that for 15 -20 years. Do you see any change in your
ambulance station in High Wycombe and will you be also investing in the
Mark Ainsworth/Sam Burrows - 1:18:53
maintenance of your vehicles? And as Councillor Raghav was saying to myself, it's our board so we know it very well and we also know the issues of parking.
So could you please tell me what you're going to do? So our long -term strategy is
Cllr Clarke - 1:19:12
to move to larger. Just one question, long term, how long is long term? So it depends
Mark Ainsworth/Sam Burrows - 1:19:17
what funding becomes available. So we've put in a bid, there's been some national capital
money released for next year and we have put in a bid to build our first hub and whilst
I accept High Wycombe is not a good state, Oxford's in a worse state. So we have gone
with our bid for Oxford first and High Wycombe will be second. If that money is released
every year then High Wycombe will be submitted for the next financial year.
A hub will take two years to build because it will be purpose -built. We've tried to
convert buildings in the past and they never end up how you need them so it'll
be a purpose -built facility which will include fleet maintenance at the site,
It will include training facilities for our staff at the site and it will include enough
parking, which becomes an issue wherever we are, for all the staff that have moved to
that location.
And we would also look at any corporate services that would need to move to those locations
as well.
We won't hear until the summer whether we get that first bid accepted but certainly
High Wycombe is next on the cards to do.
And as we move forward over the next 10 to 12 years, we will reduce the number of current
ambulance stations we've got into those larger hubs.
So for example, and I'll speak from where I live around Reading, Reading and Bracknell
would become one hub rather than two separate ambulance stations.
We've done it in South East Hampshire where we've moved Fairham, Gosport and Portsmouth
all into one hub, but that was a conversion of a building and that's why it's not quite
where we need it to be and we've got 300 staff based on that one location whereas
High Wycombe's got 90 staff so that's the size difference. With regards to High
Wycombe, our intention was to procure a new facility and we'd identified some
land and we were working with the council. Unfortunately the cost of that
land went up considerably so we had to abandon the decision to build that site
Yeah it become unaffordable to move there. So what we have done, we've secured some,
I can't remember the name of the funding, but there's some estates funding that comes out from
National Round improving infrastructure and we've secured some money specifically for High Wycombe
and we have got plans in place which we're just going to start sharing with staff and as we do
so I'm more than happy to share with yourselves,
around redeveloping that footprint.
So because we've no longer got patient transport services,
that's freed up some garage space.
So we're looking at removing some of the garage space
to make more parking available,
redo the parking to make it more suitable for staff cars
rather than big ambulances,
but also improve the accommodation block for the staff.
It is way overdue, we acknowledge that,
but it is balancing what we do wear
and I don't know how far you look outside your area but I'm in regular discussions
with the Councillor from the New Forest at the Minnows looking at what we do
with High Bamblyn station in the New Forest which again is falling down
around us and it's through historic lack of ability to invest in the estate but
High Wycombe is definitely on our urgent to -do list and particularly as we
recruit more staff we can recruit more staff into High Wycombe so the parking
problem becomes greater. We have looked around High Wycombe over the last 12
months to see if there is another property we could move to or develop and
there's just nothing that comes up on the market that's big enough for what we
need that isn't going to cost more than what we've currently got.
Thank you very much. Councillor Pitney.
Cllr Shade Adoh - 1:23:13
Thank you. Thank you both for being here. It's great to hear some information. On the
Cllr Shade Adoh - 1:23:22
Cllr Stuchbury/Cllr Pinkney - 1:23:26
additional info pack, you gave some information around community first responders, which are
members of the public who are trained to volunteer. Can you give us an idea of how many first
responders we have in Buckinghamshire, what kind of impact they make to the service and
Mark Ainsworth/Sam Burrows - 1:23:39
Would you, do we need more of them?
Yes, we need more. It's a simple one.
And we've got just over 800 across the trust. I'll have to come back to you with the exact number in Buckinghamshire
because they operate as schemes.
And what we try to do is sort of get six to ten people to operate as a scheme in their local community
and then look at how they develop to cover 24 hours a day, seven days a week.
So they are volunteers.
So they are a huge benefit to us.
We do an annual award ceremony for them to recognise the outstanding practise.
They are our lifesavers and that might sound dramatic but they are.
They get to Kadekares in their community far quicker than we can with an ambulance.
They deliver the immediate CPR, they deliver defibrillation, they maintain airways.
So all those basic skills that keep somebody alive till we get there,
they are undoubtedly the heroes of the local community and they do it for the local community.
and we acknowledge that you know they're doing this in their own time but it is a
huge benefit to the patients they attend. We are always recruiting but it's really
difficult if one person in the village says they want to do it we need to try and
encourage them to try and get four or five more people to join them because
otherwise when there is a cardiac arrest in the village if that individual isn't
there we've still got not not going to cover in that village. Like I say we do
publicise it and if people need more information more than happy to come to
that team to come and talk to different groups because we have trainers that do
the train specific group of trainers that do the training for the volunteers
so they train the community first responders but they train our military
co -responders as well and they train some of our fire co -responders around
Buckinghamshire and Oxfordshire so if there is an ask we can certainly get
people on to community groups to come and have a look at how we can recruit
Cllr Stuchbury/Cllr Pinkney - 1:25:32
more people. Just to quickly say that yeah very happy to help and promote that
so if you're working with Community Impact Bucks and their
Volunteer Bucks platform anything else to promote that so it sounds like a
Mark Ainsworth/Sam Burrows - 1:25:47
fantastic team. Thank you. Thank you. Councillor Galb. Sorry I've been so quiet
Cllr Shade Adoh - 1:25:50
Cllr Gomm/Cllr Hussain OBE - 1:25:53
Chairman all day but generally good to see you. And yeah like colleagues have said
what great service you do supply our area and beyond now. I'm going to go
dig a different direction slightly. What I'd like to know, you mentioned about people using
you like a taxi service, have you seen, since people can't get to their local doctor and
then they go to A &E, have you found an increase in phone calls to try and use you as another
route to get into hospital a bit quicker? Has that put more pressure on?
So one of the things we've seen is that 111 demand. So 111, when it first came in, was
very much a night time and weekend service and we developed rotors that
meant we had a few staff that worked during the day when they did occasional call and
we really maxed out on our capacity overnight where you know you couldn't
access health overnight. We have seen a change with increasing demand in the
mornings so we are seeing particularly on Monday and Tuesday morning we're seeing
a big increase in one -one -one calls where patients are trying to access
healthcare, they don't want to call 999 so the obvious route is to call 111. As you
Mark Ainsworth/Sam Burrows - 1:27:01
call 111 there will be a non -clinical person who triages your call. The
pathway system that's used will tell the call handler which is the best route
and that could well be directing you straight back to primary care. We're
working closely with primary care to make sure there's the capacity for us to
to book those patients in so some surgeries allow direct bookings that if
you phone 111 we can book you straight into an appointment that day in your
surgery. Other surgeries don't do that. Most surgeries answer phone messages
will say to ring 111 as well so if you can't get through or if it's not
emergency ring 111. So again that's driving up that demand. What we then see
is if we haven't got enough call handlers in 111 if you're on the phone for three
or four minutes waiting for us to answer it which on a busy day you could well be
and you're really concerned about your health, you put the phone down, you're going to ring 999.
So again on a Monday morning we're now seeing a 999 demand go up because patients are trying to access health.
Now fortunately because we've got the clinicians in the control room for 999,
they can offer clinical advice over the phone and hopefully avoid sending an ambulance.
It is a really complex system, if anybody, any member wishes to come and have a view around,
it is Bicester so it's a bit of a trek I'm afraid,
But if anybody wishes to come in we can host a visit around the contact centre because
in Bist we've got the 111999 contact centre, the air ambulance desk is there, our clinicians
that do the hear and treat are based there as well.
So it will hopefully give you an insight into how complex it is for just picking up the
phone to ring in our services.
I'm glad I asked the question because the Deputy Cabinet Member, her pen has been like
hot for the last two or three minutes, uh, taking notes down.
Just one little thing I want to comment.
It's lovely to hear how great you're doing, um,
your service for our community, et cetera. What I would like to know then,
this is just off course again, slightly.
I'd like to know if our community community are treating your staff with respect
because I know that they deal with a lot of abuse and I'd like to know,
has that abuse dropped off or do you still receive a lot of that?
No, we're sorry to ask that question. Unfortunately, we do still receive a lot of abuse
And that's either on the telephone
so we have I
Chair our rain networks where race equality inclusion network
I'm exactly for that and we've got a number of international nurses that we've brought across from African countries and
We're picking up a lot of feedback that people can hear their accent and they're getting racially abused on the phone
So we do a lot of work around how we train them and we are allowing them to
terminate the call. So we will not stand any racial abuse or any abuse to our staff.
We also get public phoning up and rightly so they're concerned for a
relative. We're not getting to them as quickly as we can. We're not meeting the
national staff response times so they will call back and ask where their
amateurs are. Again that can escalate into abuse on the telephone. Our frontline
staff are meeting the public face -to -face. Again, you could have waited
three hours for an ambulance and they turn up, they'll get abused because of
the wait, which I totally understand how frustrating it can be if you wait a long
time but our staff are not there to be abused. We are encouraging our staff to
wear body -worn cameras. We haven't mandated it like the police have. It is a
personal choice to take a camera and wear it and we have used some of that
is to prosecute people who have verbally and physically assaulted our staff.
Verbal abuse is the higher rate, there is the occasional physical assault, but it
is mainly verbal. We are looking at whether we mandate the cameras or not.
There is an apprehension from some of our staff that they've been listened to all
the time and they never have a time to tell them it's not recording unless you
push the button. It's still that relationship to overcome with some of
our staff, but it is something we're trying to stamp out. There has been
national campaigns on it as well and we continue to push it locally. We don't
have the rates that some other more urban trusts have but it is still very
prevalent amongst our workforce. Yeah I suggest get those cameras but apologies
from all of us to your staff for tolerating that sort of behaviour. I know
people get stressed but it's something that needs to be addressed. Thank you.
Thank you very much.
Cllr Shade Adoh - 1:31:25
We've got paramedics here.
You've increased it, haven't you?
Yeah, you've put it up.
It's warm this side.
It has been increased.
You have increased it, haven't you?
Yeah, you have.
I'll tell you what it should have been.
Thank you.
I can pin you to warm over here, Chairman.
Really?
Oh my God.
It's hard to be hiding a screen, Chairman.
Thank you very much. And I just have to sort of put on the back of what Councillor Gummer
said. The fact that one, we would like and I'm sure we'll have that discussion sometime
later. Maybe we can have a joint visit. We all come and see what the space is like. But
also to say, you know, a big thank you for what you do and nobody in any situation should
be able to accept any form of abuse.
And also, I hope we will take it to our residents
and encourage them to watch this session
so that they can hear from you what is done,
how it should be done, their responsibilities to themselves
and to the community.
Because you have said a lot this morning
about what you are doing and how that impacts people.
So we can take that out to say this is what you need to do.
Don't call this number at this time or be careful.
Go to your GP.
Don't use the ambulance service as your taxi choice.
So we will take that out and hopefully with our officers and the Councillors as well,
the information can be shared through different networks and we'll continue to work together.
So just to say thank you very much and we appreciate that.
Councillor Neillan.
Thank you very much.
Thank you for a very interesting session this morning.
I've learned a lot over the years
with the new Councillors, so thank you for that.
Obviously this is quite an innovative project.
Cllr Shade Adoh - 1:33:38
Zoe McIntosh/ Cllr Kneller - 1:33:44
A very innovative project that you're doing here.
I was interested a bit more in terms of perhaps more strategically.
What's been your biggest learning or challenge?
You're not really piggybacking on models that already exist out there.
And has there been anything that's been quite surprising or unexpected during this process?
Cllr Shade Adoh - 1:34:05
Mark Ainsworth/Sam Burrows - 1:34:06
Are you speaking specifically around the collaboration and the group model with South East Coast Ambulance?
Yes.
The bit that I suppose has surprised me most is the enthusiasm of our management teams
to get to work together across the two trusts and to start looking at how they can develop
the service because you do become quite insular within your own footprint. I mean we provide
quite a vast geography as you know but we're still the second smallest ambulance service
in the country. We then become the largest ambulance service and there's a bit of apprehension
around I could be in Bicester one day and Kent the next day, how do we do that? I think the
appetite from our staff to make sure they learn what the other trusts are doing, and
that's both sides, there's learning on both sides. There is apprehension, we don't know
what the new chief executive or chairperson are going to choose how the trust will run
and there's various models of group models around hospitals across the country with a single board, two boards,
so I think there's a bit of apprehension, me personally, of what the future looks like.
The bit that for me, again, personally that stood out the most is the commissioning that I went through earlier.
How neighbouring ambulance trusts can be commissioned so differently to provide such different service,
and that five minutes difference on category two
is whether somebody gets into a stroke unit
for thrombectomy on time or whether they don't.
Yeah, that's the difference that five minutes can make.
And I think that's where, certainly from an NHS England
region, is around how we make sure the services
are delivering, because again, we're still in the top half
of the country, both trusts.
It's how we get to level up together,
and whether we ever become the top performing
ambulance trust, who knows?
but with the right level of investment, the right efficiencies that we make, the delivery of care
will improve. But yeah, the funding difference has probably been the biggest surprise.
Cllr Shade Adoh - 1:36:12
Thank you. Thank you very much. We've got two more questions and we've got a very swift,
precise on those questions and I know you will, the two of you will. Councillor
Hussain, Mabu Hussain. Thank you Madam Chairman. I think you're lucky that I don't have a question.
Cllr Gomm/Cllr Hussain OBE - 1:36:25
my question is being answered and I'm grateful but I think it has on the mic I'd like to say that
like Mike called it council clerk said and myself we aren't we're coming in a central part away
we're come anything we can do assist to help we are more than happy to support.
Thank you very much. Councillor Mone to say.
Cllr Shade Adoh - 1:36:45
Cllr Moore/Cllr Hussain - 1:36:48
Thank you. My question Mr. Mone to cover about the abuse if we anything we can help we're happy to
and I would like to visit the centre if it's possible.
At least we can go back to the community,
because I understand you get a lot of abuse,
if you're late five minutes, I understand that life is important,
but staff shouldn't get abused.
Well put. Thank you very much.
Chairman, in terms of the visit to our control centre,
Cllr Shade Adoh - 1:37:15
Mark Begley - 1:37:17
if you direct it to myself,
I'll do the organising for you. I would urge you to come and have a look at it.
Certainly you will walk away absolutely in awe of what our staff do. It's an
incredible centre and the professionalism is just, it's just
brilliant there. I can show you pictures, show you videos, but you need to see it
in person to see how well, how efficient and how professional it is and how
they're dealing with members of the community.
Thank you.
Thank you very much.
Family, we want to say thank you for your time.
Thank you for coming.
Cllr Shade Adoh - 1:37:57
And apologies, we had to do that five minutes initial intro.
But I hope you enjoyed.
Very interesting.
Thank you very much.
I appreciate your time.
Thank you.
Good luck with your action with the chair.
Thank you.
Cllr Shade Adoh - 1:38:33
If you know any candidates, that's enough.
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Cllr Shade Adoh - 1:42:18
Welcome back.
Thank you very much, and thank you for coming to our session today.
We appreciate it.
Welcome to Sarah on my left, to Lalita, to Sam Burrows, and to Gemma Thomas.
Just to give us a background, this is us looking at the overview,
and I need to emphasise that to colleagues.
is an overview of the Women's Health Service.

7 Women's health services

As part of the Women's Health Strategy for England,
integrated care boards are establishing women's health
hubs across the country.
As part of the scoping discussion with health
colleagues, it became apparent that there has been work around
developing women's health services in Buckinghamshire.
The current changes with the integrated care board provides
opportunities for further work in this area.
This item will be an overview of what services currently exist
for women in Buckinghamshire and ICB colleagues have requested
to come before the committee at the later stage
when these services are more embedded
across the wider geographical Thames Valley.
So over to you to give us an overview on this item.
Please, and when you do, let us know what your role is
so that our colleagues will know how to address
their questions as well.
Thank you.
/Sam Burrows - 1:43:46
Thank you so much and good morning everybody.
Very lovely to be here with you.
My name is Sam Burrows.
I'm currently the Managing Director of NHS Frimley
Integrated Care Board.
But on the first of April,
we'll be the Chief System Development Officer
for the new NHS Thames Valley Integrated Care Board.
And I know that many of you will be aware of the changes
that are currently happening to the commissioning sector
in NHS nationally right now.
thank you for referencing it in your opening chair. But just to be really clear to colleagues
have a total understanding of the changes which lie ahead for us, the current integrated care
board in this geography which is the Buckinghamshire, Oxfordshire and Berkshire West ICB will be
dissolved on the 31st of March as will NHS Frimley ICB, my current organisation, will also be dissolved
on the 31st of March and on the 1st of April we will establish the Thames Valley integrated care
board which will cover Buckinghamshire, Oxfordshire, Berkshire West and what is
currently the eastern half of Berkshire currently covered by NHS Frimley ICB. So
in many ways this is a bit of a critical and important milestone for us as a part
of that journey. It's our first opportunity to meet with many of you, the
chance for us to say hello and get to understand a bit more around Buckinghamshire
and the things which are important to you and we're really really happy
here and to get the opportunity and the chance to have our first conversation
with you. I'm relatively confident this is the first of many more to come so we'll be getting to
know each other over the years ahead. But today we've been asked to come here and speak to you
around women's health and in particular women's health hubs. Looking forward to having that
conversation. In a moment I'm going to hand over to Dr Lalitha Iyer to my left who's going to give
you a bit of a broader clinical overview around our approach and I'm really delighted that Dr
Sarah Avery is here with us as well who can speak a bit more around our local offer in Buckingham
around the service provision that local people enjoy. Our commitment to you today
is that we're not going to talk for too long. We really want to hear your
questions, to have a conversation with you, so we'll try our best to be brief.
But for now I'll hand over to Lalitha who will take us through to the next
part of the presentation. Thank you. Thank you Sam and thank you Cenac.
Dr Iyer/Gemma Thomas - 1:45:50
So I'm the Chief Medical Officer for the Bob Anne Primley ICB and the Future
Thames Valley ICV. I'm also a gynaecologist by profession and a GP. So I'm really pleased
that the focus on women's health is a continued focus in spite of all the national, local,
and system changes happening. So I'm really heartened and pleased to be here to talk about
this topic and Sam knows that I say this from the heart and not just because I'm here. We
So what I want to do is just sort of set the context nationally and locally at an ICB level
and then hand over to Sarah.
So we know that the Women's Health Strategy is going to come up with a revised version
sometime in March.
We also know that there are exciting developments such as the online hospital which has certain
specific conditions, but we've managed to get to important
gynaecological conditions on that online hospital, so women can have better access.
We know that there is an enthusiasm even as a southeast region where we recently
had what's called a learning improvement network where
all the ICBs from across the southeast came together
and gynaecology was one of the work streams alongside urgent care and mental
health, for example. So the ideas that emerge from there are
also going to be taken forward as a system. We are using organisations like the Health
Innovation Network, which is a network which can support us with looking at strategy and
so on. And then on my mind I want to reflect on what is actually a women's health hub.
It doesn't necessarily have to be a physical building. The concept and the principle of
it essentially is bringing care closer to home, bringing care closer to where women
want to see the care. And if you reflected on the Health Watch report, which you kindly
sent us, it actually said women want to be seen either at their practises, it said they
want to be seen in the community. They prefer not to go to the hospital much as they love
the hospital colleagues and the professionalism that they show. They want to be there for
the right reasons. So what we want to focus on and talk about today is a
little bit of what you already have and actually you are in a really good place
when I compare it with other geographies within the ICB. But I also want to say
that when we reflect on what is the core mission of an ICB and as we come
together in Stemms Valley ICB, our core mission is to improve outcomes for our
population, reduce inequalities, so identify the gaps and then reduce inequalities, and
we want to improve access to consistently high quality services.
And if you looked at our Thames Valley Commissioning Intention document, you'll find that we have
said that women's health hubs, the principle of it is really important for us and we want
to commission it, but we want to take time and do it right, so we want to look at the
the evidence, the mapping, the inequalities, as I said, and then make sure that every woman
within the Thames Valley Geography, whether she lives in Buckinghamshire, Oxfordshire,
Berkshire, wherever she lives, has equal access.
We also want to make sure that if we are looking at leaflets and information, and again the
Health Watch report talks about easy -to -read leaflets, communication, cultural competency,
we want to make sure that we do all of that at scale, do it once, do it effectively, and
and then spread it to wherever is needed.
So with that, I'll hand over to Sarah.
Thanks, Lalitha.
Thank you, Chair, for the opportunity.
/Sam Burrows - 1:49:35
So I'm Sarah Avery, I'm a GP.
I'm the Medical Director at FedBucks,
which is the GP Federation in Buckinghamshire.
And we are also an upscale healthcare provider
for urgent community and primary care services
across Buckinghamshire.
One of the services we deliver is community
the intermediate gynaecology service, which I'll just talk to you briefly about how that
is.
There was a bit more detail in the papers that came and I'm very happy to take questions
afterwards.
So, sorry, is that better?
Great.
Sarah.
So, what we deliver at the moment, and we're working closely with BHT to expand on this
already and we're close to doing that, is a service that delivers specialist
gynaecology care in GP practises by GPs with special
interest in gynaecology and menopause and also by
gynaecologists coming out of the hospitals and working in those GP
practises delivering it directly. And we work out of practises all over
Buckinghamshire and so we're really seeking to reach
women where they are. It's been developed to
the access and reduce that reliance on the hospital care, but also it's timely.
So our average waiting list across all our services is around nine weeks from referral
to being seen in these community settings.
At the moment we're seeing 4 ,000 patients a year and through managing up to sort of
7 ,000 patient encounters they may need a couple of different visits for the service.
And we're quite responsive to the system needs, we hope.
So we recognised that there was a gap in specialist menopause provision, for example, and we've
added a specialist menopause service to the intermediate gynaecology service in August
this year, which has had really good feedback from the patients that have used it.
And what we're looking to do is actually expand on that further.
We've already audited some of the referrals that are going into the hospital to see what
more could we do in the community, and actually we think a significant proportion, perhaps
the
community and the community is a very
We are working directly with the acute
trust to see how we can do that together and we are hoping to do
that this year.
In terms of feedback, we know that the
patients using our services have given us consistently positive
feedback about the services and the outcomes and we want to
find that working out of GP practises works well rather than trying to build a shiny women's
health hub in one place. We find that if we work out of a GP practise we can go anywhere
in the county, we can pop up where the need is. We're working with those local GPs often
known in that practise to the women that are visiting it and we're also building the skills
within the GP practise team by having those community teams coming into their practises.
So we find lots of benefits to that model of working as well.
And we link directly with the hospital.
So if we have women referred into our service that needs to be managed in the hospital instead,
we triage all of our referrals and we do that immediately.
That referral goes on.
That's all within two days of receiving the referral.
Likewise if the patient needs something further afterwards, we seamlessly refer them in.
into that and into the hospital without having to go back to their own GP to do
it. I hope that summarises it.
Cllr Shade Adoh - 1:53:20
/Sam Burrows - 1:53:23
I think at this point given our commitment to not say too much we were
Dr Iyer/Gemma Thomas - 1:53:27
very happy to open up the item to the floor for questions. Thank you. Thank you
Cllr Moore/Cllr Hussain - 1:53:34
Chairman, very kind. Thank you for your report it's much appreciated. I just
want to ask a question about interpreters please. I understand across the country trusts and ICBs
the cost of interpreters have doubled since the pre -pandemic falling to the Telegraph 2021.
Spending was about 31 million then it went to 39 .8 million by 2021 -22. Our recent figures
indicate at 64 million pounds and a number of women have spoken to me and said why do I have
to pay for parking for maternity care but men can get free translation services
and I understand in the letter is part of the report it says access to
interpreters is a fundamental choice and it should be developed with
consideration to most commonly spoken language causal communities this seems
to be a very spiralling cost and how can we ensure that we ensure that efficiency
and this money actually goes towards frontline women services thank you
Dr Iyer/Gemma Thomas - 1:54:31
Yeah, thank you. I think it's a really important issue that you raise actually, and you're
/Sam Burrows - 1:54:34
right, costs have gone up significantly in this space over the last few years, as have
cost for many other things over that time. And I think we're all recognised as a general
cost inflation across the board for services, whether inside the health economy or more
broadly. And I think clearly we have an opportunity here with technology that is being developed
and coming down the line to fundamentally change the way in which interpreting and translation
services are offered to local people. And there's a huge amount of work happening nationally
and internationally to explore what those options may be.
I think my genuine hope is as we go into the rest of this decade,
we'll start to develop an offer that can be given to local people,
where actually it's a better service at a lower cost.
We're not there yet, clearly, but the status quo isn't sustainable either.
And that's part of the work that we've got to continue to do together
to find something which works for local people.
I think it's really important though that as we do that,
that can't be something which only we develop in isolation.
We'd want to work with our colleagues, whether they're in Health Watch
or whatever succeeds it, colleagues like yourself, to be sure there is something which genuinely
works for people and is sustainable and affordable.
Lelyitha, you want to add to that, I'm sure.
Dr Iyer/Gemma Thomas - 1:55:39
Yeah, I just wanted to add a practical perspective as a clinician practising in an area.
So I practise in Slough as a GP with special interests, and there are more than 32 languages
that patients who are registered at my practise can speak.
It's really important that we can get the patient perspective right and understand what
they are saying and for them to be clear on my advice and the same for any other GP or
clinician seeing the patient. So the interpretation forms key part of our consultation with the
patient.
Now what I find practically is that some patients will come with their relatives, their son
or daughter, but again, when you think about women's health,
often there are embarrassing questions there
in the consultation that they don't necessarily
want their daughter or son talking about.
So in that scenario, they sometimes bring a friend
they feel confident about.
And clearly, those are not paid interpretive services.
What we've ensured as an ICB is that if a clinician needs
the interpretive service in a practise,
they have it available quickly.
and often unlike a hospital where they might say,
do you need an interpreter?
And arrangements are made in advance,
or where they are trialling something technology or digital based.
At a practise, you don't know this patient needs an interpreter
until they walk into your room.
So we have commissioned telephone -based interpreter services,
where you have the patient in the room,
they've said the language they want the interpreter in,
and you can actually log in, go into the system,
and say which language. Sometimes it's languages like Pashto etc. Sometimes there are clinicians
who of course speak the language of the patient which is then not a problem. And we then get
the interpreter on the phone and it's a three -way conversation. Clearly the ten minutes is not
enough. In that case the GP does overrun but you want to do the patient, you know, you
want to do right by the patient. And so I think what I'm trying to say is that on the
on the ground, although the article may say X amounts, etc., on the ground, it is a real
practical issue and I think as an ICB what we need to ensure is that we do have interpretation
services available which can be agile and quickly accessible if a clinician needs it.
So that's why I wanted to bring the clinical perspective into this conversation and I hope
it's been helpful.
Cllr Moore/Cllr Hussain - 1:58:16
Thank you Chairman, if I may, could I request the data of the cost of translation services
in the ICB please?
Yeah, I don't know it off the top of my head.
No, of course.
But for another time I mean.
Cllr Shade Adoh - 1:58:22
Thank you.
Absolutely, yeah.
Thank you very much.
Councillor Picnic.
Hi, thank you very much for being here, I really appreciate it.
Cllr Stuchbury/Cllr Pinkney - 1:58:34
I have a question because the hub approach is about delivering in the community and I
there are plans to involve the community as part of that delivery either in prevention or other
ways. So other plans ahead at the moment are kind of working with the voluntary community sector or
with individuals in the community to help with this service if that's appropriate.
Dr Iyer/Gemma Thomas - 1:59:00
Did you want to say anything? Hi I'm Gemma Thomas, I am Director of strategy at Beckinshire
Healthcare Trust and Director for Integrated Care for the Place -Based Partnership. So the work that
Sarah described earlier around the community guiding service and trying to get more services
into the community as part of our neighbourhood programme which we have spoke to you about
before and will come again in the future. And as part of that we're engaging with communities,
we're engaging through the community boards, we've been engaging with PPG groups, we've
been engaging with the volunteering community sector, they sit on the steering groups for
all of the neighbourhoods and the programme groups for all of the neighbourhoods so they're
engaged through that process. We also have Health Watch Bucks engaged at all levels in
that process providing that patient and public voice and we have members of patients, we
have patients and members of the public on the steering group so we will get their views
through that and as we develop this service we'll also seek engagement from people using
these services. And then I just wanted to say as well we've got a Women's Health Day
at Health on High Street in Aylesbury next week on the 4th of March to coincide with
International Women's Day and there we'll be asking for feedback and input on
women's health services across the county.
And I just want to say that you're trying to work with the community boards
Cllr Shade Adoh - 2:00:17
as well. Yes. So you know to be a good thing to do to get into the community
yeah yeah yeah they're trying to have meetings with community boards and
going out to talk to talk to them so that that's quite good.
Councillor Loyce, Dutchbury please.
Cllr Stuchbury/Cllr Pinkney - 2:00:38
Yeah, thank you. It's always interesting that the first three questions are male talking about women's needs.
Great look, great look, great look. Men talking about what women should have.
I don't think it's where we should be. A political point made.
The thing that I am really concerned about is today,
And today, prevalently, you will be listening to the news that maternity care, the inequalities
in maternity care for people of race, colour and creed and the report which we will all
listen to shows that there's some real inconsistencies in care for South Asian people and assumptions
about Afro -Caribbean and African people going in.
It's quite shocking, it's quite shocking to be frankly honest that we are in 2026 and those
defined characteristics of people are still not being accepted. I know that you as professionals
do everything you can to stop that but I do think the fact that that report has come out and we don't
know because it's a it's a generic report that whether that we are implemented in that or we're
not implemented in that. But I do ask that we come back here when you do know because
we must like the question about language and being able to get access to service. If you
can't actually interpret what you're going to do you won't get a service. Which is very
much what the report was saying about other people deciding how they were and what they
should do. So I'm very concerned about that because the start of your life and the maternity
section which they were talking about is when you're very on your own, you could be in a
maternity ward, you could have a partner and not have a partner and at that point you are
most vulnerable. So please come back with something about that and comment on your views on it.
and I'm also concerned about the other end of it.
We always say this idea of digital advance.
I've got an 86 year old mother.
When you mention digital advance, she advances verbally about how she can read and write
and nobody's listening to her anymore and no one will accept a letter and if you do
write a letter it will never get there or you won't get a response.
She's very strong -willed, my mother, and I enjoy every bit of it.
But I'm saying that she had no effect on me whatsoever.
But I do think that...
No, but actually, I do think those two ends of the spectrum...
Well, I'm trying to be serious here.
The digital is seen as a negative to that age group of people.
And they have lived a good life and they deserve equality.
Cllr Shade Adoh - 2:03:39
/Sam Burrows - 2:03:41
Dr Iyer/Gemma Thomas - 2:03:42
I'm really happy to note the remarks, they're really well made actually and we all recognise
the challenges and the maternity report that was released this morning as well for the
Cllr Shade Adoh - 2:03:49
population and certainly many of us have had personal experiences that resonate from what
was in that report as well so thank you for stating it. I would just send the digital
exclusion piece quickly, Cher, if I may, it is something we're really passionate about
We've done so much work on this, particularly since the pandemic, when many services did start to shift to a more digital channel,
rather than the traditional face -to -face models of care.
And we've learned a lot during that time, and the only thing I would kind of say to reflect on is,
we make no assumptions about people's digital literacy, and actually we have experience of working with
frail and elderly cohorts who love digital care models, because they give them new ways of accessing services,
that give them more contact with their health and care professionals who look after them.
And we've worked with younger populations who actually have struggled with them for
different reasons. So we go into that space with no judgement and no preconceptions, but
we've learnt a lot and I think there's still a lot of work to do in that space.
Yeah, and I just wanted to add on the inequalities front, and women in general, and we will come
back with the maternity, reflections on the maternity report, but national leaders have
always alluded to the fact that we need to look at women holistically, and if you can
get their health better even before they get pregnant, they go through pregnancy better.
So actually that sort of thing. But also it's heartening to see that there are already dashboards
identifying inequalities.
So today, as we sit here, I can go into a national dashboard
and see within Bux, which are the women who
are not accessing hormone replacement therapy,
for example, who are not getting the right treatment
for their menstrual problems and so on.
And with maternity, are they taking their folic acid?
So we can get all of these kind of bits of information.
Dr Iyer/Gemma Thomas - 2:05:38
And then the maternity care, we will
wait for the finalised report from Baroness Amos
and certainly bring you some reflections back.
Very happy to do that.
Thank you very much.
Cllr Shade Adoh - 2:05:50
If I may, because we're running kind of late on our timing,
so precise questions.
And if somebody has asked your question already,
you can actually see, actually, my question is being answered.
I think Councillor Mars, Usain and Mabou Boussain did say that earlier.
Councillor Leslie Clark, please.
Thank you, Chairman.
Cllr Clarke - 2:06:10
FedBucks put into place quite recently,
and with its inception were you also aware of the planned changes to the ICB that we've now got?
So, Bucks has expanded out and we've got John Radcliffe, we've got Frimley, we've got Wexham and all that.
Were you aware of the expansion when you were putting this into place and have you got plans to expand it across all of that area?
Were we aware of the changes to the ICB restructuring?
/Sam Burrows - 2:06:44
So the community gynaecology service has been in place for several years actually, predating
the changes to the restructure to the ICB, but certainly we've been aware of the expectation
of changes to ICB across the country of course.
in terms of the expansion this is something that we've been working
directly with the trust on to try and provide that local solution in the
Dr Iyer/Gemma Thomas - 2:07:22
meantime yes yes we were aware of the changes to ICB you've got the expansion
Cllr Clarke - 2:07:24
Dr Iyer/Gemma Thomas - 2:07:31
planned for the extra area that we've now I think that's a matter for the I
/Sam Burrows - 2:07:33
is the commission and currently we commission on geographically bound areas and for fed
parks that service is commissioned for Buckinghamshire um we're not yet at a point where we'll be
Cllr Shade Adoh - 2:07:46
having a conversation around changes to geographies. Thank you. You may have to think about why
so when you say you're not there yet are you going to be there and when are you going to
be there so that by the time you're coming back you come back with that yes we are or
We are still working on it.
This is what I touched on in the introduction, that essentially if you looked at the Thames
Dr Iyer/Gemma Thomas - 2:08:05
Valley, which is the geography you're talking about, Buckinghamshire, Oxfordshire, Berkshire,
across Thames Valley we have published our commissioning intention.
So what do we want to do?
And we have set out an intention that we want to have women's health services closer to
the community and not needing women to go to hospitals.
Clearly there are four different hospitals.
the one in Bucks is represented here. We have set that out but we want to, and I
have spoken to our chief who is in charge of commissioning, and we are very
clear that what we want to do is we want to do it in a evidence -based measured
way even though it may seem like on the 1st of April when we become Thames Valley
you don't have these services like FedBucks for example across the four
geographies. We are already in the process of A taking actions from that
learning event that I spoke about, that is an ICB action. We are in the process of mapping
what are the services that are available where, what are the outcomes these services provide
because Oxfordshire may have a different model of delivery from fed bucks but if the women
in Oxfordshire are getting the same outcomes as in Buckinghamshire, we are happy with that.
So we want to do an outcome based efficient model for the women we serve. We want to take
bit of thought and consideration into it and then we'll design it. Could I just
Cllr Clarke - 2:09:27
Cllr Shade Adoh - 2:09:28
come back on that? That's more or less answering the question. The
Chairman referred to FedBucks talking to the community boards. You've got the
Chairman and the Vice -Chairman of the High Wycombe Community Board and we don't know
anything about it. So to come back on that I think it's the neighbourhood
teams that have done that. So we'll go back to our integrated neighbourhood team that
is based in Wickham and we'll make sure they are reaching out to you.
Thank you. Councillor Mabou please.
Thank you very much Madam Chairman. I think my question is first of all that you people
Cllr Gomm/Cllr Hussain OBE - 2:10:06
do a wonderful job and like Leslie said we are prepared to help and support and we are
both Chairman and wide Chairman of the community board. You know we can work together as a
My question was earlier on when we mentioned,
my colleague was raised regarding the translation.
I just travelled about three or four countries
and they use AI system which is very sort of beneficial
and I just wonder if you were doing that system or not.
Yeah, so that's exactly what I was alluding to
in my response.
/Sam Burrows - 2:10:33
We are aware of new technologies
which are becoming more available and mainstreamed
where taking on tasks that used to be
particularly expensive like translation
can be done at a much lower cost for people
in a way that is sometimes at a higher quality as well.
We just need to keep working that through.
There are other ethical and technical considerations
to work through on that.
We're not there yet, clearly,
but that is the opportunity that is coming down the line.
Definitely.
Thank you.
Councillor Sherwell.
Cllr Shade Adoh - 2:10:58
Thank you.
Cllr Shade Adoh - 2:11:03
There's a lot of concentration in people's minds
Cllr Wassell/Cllr Sherwell - 2:11:07
when they talk about women's issues in health
on maternity services.
But there are an awful lot of other conditions
that are part of the female biology
that are not directly,
may have contact with maternity services,
but they're not directly related to maternity services.
They're about other biological processes
that are going in in the body.
And I think that those are not as widely known publicly
perhaps as they ought to be.
And I've certainly heard radio and paper storeys recently
of absolutely horrific lack of treatment,
because male GPs usually have not had the understanding
of what is actually going on in the female body to diagnose.
moves. And that seems to be quite a difficult bridge to get over. Could you tell me what
you're doing to try and tackle that lack of knowledge? I don't want to call them obscure
because they aren't obscure issues, but they're obscure in the sense that they're not greatly
publicised issues.
Cllr Shade Adoh - 2:12:29
Dr Iyer/Gemma Thomas - 2:12:32
While you were speaking, I was reflecting on the well -known difficulty women experience
in having their cardiovascular disease diagnosed.
There's evidence that many women who've gone to various settings, whether it's practises,
hospitals with conditions like a bit of chest pain have their diagnosis of a
serious cardiac problem delayed when you compare it to men. We know that when
medications are trialled typically there are more men than women in many trials.
We also know that ethnic minorities are not well represented in trials. So all of
this kind of contributes and I guess there's also something around the various
different presentations of menopause in a woman,
the dwindling hormones that people don't always recognise.
So to your point that what are you doing about it,
I think the crux of it is about empowering women on one hand
and men.
So when I did two years ago when there
was a focus on women's health and I did some staff briefings,
it was really good to see there were equal number of men
and women who were staff here, just like when one of you
said there are more men asking questions here
about women's health.
That's really nice to see.
And I think we need to empower the population and women
with culturally appropriate leaflets available
and conversations available for them.
But at the same time, it's about empowering the clinicians
on the front line to recognise that when
a woman within a menopausal age comes with something
that may be anxiety or mood or something else,
do think of other things that are causing it.
So certainly I think that's the two -pronged approach we're
taking on one side with the population
and one with the clinicians.
And again, organisations like FedBucks
can help us do that within Buckinghamshire.
Thank you very much for that response.
Cllr Shade Adoh - 2:14:34
On the back of that, I just want to ask if you're aware,
because you have mentioned Healthwatch.
Yep.
And so you must have read the reports, which is
part of the paperwork as well, and it talks about the barriers identified. And I think
you sort of mentioned one or two on that from just what you said. So through the commissioning
service, how are you addressing that? Those barriers that you would have read in the Health
Watch reports.
Dr Iyer/Gemma Thomas - 2:15:07
So I've got the report here all highlighted as well, so I can tell you I've read it. And
did say, they told Health Watch colleagues around what were the common conditions, and
I think Sarah has alluded to how they're responding to those asks of common conditions. Women
have said that they want care closer to home, and here we've confirmed that care is being
delivered closer to home. Women have said, or Health Watch colleagues noted that there
was a little bit of reticence around having tests for screening, for example, around smears
and all of that, and that is what I was talking about, culturally competent communication
and media releases.
So we've done little snippets of videos on breast cancer screening, for example.
We know, again, women regardless of, I think, ethnicity, are a bit worried about going for
those kind of screening things.
So we've produced those little videos, and we are in the process of socialising all of
that across Bob as well. In terms of easy read leaflets, which was something else that
came up here, I must say there are some easy read leaflets, not all, but that's something
for us to think about. In terms of timing of appointments, practises are delivering
services on weekends and out of the standard working hours, and if women chose to, FedBucks
is always happy to modify the timings of appointments as required.
So for me, these were kind of the standout things that I picked up from this report.
And although the report just mentioned cervical screening, I wanted to say that it is not
just cervical screening.
And there's also something around mapping the uptake of all the nationally commissioned
screening programmes, breast cervix and bowel cancer screening, and then looking across
the geography as to where are the gaps and inequalities and what are the reasons behind
it.
Is it an age reason where working women are not coming?
Again, I think your report does touch on the difference between the ask of working women
versus people who are not working.
Is it to do with ethnicity?
Is it to do with deprivation?
And then addressing the right reasons behind it.
So I'm hoping that as we come together newly as the Thames Valley ICB, all of these can
be our priorities but to be realistic this will take time because I want to ensure that
the enablers such as data are available and then bring everybody with us.
Cllr Shade Adoh - 2:17:43
Thank you very much. Do mind about the age because there's a difference in the requirement
of focus for women from 18 and a woman of 30 or a woman of 40. So in design and the
mapping, we need to make sure we consider that as well.
Councillor GOM please. Thank you very much, Chairman. I'm going to
Cllr Gomm/Cllr Hussain OBE - 2:18:05
go in defence of Gemma over there actually because she had mentioned earlier on about
their group connected with community boards. I wouldn't go to your offices, I'd look at
our offices to be honest because I'm on two of those groups. In actual fact we got one
in a couple of hours time, the Buckinghamshire integrated neighbourhood steering groups and
they are extremely good. Get to meet so many people. I like a recommendation
chair that all of us members should join those steering groups just to understand
what goes on. So they do a brilliant job. I don't get to all of them but your
staff are very good. I needed to say that because they are good.
Thank you. Thank you. Councillor Heater.
Dr Iyer/Gemma Thomas - 2:18:53
/Cllr Darby - 2:18:54
Thank you, Chair. I'm really pleased to see this report and to see how well established
this service is now. It's really encouraging and it's very much needed. But my question
is about access and referrals. I'm just seeing in the report that it says about the referral
pathway. I mean, is this service something that women can just refer
themselves to or do they have to go through their GP? Thank you. So this is a
/Sam Burrows - 2:19:25
referral service from GP practises, so it's specialist care and so it is from
referral from a GP into the service like any other special... Is this better? I didn't
I was softly spoken until today.
So yes, it is a GP referral service because this is specialist care.
So that's the model that we have.
So much like referring to any hospital secondary care, specialist care, it's the same.
And so we have this through the same referral pathway.
Cllr Shade Adoh - 2:20:04
/Cllr Darby - 2:20:07
So following on from that is I just wonder how would women know that this service is
available? Because I'm not sure it's widely known.
/Sam Burrows - 2:20:17
Thank you. And I think that's something that the report's
been really helpful in raising actually is that awareness of the services and certainly
I think it's something to work on.
And through the community boards and other ways that we can engage our patients and residents
in designing the service, also in communicating about the service and expanding that awareness.
It is a specialist service.
So it would be via your GP tube.
So I think part of it is actually about making sure our GPs are aware as well as our patients
to ensure that they're aware of the full scope of services that they can refer women into
to make sure they're getting to the right place.
Cllr Shade Adoh - 2:21:02
Cllr Shade Adoh - 2:21:04
Thank you very much. Based on, because there's so much people are asking, and we know this
is an overview, and that's what you will take away, and hopefully when we meet next time
will have more catch up to do and also more detailed answers to what people have asked
and the engagements you've done and how far reaching it has been. I think that would be
a good to come back and hopefully we'll have more women hubs and more interactions with
women. Councillor Neillat please.
Cllr Shade Adoh - 2:21:41
Zoe McIntosh/ Cllr Kneller - 2:21:43
Thank you. I represent Chesham and we've got two surgeries, one in the north, one in the
south and my experience and impression is that they're all very engaged and interested
in these kind of services and inclusive. They are quite small buildings and I assume this
is part of the vanguard of the rollout of peripatetic services across a number of specialities
over the coming months and years. What is the situation generally in terms of Buckinghamshire
and the GP practises being able to actually support and host these and really are we going
to be needing to look at a different model in terms of where people come and being much
community is much more inclusive. It's great that we
have got this approach in terms of guiding services but I'm sure
there's lots of others for men and children that we will want
to see directly in the community. Thank you.
the
/Sam Burrows - 2:22:47
≫ Thank you so much. I think your question is
pertinent and a much larger issue than what we are discussing
today. We recognise governmental policy in the 10 -year health
plan published last summer is to move ever greater volume of care
away from hospital sites into community locations.
Sometimes they will be into GP practises and we are expecting
backing ag watch feedback and
more of these services closer to people's homes and where we can't do that certainly in our part
of the world for the last few years we've had great success in accessing government capital to invest
in building and redeveloping facilities to expand that capacity as well so there are multiple routes
open to us I think to achieve that and working within some of the constraints that we have today
is truly challenging but I'm actually quite hopeful that we're going to be able to do more over the
next couple of years in this space. Gemma do you want to pick up around the BHT party specifically?
Dr Iyer/Gemma Thomas - 2:24:07
Yeah, so we've had you're absolutely right and there's lots of conversations that you'll hear nationally about women's health hubs and neighbourhood health
hubs and mental health neighbourhood hubs. So in Buckinghamshire we're trying to bring these conversations together
We're working closely
with the council as we have for a number of years but kind of reinvigorating that in developing a one public estate approach
So including the fire service police local authority NHS and also the voluntary sector to make the best use of our estates
including kind of general practise. There are some practises that are large and
have additional space, there are many that don't. We have community sites, VHT
across the whole of Buckinghamshire, Oxford Health have sites, so we're trying
to make the best use of those sites and also try to make it as easy as possible
to access those services, not add different hubs where you have to go to
this hub for that service and this hub for that service to try and think of
people as holistically as possible. So with Craig's support we've kind of
reinvigorating the one public estate across Buckinghamshire through the neighbourhood
programme and we'll bring that through as that's more developed in the coming year.
Cllr Shade Adoh - 2:25:12
Zoe McIntosh/ Cllr Kneller - 2:25:13
Can I volunteer Chesham for a one stop hub please?
The health and the high speed.
Cllr Shade Adoh - 2:25:20
Dr Iyer/Gemma Thomas - 2:25:22
Cllr Shade Adoh - 2:25:24
Craig does mention that to me most times.
I see.
And I do at every opportunity.
Zoe McIntosh/ Cllr Kneller - 2:25:29
Cllr Shade Adoh - 2:25:33
Cllr Shade Adoh - 2:25:34
Of everybody from Councillor Clark all the way to Councillor Wessel.
That would be a list of what they all want.
So, the last question goes to Councillor Wessel.
Thank you, Councillor O 'Dowd.
Cllr Wassell/Cllr Sherwell - 2:25:49
Yes, I represent Tottridge and Bowdoin in Wickham, which is one of the areas of deprivation.
And I'm with Councillor Adéle on the PPG. But I meet a lot of women who are in poverty.
And it's quite global, really. It can be food, furniture, benefits are all and so on. And
sometimes i have a lot of difficulty persuading them to go to GP
and you know if they need a letter or something
they'll say well I'll have to pay for it
but I do get most of them to GP but some are very underweight
and quite frail
of different ages
so
yes and in my professional work
I manage quite a few groups for women from different minority groups. Although they do
talk very positively about support from their GPs.
So I just, I mean when I first heard about the Hub I said, well where is it? And I was
quite excited about the neighbourhood group. I thought it might be a building. But I'm
wondering how to try and engage some of these deprived and not very well self -advocating
women when they need the specialist referral.
/Sam Burrows - 2:27:29
Dr Iyer/Gemma Thomas - 2:27:30
Thank you, and it's such an important question, and we know very well that actually it's your
social determinants of health rather than your healthcare which will have the biggest
impact on your health outcomes, and so it's so important that that is what we focus and
manage. I wonder if I can talk briefly about community health and wellbeing workers, which
is a project that is starting, has already started, already in training, hopefully knocking
on doors from March. And so this is at the moment a relatively small pilot based in two
areas in Buckinghamshire, Castlefield, Wickham and Quarrensdon in Aylesbury, where exactly
that is the purpose of the community health and wellbeing workers. So this is a universal
offering to all residents, all households living in a specified area, literally a knock
on the door, come on in, meet me, what is it that you need, with no agenda coming from
the community health and wellbeing workers to say you must come and have your smear done,
you must have this. But we hope that by engaging with residents who are finding it harder to
access services, understanding what their need is, linking them up to solutions to those
needs through social prescribing and similar sorts of projects, we'll be able to then be
/Sam Burrows - 2:28:44
able to help them and support them to access their health needs as well. It's a small pilot
at the moment, we hope that it will be successful and be able to offer it to more residents
in Buckinghamshire.
Thank you, just a job.
Cllr Wassell/Cllr Sherwell - 2:28:56
Dr Iyer/Gemma Thomas - 2:28:59
Cllr Shade Adoh - 2:29:04
Thank you very much for your time. I was going to ask a question from our local authority
representation, but I think it's kind of alluded to that partnership working the set -up, and
you've put Craig on the spot on what he's going to be delivering on everything else.
But I think looking, going forward and us working together
and you coming back with something for us,
sometime in the future, not very long,
it would be good based on what everybody has said,
what is the engagement, how far has it been,
where are the places that people can easily access,
because sometimes you don't want to go to the GP
because you might meet somebody there,
But a safe, discreet place that I can just walk into for women, I think is vital.
And also, the community, people starting in March, it would be good for us to know when next year coming,
how was the impact, what has been done, what was the take -up, how is that affecting people.
And are you working with the council on that?
Because there's that reach to go with all those effects.
And we've had a lot of requests from colleagues.
So when we're next meeting, it would
be good to find out how far you have gone, what the reach is.
So I want to say on behalf of everyone here,
thank you very much for what you're doing.
Very short notice.
And I hope Sam and Lavita, you feel that it was worth it.
because we had this conversation and you wanted to come and give us two hours, one hour because
you thought it was, honestly colleagues I have to tell you they were scared. They thought
oh cancer loss would ask all these questions, they would push us and I'm like no we're not
like that. So I hope you feel comfortable and coming back next time would be even better.
Thank you for your time, we appreciate you.
Thank you very much for having us.
/Sam Burrows - 2:31:06
Cllr Shade Adoh - 2:31:09
you

8 Q3 performance - Health & Wellbeing portfolio

Cllr Shade Adoh - 2:31:57
This should be a very quick one, I hope.
And no?
Okay.
Cllr Wassell/Cllr Sherwell - 2:32:04
I'm relying on our cabinet member, our officers, to make this a very quick one.
Cllr Shade Adoh - 2:32:11
So this is on health and wellbeing portfolio.
And our presenters today are the cabinet member for health and wellbeing, Councillor Isabelle
Derby, corporate director, adults and health, Craig McCodle.
And the item today is to provide members to review the performance indicators for the
health and well -being portfolio.
To read the indicators for quarter three, the number of older people, 65 plus, admitted
to permanent residential or nursing care homes per 100 ,000 population, the percentage of
young people whose adult social care assessment was completed before they turned 18 years
old.
Over to you, Councillor Dabih.
Thank you very much, Chairman.
/Cllr Darby - 2:33:00
And, yeah, obviously we don't like red indicators, but they are part of the world, and we wouldn't
have indicators if they weren't supposed to be meaningful.
So whilst the number of older people admitted to permanent residential nursing care is red,
we are performing well against the southeast and nationally.
So our Q3 figure is 57 people better than the Pro Rata South East figure and 84 people
better than the Pro Rata National figure.
So our target was set as an average of the last three years' performance, which again
was better than the South East average, which is what most other indicators are set at.
So that is an explanation really.
Obviously we would like it to be amber or green, but we are working really hard and
Some of this is absolutely beyond our control because it would be wrong to deny somebody
a place just to reach a target.
If somebody needs a place, then they get one.
And obviously the churn of places is outside of our control.
So if you want to move on to the next one, which is the transition.
So this is the number of young people whose adult social care assessment was completed
before they turned 18. Now, we are absolutely aware that this is an area where we need to
get better. We've seen performance fall this year, and it is red, but our performance does
look bad. We are looking at a very, very small number of young people that come through this
service and one or two late assessments really bring the percentages down. But saying that,
every person who is part of this statistic is somebody who needs our care and attention.
Some of these will have been assessed just after they become 18.
Some of them will have just come onto our radar.
They won't have been on our radar before.
They won't have been going through our perhaps children's services.
But it is an area where we are absolutely determined to improve.
So those are the two red ones.
I would just turn to the carers' assessments, which is an amber.
We've had a slight decline in performance this quarter with 24 assessments below target.
And we are continuing to work closely with carers' BUCs to identify carers and ensure
that they get the right support.
And we know that there may well be a plateau in performance because when there's been a
big push, which there has been recently, to identify carers who it's up to them whether
they come forward, a lot of them, unless the client has a social worker, we wouldn't necessarily
be aware that somebody is a carer. And there is going to be a plateau where sort of the
people that we've been trying to reach have all been reached and those that want to engage
have engaged. So it is ongoing work. Again, we've got the percentage of births that receive
a face -to -face new birth visit within 14 days by a health visitor. Again, that is
that is amber but we've had reduced capacity over the holidays and also we
have to look at parental choice of timing. So there will be parents who just
say I'm terribly sorry it's not convenient for you to come today can you
come next week. They'll still have engagement with a health
visitor and a very high percentage do but it means that that target 14 days is
And again, some of that is personal preference and some of that is because we just haven't
had the capacity to do it.
And I think we should actually also, I would like you to be aware of the, an indicator
we've had that's moved from red to green, which is the percentage of people who have
set up a quit smoking date and have successfully quit for four weeks.
And it's also achieved the service target in two terms of numbers of quits at 304 against
target of 250 and that is good. We've also had another couple of indicators that have
moved from amber to green. So things are progressing. We can't make it all wonderful overnight,
but I feel very confident that we are doing a good job, but there's always more we can
do. Thank you.
Cllr Shade Adoh - 2:37:25
Thank you very much, cabinet member. From reading the paperwork and what you've just
said, there is improvement and from what I'm hearing is how quickly we are improving and
how much more we need to do. And obviously that has some factors that make that happen.
My question to you is what's one or two things that you have identified that needs to be
done and what are you planning to work on that?
/Cllr Darby - 2:37:58
As I've said, on the first one, some of that is out of our control.
We can't say how many people are going to come through the front door and need residential
care and how many, you know, and sadly how many will perhaps no longer receive it, need
it because they have gone on to other care or have departed this world.
So, you know, those are things which are completely and utterly out of our control.
So, you know, we are trying our best.
McArdle/Adonis-French - 2:38:30
What we are doing is we are making sure that people who don't need to go into care are
cared for in the community.
But the most important thing is that the care that everybody receives is appropriate to
their needs.
/Cllr Darby - 2:38:43
So it's – and I would just like to say, you know, we've got Tiffany here who works
It's incredibly hard every single day, pushing, questioning, does this person need the very
expensive and let's be honest about it, it is all about also about budgets.
Do they need that care?
Is that appropriate?
We want people to be able to live their best lives.
And perhaps being institutionalised is not quite right for them.
And it would be better if they were in their own home.
And we also work really, really hard on reablement to make sure that people who have that capacity
to get that little bit better and be able to lead a more independent life can do that.
I don't know if Tiffany or Craig you want to add to that?
McArdle/Adonis-French - 2:39:27
Just generally I'll answer the first one. I'll hand over then to Tiffany Adonis -French
who's the Service Director for Adult Social Care Operations.
And I'll ask Tiffany to touch on the transitions which is probably where the question's coming from,
Chair, in terms of that. In terms of long -term admissions to residential care homes,
we're still doing remarkably well as cabinet member indicates in terms of
that and overall we're actually proportionally supporting more people in
the community so that's the key indication that we actually track so we
have we're supporting more people in the community as a proportion overall as
well so that's a really good indicator and councillor Darby is absolutely right
we go through this process of trying to able people as well so overall we're
still confident although the indicators read that those going into residential
care are going in who need it in terms of that. There is a cohort who we've identified
where we need to do further work on and they're a cohort we would call depleted self -funders.
So these are self -funders who move into care and we don't know, then they run out of funds
and then they become our responsibility. We need to do an education piece on that and
it's something that we're going to do in the next financial year, chair in terms of that.
that's one of our priorities because we don't want them going into residential
care either too soon as well so that would be our big game changer in that
sort of space. Tiffany's been working really really hard on transitions in
close connexion with Alison Mundt as well as service director and children's
services so I'll just let her talk through some of those improvements. Thank you
Thank you chair. Yeah so in terms of transitions we recognise it has been a
bit of a challenge for us and we haven't always been able to facilitate the
positive customer experience that we would like. A couple of things have happened, we
set up a transitions board and that's being sponsored jointly by myself and Alison Munt
who's the service director in Children's. What we're recognising most importantly is
we need to start the process much earlier. So we've taken some steps essentially to grow
the team. So it's a combination of adult social services and also children's services working
together in partnership so that we're really confident about the young people who are coming
through our pipeline through children's services transitioning into adults. That
will give us an opportunity to work with them at a much earlier stage. So
currently we're working with young people about 17 and a half. We recognise
that doesn't always give them the best experience because we haven't got the
time to really support them through the next stages. So we're identifying a
couple of workers between myself and Alison that we can pool our resources to
promote that experience for the young person and their families
to make sure that they know what's available to them
different legislation, Children and Families Act moving into
the Care Act and they can feel very confident about the support that they're getting
so we're starting to push back now to 16 years old
I am pleased to confirm that we have allocated
everybody that's turning 18 this financial year
we've got 17 young people for the first quarter of
26, 27 and we've got identified workers for those 17.
So we can see that we are starting to make some progress to enhance the good customer experience that we want to deliver.
That is very good.
Cllr Shade Adoh - 2:42:49
Well done. That's very good.
Do you have young people, you know, because of the transition patient experience group?
For them or because you, depending obviously because you sometimes work with their carers or parents.
Absolutely.
Yeah.
We also get a lot of intelligence through shout out for SEND, so we work very closely
with representatives basically from the SEND cohort helping to educate us basically about
their experiences, what they would like to see more of and how we can support them basically
McArdle/Adonis-French - 2:43:22
to identify practical solutions as well as long term sustainable outcomes as they progress
into adulthood.
Thank you very much.
Cllr Shade Adoh - 2:43:28
Councillor Wessel please.
Cllr Wassell/Cllr Sherwell - 2:43:36
Thank you. I did have a look at the figures and the percentages and they weren't actually
too bad. It's just that where the target isn't met, it affects these individuals who want
to have the best possible life. So with Home First, I just wondered whether, do you have
any service like living carers or wardens in sheltered accommodation does
McArdle/Adonis-French - 2:44:09
that kind of factor make any difference because the older person's figure isn't
really too bad when you look at the benchmarking and so on. Do you have any
additional support you can put in? So there's a number of options available to
keep people at home. We don't necessarily fund sheltered housing as it was once known.
That used to be a government programme many years ago through the Supporting People programme
which is sadly reduced in terms of that. But a very important programme in terms of that.
But we certainly have situations where we fund living carers for example. We have been
able to try and get people back on their feet in terms of that and our big one is really
home care where we're promoting as well. And then we're looking at other options such as
extra care housing which is sheltered housing plus council of
absolutely into that sort of sense.
Yes I know that from Huenden Gardens.
Cllr Wassell/Cllr Sherwell - 2:45:07
With the young people I wondered where these referrals come from for their
17th and 18th birthday. I mean you've explained about the two workers so why
are they being referred late if you know when their birthday is.
McArdle/Adonis-French - 2:45:22
I think it's really been about capacity in the adults team to receive the young people
that are coming forward and so we've recently addressed that by putting additional resources
into the service.
So we've got enough resources basically to manage the pipeline that's coming through.
So they'll have a better birthday present and...
Cllr Wassell/Cllr Sherwell - 2:45:40
Hopefully yes.
Thank you very much.
Cllr Shade Adoh - 2:45:44
Councillor Starchbury please.
Cllr Stuchbury/Cllr Pinkney - 2:45:50
Yeah thank you and thank you for your continuous commitment all of you to look after people
it's a credit. One of the things that do concern me is going forward and every time there's
ever a change it's more responsibility and quite often with no money to take that responsibility
forward, what work are you doing looking at your report, what work are you doing to position
yourself the best you possibly can for the changes in the care, in the sense that community
hubs and care moving closer back to home, that's the direction of travel has been for
some time. With that you've got more money in terms in the community health, the health
funding for the council. I worry that we may with the new health hubs and putting people
back in the home, having the resource to actually, people will say well I don't need to fund
that because I'm in my home, where they would go to a care home and we want people to not
end up in Care, how are you positioned to do that? Because I think you'll get more
people coming back there because Care looks, going forward, actual Care home
places just look so astronomically expensive so we want to make sure we
don't put people in there till they actually need to be in there. So it's the
bit between there and you feel robust enough to manage that and it's going to
grow that's what I'm trying to express that part's going to grow the service
and that everyone will be, some people will end up being sale providers, some people won't
and that's quite a new budgetary thing which will grow with your responsibilities and meeting that.
I'm not sure where we are next year, year after to meet that cost because it's a big cost.
/Cllr Darby - 2:47:45
Well we have some very very professional budgeting experts who within the council
who actually model all this and the whole way that we are managing to manage the budget
is by shifting the cost of care to the lower cost care of in home, the even lower cost
care of re -abling people so that they don't need any or they need less care. So we are
already doing that. So in terms of going forward, we are planning that the profile, if you like,
will be more people at home living better lives and only the very, very needy going
into residential care. So I'm confident that we are doing the best job we can with the
team that I've got here to make sure that we will be able to do that. And yes, it will
mean that we will need more people working in the care sector providing domiciliary care
and residential care, but that is for the providers to do and they are well aware of
that, they know what our demands are likely to be as well. So we don't appear to have
issues in providing care. If somebody turns up tomorrow and needs care in their home we
are able to react incredibly quickly and I think that is also evidenced by when we have
people coming out of hospital, we very rarely have to delay or
significantly delay a transfer because we can't find, we can't mobilise the care
in their own home.
Thank you for the response, it's just the Public Health Fund
goes up and your responsibilities grow and the ageing population is getting older
Cllr Shade Adoh - 2:49:32
and you've got to look in this room and you know I mean you look what's the next
Cllr Shade Adoh - 2:49:36
Cllr Stuchbury/Cllr Pinkney - 2:49:39
ten years, five years is going to be that bump, the baby boomers are coming through
and that's going to be quite difficult to manage.
/Cllr Darby - 2:49:47
Absolutely and I think the other very, very important thing is that we have to, and this
is the public health work that is going on also in this portfolio, is the preventative
work. Actually helping people to live healthier lives, educating people about lifestyle, not
nanny state as such, but trying to let people know that if you carry on eating a takeaway
or three takeaways a day and smoking however many cigarettes and drinking how much alcohol,
you're likely to have quite a lot of health conditions as you age. And I'm taking an extreme
example there, but it is just this education of people helping them to see how they can
take more responsibility for their own health, which means they will have better lives, happier
lives, not have so many years before their death in poor health. So it is that education
thing as well. So yeah, that's going on too.
Thank you very much. Councillor Picnic, please.
Cllr Shade Adoh - 2:50:51
Cllr Stuchbury/Cllr Pinkney - 2:50:55
Yeah, I was just, a question about the transitions, and to thank you Tiffany for the information
Craig, our last selectivity you could have said that the transition board was just about to meet.
I wonder if you could explain a little bit about how the transition board works, how often it meets and what it does.
And second, the work that you're doing, how quickly do you think that's going to have an impact?
Are we going to be below target for much longer or are we going to see some improvement?
What's your feeling, what can you reassure us?
So our view Councillor Pinckney is we won't hit the target this financial year because
McArdle/Adonis-French - 2:51:27
we've got one quarter to go and we've modelled all those and even though we're going to assess
all those in time it still won't affect the out term position but next year we're absolutely
confident that that target will be back on track. It will still be a cabinet member indicator
hopefully if it goes through the correct process and certainly Councillor Derby is really championing
this one as well so we hope that you'll be tracking this indicator next year so you'll
be able to hold us to account. Those short term changes that we've put in place, Councillor
Pinkham, we think will help in terms of that, addressing it quickly. The more detailed work
is around the transitions board so that's chaired by Steve Bambrick who's another corporate
director. I think we meet every month at the moment in terms of that, good representation
across children's, adults and other directors.
We've allocated a programme resource to it as well
and we're doing a big data analyst piece now
to see where cases have worked, where they haven't worked,
so we can really understand that
and we're getting the needs profiles tracked through as well,
so we get an earlier handle on children coming through in terms of that.
So those are our more medium -term places as well.
As part of that work, we've also got to work with our supplier market,
our providers to make sure that they're working with people as well,
both in children's to teaching them the life skills and all the way through to adults as well.
So it's a continuous journey in terms of that.
But we think the initial steps have now been put in place to address in -year performance.
I'll be back here at some point and that indicator will be red for the fourth quarter.
So I'm just giving you it all on notice at the moment. That will be red that one.
But next year we'll hopefully be back on green.
Thank you very much. That's good. We'll be holding you to that.
It will be red for the next one.
Cllr Shade Adoh - 2:53:09
Councillor Clark please. Thank you chairman. Just a couple of questions
Cllr Shade Adoh - 2:53:21
Cllr Clarke - 2:53:23
on some of these percentages that we have in front of us. Do you agree that the percentage
of young people whose adult social care assessments were completed before they turned 18 and you
now finding that you're getting them late points to silo working between
adult social care and children services and yes I see that you put something
into place to actually change that but was it silo working? That's on that one.
McArdle/Adonis-French - 2:53:52
Cllr Clarke - 2:53:55
On your percentages of births received for face -to -face you know new birth visit
You've got here that adjustments will be made to the providers demands and
capacity modelling for the next holiday period to mitigate for the decrease.
Surely that should be in place already not you're just putting it into place.
A little concerning and your number of younger people aged 18 to 64
admitted to permanent residential nursing care homes. The target is 11 .6 yet our out turn is 9 .8. Should that be amber rather than green?
And the last one, percentage of people who have set a quit smoking date and have successfully quit, have they quit smoking or have they gone on to vaping?
Thank you.
Cllr Shade Adoh - 2:55:07
/Cllr Darby - 2:55:09
If I just take the last two, so the 9 .8 that's good because it's less than 11 .6 and a low
number is good on that one so we're better on that one and the smoking one, no that is
stopping smoking is not vaping.
That is, yeah, absolutely.
So obviously, people have used vaping as a substitute for
smoking, but we want to get people off
nicotine altogether.
And the team that we've got work incredibly hard and
literally engage with individual people.
And I've been out in Friar Square where I've seen the
conversation take place and there was a lady who wanted to give up smoking and her details were taken and everything and
They will then be contacted by that person who took their details
I'll give you a ring tomorrow and we'll talk about it more and so, you know
It is and I think the most important thing is is that kind of one -to -one support when people need it
And that is how that is how we are successful in getting people to give up
Would say we're now down to I think eight point three percent of Buckinghamshire residents smoking and we need to get that down to
and we are getting down to the hardcore smokers perhaps, but the work goes on on that.
But we are determined to get people healthier and get rid of nicotine altogether.
Cllr Shade Adoh - 2:56:38
McArdle/Adonis-French - 2:56:43
So in terms of your first two, Councillor Clark, the first one is lack of...
the first one was around long -term admissions, sorry, transitions, that was highlighted by
both CQC and Ofsted that we needed to get better working between children and adults
and that's been absolutely the case. So we would have to say that was the case, not make
excuses that was the case. And then in terms of your other question around health visiting,
I think that's just the way that the target's actually tracked in terms of the way we set the target
So you will get you will get seasonal fluctuations in terms of that target
So at year end, we're hoping that that will come back in because you smooth it out during the course of the year
You're absolutely right though holidays come some holidays cover every year. It's a little bit like Christmas isn't it in terms of that?
So I take the point
Thank you very much
Cllr Shade Adoh - 2:57:39
Can I just come back on that? Great because
Councillor Clark mentioned adjustments will be made to the provider's demand.
I'm sure adjustments are, I think you work with what you have as you take the package
of the people. Not that you're just introducing adjustments.
No. Yeah?
I just wanted to be sure. Thank you.
Next is Councillor Gough, please.
Cllr Gomm/Cllr Hussain OBE - 2:58:11
That's very kind, Chairwoman. I was just going to take advantage of while I got the Deputy
Cabinet Member here that's very passionate about dementia and carers, etc. I just want
to bring to our attention, and I will come to you privately as well, the reason I'm doing
it on their place, I want to find out how many carers have to end up paying additional
council tax when their person they're caring for goes into a care home, then they come
back home for a while in and out. This council hits people like other carers for cancer attacks
while they're flipping around between care home and back home. So I just want to bring
that to your attention but I'm going to have a private chat with you. It's quite, you know,
wrong that that happens but I'll explain better one to one. But I want people to hear because
it's happening out there and that's wrong.
Thank you for raising that. We'll start with the people.
Cllr Shade Adoh - 2:59:00
Thank you.
/Cllr Darby - 2:59:03
Cllr Shade Adoh - 2:59:05
So you will, Deputy Cabinet Member, does that mean you look into it and send a
/Cllr Darby - 2:59:12
report to us as well so that we know? I think that this actually covers
another portfolio dealing with council tax as well but we will.
Well let's have a conversation offline and then we can take it forward with
colleagues.
Thank you.
Please.
Cllr Shade Adoh - 2:59:35
It's just a bit of a shameless plug really because you talked about prevention and we
Zoe McIntosh/ Cllr Kneller - 2:59:37
do have a project called My Health, My Responsibility that's running at the moment and that is all
about understanding people's attitudes to healthy living, things that they can do themselves.
So if councillors could help share that with their residents that would be really helpful
we're very happy to do focus groups and come and talk to people as well.
/Cllr Darby - 3:00:04
Thank you very much and would you be able to perhaps share
some details and we could potentially get them out to all councillors to share?
I mean let's shout from the rooftops.
Cllr Shade Adoh - 3:00:19
Cllr Shade Adoh - 3:00:20
Thank you very much. Because we don't have any more questions and I
I appreciate what you've done and being here with us
and the opportunity to hear from our other partners as well.
And I could see that both of you were taking notes.
And I think the beauty of this, looking, you know,
for public that will be listening to us,
is for them to know that there is partnership working
across acute setting, across health, across social care,
and that it is that togetherness and knowing what is going on
within both that is helping our residents and hopefully putting them in the right place
with the colleagues Satya and Health Watch, making sure we take that out.
/Cllr Darby - 3:01:07
Thank you very much, Chairman. Can I say that Bucks would be a much poorer place if we didn't
have the level of partnership working we have across health and social care. It really is
very, very special, but we can always make it better. I think the big secret of success
is never resting on your laurels, is always looking at new ways of doing
things because the world is a never -changing place and we just you
know we're in perhaps quite a, well we're in a very huge climate of change at the
moment with the NHS but we have to make things work. The NHS ideas are they're
committed to help people be healthier, keep demand levels down and you know
let's be honest, keep costs down, that's what we're about as well and I
think together we can be such a strong force.
Cllr Shade Adoh - 3:01:56
Thank you very much and that's why we're here to scrutinise critical friend in a creative
way.
So thank you for coming, thanks a lot, we appreciate you.
Cllr Shade Adoh - 3:02:06
I've got to get used to this.
Cllr Shade Adoh - 3:02:08
Thank you very much.

9 Emergency Care provision across Buckinghamshire - scoping document

Agenda item nine and this is where we're looking at the rapid review on the emergency care
provision across Buckinghamshire.
The scoping document, everybody has had access to that,
apart from some of our colleagues that are joining us
for the first time today.
So I'll just read this bit, and I'm sure you've all read it.
At the last select committee meeting,
members agreed to undertake a rapid review into emergency
care across Buckinghamshire, using the ambitions around
improved access to services, publishing the NHS 10 -year plan
and refreshed health and social care strategies.
This item is for the committee to discuss
and agree the scoping document for this piece of work.
Evidence gathering is to take place
throughout March and April,
with the draught reports coming to the first
ask select committee meeting in the new council year.
So we need to agree the scoping document.
Any ideas on it?
any comments on the documents that people have gone through?
Cllr Shade Adoh - 3:03:27
Cllr Clarke - 3:03:29
We had SCAS here today and they would actually be able to help us with
informing whether there's an inequality in emergency care for people in Wickham.
And they were saying that is it five ambulances a day come from Wickham up to
Stoke Mandeville. We don't seem to have scans down on our list to perhaps ask
whether they can say there's an inequality of healthcare or emergency
healthcare because I think they're the people that actually deal with the
emergency healthcare aren't they?
Where abouts? I've got the document. So I've got lead service officers and health
partners.
I'm not looking at that bit, I'm looking at the lead service officers and health partners.
OK, let's see, if you look at the bottom of page 40A...
40 what, sorry?
...the key decision -makers.
And partway down at the end of the street, we've got South Central and the Link Service.
So we will be hearing from them as part of our evidence -based...
Well, you also heard today, didn't we?
Absolutely. So they will be definitely part of the evidence -based...
Do we interview them as a group or do we send them out a selection of questions?
Cllr Shade Adoh - 3:05:19
That's what we need to look at as a committee.
Cllr Shade Adoh - 3:05:24
How do we want to scope?
How do we want to look at it?
What's our plan on having to find out this information through everybody?
Because we can have them come in and talk to us, and from there we gather data and be able to do our reports.
And don't forget we will need to meet all those people listed there.
And I have already suggested that we probably have a visit as well to Stoke Mandeville A &E as a group who talk to BHT and see how that can happen.
for the rapid review, for the emergency care to see how does that work.
So, you know, I know Councillor Stauchbury is no longer part of the team,
but I was just wondering, I can hear you talking to, I can see that you're talking,
I'm wondering if you're engaging with us.
Cllr Stuchbury/Cllr Pinkney - 3:06:21
I will always engage with you, whether you wish me to or not.
So, it's just part of that we need to know how we're working on this.
Or do we do it in such a way that we go away and come back, or we have our next meeting?
Yeah, I was going to say, today is just about agreeing the scope of the work.
Cllr Shade Adoh - 3:06:40
We've got our first meeting set up for the 9th of March, which is just for the members
of the review group, where upon which we will go through the days of evidence gathering,
making sure we've got a draught put forward for that meeting.
So that's for today, it's about getting the committee to agree to the draught scoping document, which hopefully you've all seen and can agree to.
I think it actually comes up.
Everything, okay. Councillor Picnich, are you happy with the scoping?
I am, yeah.
Okay, and then Councillor, Councillor Haynes, Councillor Sherwell, are you happy with the scoping document?
Absolutely.
Thank you. Zoe, are you happy with the scoping documents?
Zoe McIntosh/ Cllr Kneller - 3:07:27
To answer a question about the friends and family feedback and the complaints and compliments.
So the friends and family, you're going to look at friends and family data from, yeah,
and it's quite useful to get that broken down into demographics as well so that you know
you can see whether there's an inequality aspect to it.
But also you get more, it's quite high level,
so I think you are looking at the complaints as well,
are you, and compliments, which sits slightly separately, doesn't it?
Yeah, that's what I'm thinking, how does that fit with the emergency service?
But you're happy with the scope of the content activities and we can take it?
Yeah.
Okay.
And Councillor Neillah?
Yeah.
You're happy with it.
Councillor McBube, you're probably going to review it.
Good. Okay. That's good.
Cllr Shade Adoh - 3:08:17
So the first meeting is on the 9th of...
9th of March.
The 9th of...
9th of March just for the review group.
Just for the review group.
For those who have put their names down on it.
And that's the place for it?
No, it's Teams.
Teams.
We'll be on Teams.
And Councillor McBube, you're welcome to come on board.
because I know you all are very keen on what you can.
So, our work programme.
So the next meeting is on 7th May

10 Work programme

and we will be having Bucknamshire Healthcare NHS.
So 7th May.
Can we move the date to the 15th?
Or should we...

11 Date of Next Meeting

So the next meeting in May is that we're going to be looking at the end of April or the third week in May.
But we will come back to you ASAP once the report is going out to let you know about the change in that date.
But please do bear with us and we'll get that right out to you as quickly as we can.
Yeah. Thank you very much. And I just want to say thank you very much for your time.
I appreciate today.
You know, I knew I was coming in to deputise for Councillor Wilson,
and then everything happened.
Cllr Shade Adoh - 3:09:41
But I appreciate your time, and I thank you for everything,
and we've had a good session with Councillor Wilson.
So we look forward to the next step.
And yeah, we'll see you next time.
And thanks to those who turned up earlier for 9 .30.
Sorry that you had to wait.
Thank you very much everyone.