Health & Adult Social Care Select Committee - Thursday 2 July 2026, 10:00am - Buckinghamshire Council Webcasting

Health & Adult Social Care Select Committee
Thursday, 2nd July 2026 at 10:00am 

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  1. Cllr Shade Adoh
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  1. Cllr Julia Wassell
  2. Cllr Shade Adoh
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  1. Cllr Carol Heap
  2. Cllr Shade Adoh
  3. Cllr Julia Wassell
  4. Cllr Carol Heap
  5. Cllr Julia Wassell
  6. Craig McArdle - Corporate Director, Adults and Social Care
  7. Ms. Tiffany Adonis-French
  8. Craig McArdle - Corporate Director, Adults and Social Care
  9. Ms. Tiffany Adonis-French
  10. Cllr Shade Adoh
  11. Ms. Tiffany Adonis-French
  12. Cllr Shade Adoh
  13. Cllr Lesley Clarke OBE
  14. Matt Everitt
  15. Cllr Lesley Clarke OBE
  16. Craig McArdle - Corporate Director, Adults and Social Care
  17. Cllr Lesley Clarke OBE
  18. Cllr Shade Adoh
  19. Cllr Thomas Hogg
  20. Conrad Eydmann - Head of Strategic Commissioning - OP
  21. Cllr Thomas Hogg
  22. Craig McArdle - Corporate Director, Adults and Social Care
  23. Cllr Thomas Hogg
  24. Craig McArdle - Corporate Director, Adults and Social Care
  25. Cllr Shade Adoh
  26. Craig McArdle - Corporate Director, Adults and Social Care
  27. Cllr Shade Adoh
  28. Cllr Alan Sherwell
  29. Cllr Shade Adoh
  30. Craig McArdle - Corporate Director, Adults and Social Care
  31. Cllr Shade Adoh
  32. Cllr Carol Heap
  33. Craig McArdle - Corporate Director, Adults and Social Care
  34. Cllr Larisa Townsend
  35. Craig McArdle - Corporate Director, Adults and Social Care
  36. Conrad Eydmann - Head of Strategic Commissioning - OP
  37. Cllr Larisa Townsend
  38. Conrad Eydmann - Head of Strategic Commissioning - OP
  39. Cllr Shade Adoh
  40. Conrad Eydmann - Head of Strategic Commissioning - OP
  41. Cllr Shade Adoh
  42. Cllr Michael Collins
  43. Cllr Carol Heap
  44. Ms. Nicola Newstone
  45. Cllr Michael Collins
  46. Cllr Shade Adoh
  47. Craig McArdle - Corporate Director, Adults and Social Care
  48. Cllr Shade Adoh
  49. Cllr Frances Kneller
  50. Conrad Eydmann - Head of Strategic Commissioning - OP
  51. Craig McArdle - Corporate Director, Adults and Social Care
  52. Cllr Shade Adoh
  53. Cllr Julia Wassell
  54. Craig McArdle - Corporate Director, Adults and Social Care
  55. Matt Everitt
  56. Cllr Thomas Hogg
  57. Craig McArdle - Corporate Director, Adults and Social Care
  58. Cllr Thomas Hogg
  59. Craig McArdle - Corporate Director, Adults and Social Care
  60. Cllr Shade Adoh
  61. Conrad Eydmann - Head of Strategic Commissioning - OP
  62. Cllr Shade Adoh
  63. Conrad Eydmann - Head of Strategic Commissioning - OP
  64. Ms. Nicola Newstone
  65. Cllr Shade Adoh
  66. Cllr Lesley Clarke OBE
  67. Conrad Eydmann - Head of Strategic Commissioning - OP
  68. Cllr Shade Adoh
  69. Cllr Nidhi Mehta
  70. Craig McArdle - Corporate Director, Adults and Social Care
  71. Cllr Nidhi Mehta
  72. Cllr Shade Adoh
  73. Craig McArdle - Corporate Director, Adults and Social Care
  74. Cllr Shade Adoh
  75. Ms. Nicola Newstone
  76. Cllr Shade Adoh
  77. Ms. Tiffany Adonis-French
  78. Cllr Shade Adoh
  79. Ms. Nicola Newstone
  80. Cllr Michael Collins
  81. Craig McArdle - Corporate Director, Adults and Social Care
  82. Cllr Shade Adoh
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  1. Cllr Shade Adoh
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  1. Cllr Carol Heap
  2. Cllr Julia Wassell
  3. Cllr Carol Heap
  4. Craig McArdle - Corporate Director, Adults and Social Care
  5. Conrad Eydmann - Head of Strategic Commissioning - OP
  6. Matt Everitt
  7. Cllr Shade Adoh
  8. Matt Everitt
  9. Cllr Michael Collins
  10. Conrad Eydmann - Head of Strategic Commissioning - OP
  11. Cllr Lesley Clarke OBE
  12. Craig McArdle - Corporate Director, Adults and Social Care
  13. Cllr Shade Adoh
  14. Conrad Eydmann - Head of Strategic Commissioning - OP
  15. Craig McArdle - Corporate Director, Adults and Social Care
  16. Conrad Eydmann - Head of Strategic Commissioning - OP
  17. Cllr Shade Adoh
  18. Cllr Shade Adoh
  19. Conrad Eydmann - Head of Strategic Commissioning - OP
  20. Cllr Shade Adoh
  21. Conrad Eydmann - Head of Strategic Commissioning - OP
  22. Cllr Shade Adoh
  23. Zoe McIintosh - Chief Executive, Healthwatch Bucks
  24. Conrad Eydmann - Head of Strategic Commissioning - OP
  25. Zoe McIintosh - Chief Executive, Healthwatch Bucks
  26. Conrad Eydmann - Head of Strategic Commissioning - OP
  27. Zoe McIintosh - Chief Executive, Healthwatch Bucks
  28. Cllr Shade Adoh
  29. Cllr Alan Sherwell
  30. Matt Everitt
  31. Conrad Eydmann - Head of Strategic Commissioning - OP
  32. Cllr Shade Adoh
  33. Conrad Eydmann - Head of Strategic Commissioning - OP
  34. Cllr Larisa Townsend
  35. Conrad Eydmann - Head of Strategic Commissioning - OP
  36. Cllr Larisa Townsend
  37. Conrad Eydmann - Head of Strategic Commissioning - OP
  38. Craig McArdle - Corporate Director, Adults and Social Care
  39. Cllr Shade Adoh
  40. Cllr Michael Collins
  41. Conrad Eydmann - Head of Strategic Commissioning - OP
  42. Cllr Shade Adoh
  43. Conrad Eydmann - Head of Strategic Commissioning - OP
  44. Cllr Frances Kneller
  45. Conrad Eydmann - Head of Strategic Commissioning - OP
  46. Matt Everitt
  47. Cllr Frances Kneller
  48. Conrad Eydmann - Head of Strategic Commissioning - OP
  49. Cllr Shade Adoh
  50. Cllr Thomas Hogg
  51. Craig McArdle - Corporate Director, Adults and Social Care
  52. Cllr Carol Heap
  53. Cllr Shade Adoh
  54. Conrad Eydmann - Head of Strategic Commissioning - OP
  55. Cllr Shade Adoh
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  1. Zoe McIintosh - Chief Executive, Healthwatch Bucks
  2. Conrad Eydmann - Head of Strategic Commissioning - OP
  3. Cllr Shade Adoh
  4. Craig McArdle - Corporate Director, Adults and Social Care
  5. Cllr Larisa Townsend
  6. Craig McArdle - Corporate Director, Adults and Social Care
  7. Cllr Larisa Townsend
  8. Craig McArdle - Corporate Director, Adults and Social Care
  9. Cllr Lesley Clarke OBE
  10. Craig McArdle - Corporate Director, Adults and Social Care
  11. Matt Everitt
  12. Craig McArdle - Corporate Director, Adults and Social Care
  13. Cllr Lesley Clarke OBE
  14. Matt Everitt
  15. Craig McArdle - Corporate Director, Adults and Social Care
  16. Cllr Lesley Clarke OBE
  17. Craig McArdle - Corporate Director, Adults and Social Care
  18. Cllr Carol Heap
  19. Cllr Michael Collins
  20. Craig McArdle - Corporate Director, Adults and Social Care
  21. Cllr Michael Collins
  22. Craig McArdle - Corporate Director, Adults and Social Care
  23. Cllr Thomas Hogg
  24. Craig McArdle - Corporate Director, Adults and Social Care
  25. Cllr Shade Adoh
  26. Craig McArdle - Corporate Director, Adults and Social Care
  27. Cllr Shade Adoh
  28. Matt Everitt
  29. Cllr Carol Heap
  30. Cllr Shade Adoh
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  2. Cllr Michael Collins
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  1. Webcast Finished

Cllr Shade Adoh - 0:00:00
Cllr Shade Adoh - 0:00:04
And welcome to our first session of the Council for this year.
Thank you everyone for making it today, giving us your time.
Without much ado, we're starting at ten.
Thank you for the opportunity at the last full Council meeting.
should I say I was glad to be elected, selected as the chair, so you have to deal with me
for another year, hopefully.

1 Appointment of Vice-Chairman

So I have the opportunity to appoint as vice chair the previous chair, Councillor Leslie

2 Apologies for Absence and Changes in Membership

Next on the agenda, agenda item two is apologies for absence and any changes in membership.
Katie, I have to first of all say thank you Katie for standing in today for us, we appreciate
it.
You're welcome gentlemen, thank you.
Yes, we have apologies from Councillors Pinckney and Gorm and also from our cabinet member
Councillor Isabel Darby.
We have substitutes in Councillor Metta for Councillor Pinckney and also Councillor Cowell
Heap is attending, a Deputy Cabinet Member.
Changes in membership for the committee, Councillor Simon Rouse and Councillor Trevor Snape are
now no longer committee members but Councillor Larissa Townsend and Councillor Mike Collins
are new members on this committee.
Thank you, Chairman.
Thank you, Katie.
So I have to say thank you to Councillor Simon Rouse and Councillor Trevor Snate for the
time that they have given to this committee, which is very valuable.
And also to welcome Councillor Larissa Townsend and Councillor Mike Collins as new members
with vast experience to this team.
And thank you for replacing, substituting Councillor Mitter.
Thank you
Cllr Julia Wassell - 0:02:29
Cllr Shade Adoh - 0:02:40
Right on to our gender item three a day any

3 Declarations of Interest

personal or pecuniary interest of items being discussed today
that we need to declare.
Any declarations of interest?
I look across the room.
No?
Thank you very much.

4 Minutes of the Previous Meeting

And agenda item number four is minutes of the last meeting.
So we've got two minutes today to go through.
I'll start with Thursday, the 7th of May.
And we've got some actions on there
that we need updates on.
One from the Buckinghamshire Healthcare Trust.
I don't know if we have anything on that.
Just looking across the room on my right -hand side.
And there's action from the finance officer as well, which I'm sure will take up with
them.
I think those are the actions that we would have wanted updates on.
So we need to make sure we get that please Katie.
Is there any comments on the minutes before these are accepted?
Yeah, as correct records for those who were there on the 7th of May, agreed?
Thank you.
And again on the 28th of May, do you accept them as correct records as well?
Agreed.
Thank you very much.
So now, agenda item five, public questions.

5 Public Questions

I have not been told of any public questions.
Is that still the same?
Thank you very much.
Right, so my update.

6 Chairman's update

I'm sure a lot of us are aware of the Mount Vernon Cancer Centre.
That's a J -Ox meeting that we've been having for a few years now.
There was a meeting on the 16th of June to discuss plans to relocate the cancer services
from Mount Vernon to Watford General Hospital.
A draught consultation response has been prepared by the MVCCJOS to submit to NHS England.
We have been participating in this and we hope that the consultation would actually
meet the needs of the people as it is and we didn't have any reason not to support
the plan. We had the access to emergency care review and I remain grateful to all
the members that participated in it. It was an eye -opener for us a lot of
services that we didn't know actually exist and we sort of determined that we
as elected representatives equally have a duty to let our residents know where
services are what they are and to share that at every opportunity.
The report has been drafted and the first round of comments have been received.
Work is currently underway to bring the comments together and the report is due to come to
the next meeting for committee approval.
We had the Buckinghamshire Healthcare NHS Trust Quality Account thanks to Councillor
and Councillor Russell for the time that they gave in reviewing this quality account.
And we have submitted comments which were prepared through the Act Statement to BHT on this quality account.
Maternity services, there has been recent national press coverage relating to maternity services being described as not fit for now.
and no fit for the future.
That's a BBC news article of 30th of June.
This committee will be reviewing maternity services
later in the year as part of a review
of Buckinghamshire Healthcare Trust Performance.
Now our pre -meeting, we have actually decided
I would be writing a letter to the CEO
asking where we are as Buckinghamshire
on our maternity services and what if there is anything to look at how we're going to be doing
that so that letter we've agreed will be going out soon and members will be made aware of that.
Thank you so on now to agenda item seven better care.

7 Better Care Fund

Thank you Nicola for joining us and I know you have to leave at about 10.
You can stay a bit later. So welcome Nicola and we have contributors for this meeting.
We have Councillor Carol Hipp, Mr Craig McAdoo, Mr Matt Herverrett
and Mr Conrad Eddiman.
And I don't know where you fit in actually.
So we've got adult social care,
who is gonna be talking to us on everything and everything.
There's so much going on in adult social care.
So we've got Tiffany also talking to us this morning.
So, I will hand it over to you.
Cllr Carol Heap - 0:08:42
So, as Sade mentioned earlier, I am standing in for Isabelle Darby this morning.
So, you have before you the Better Care Fund plan for this item.
I'm pleased to introduce this report which provides an overview of our plan
for the Better Care Fund in 2026 -27. The Better Care Fund continues to be one of
the most important mechanisms we have for bringing together health and social
care resources and ensuring that the whole system works in a joined up way
for residents. Having this pooled fund enables us in the Council along with
colleagues in Thames Valley Integrated Care Board and our wider health partners
to consider jointly our use of resources and focus investment on
our shared priorities. The fund for 2026 -27 is close to 57 million pounds.
This is a very large amount, however we also know that demand for services and
also complexity are increasing. So we must use this fund wisely and target the
areas that will make the most impact. The plan outlined in the report sets out how
we will use the fund to support key areas including hospital discharge,
prevention services, intermediate care, reducing avoidable hospital admissions
and maintaining sustainability of adult social care services.
This plan is particularly significant because it is the first year of a new three -year
National Better Care Fund framework covering the period from 2026 to 29.
It has been developed jointly with our NHS partners, including Thames Valley ICB
and the Buckinghamshire Healthcare NHS Trust.
It has been submitted to NHS England
following extensive collaboration, discussion, planning and review.
Members will see that the plan continues to align investment
with both national and local priorities,
including supporting home -first approaches
and dedicated discharge beds
to allow people to move out of hospital quickly, strengthening community -based
services, improving discharge pathways and helping people to remain
independent within their own homes and communities. New areas of expenditure in
this plan include investing further into integrated neighbourhood models of
delivery and resources to tackle the waiting list for dementia diagnosis. The
The report also highlights the governance arrangements
underpinning our approach to using the fund.
The team hold a joint commissioning meeting every month
with council and ICB colleagues
to review performance of jointly commissioned services
and metrics relating to the fund.
The health and wellbeing board also have regular oversight
of performance and delivery.
Overall, this report demonstrates how Buckinghamshire is continuing to use the Better Care Fund
to strengthen integration across health and care systems and to improve outcomes for residents.
So we're joined today with colleagues from the ICB, so Nicola Neuston is leading on this
and she's here.
And as has already been said, we've got Matt Everett from,
who's Service Director for Strategic Commissioning and Conrad Eidman,
Head of Strategic Commissioning and Lead on the Better Care Fund for the
Council.
So we're very happy to answer any questions you may have on this report.
Cllr Shade Adoh - 0:12:49
Thank you very much. Uh, Deputy Cabinet Member, uh,
Before we go to questions is any contribution from?
Okay, Councillor Russell
Thank you, sir
Cllr Julia Wassell - 0:13:14
One of the things that's often
Said by in the communities that the waiting list
time for assessments is long. But when I looked at the CQC report, I was surprised, well,
it didn't seem as long as I thought it was going to be. Is that something that you're
working on, the assessment times for this fund, for the clients? That's my first question.
The other one was that because of the heatwave I've been looking up how to get
funding for air conditioning for people with chronic health conditions and it
does say that the disability facility grant could provide funding if it was
necessary.
Councillor Wessel, can I kindly ask if you move your mic closer to you?
Oh, yes.
Thank you.
During the heat wave, if people have chronic conditions or breathing difficulty, the disability
facility grant could pay for air conditioning if it was thought to be necessary.
Has that been looked at at all?
Also what are your high areas of unmet need?
Is it linked to delayed discharge because the lengths of time of delayed discharge?
It's a bit of it's a bit difficult to get your head around these figures because you've got three different figures relating to it
One better than the target one slightly below target another one better than target
So those are my areas of interest
assessments, air conditioning in homes and the link between unmet needs and delayed discharge.
Thank you.
Cllr Carol Heap - 0:15:30
Could I just clarify what type of assessments are you referring to?
The needs assessment.
Cllr Julia Wassell - 0:15:39
And are these in the report?
They were in the CQ for the needs assessment under the Care Act which can be funded by
Better Care Fund.
Okay.
Craig, thanks.
Thanks, Councillor.
Craig McArdle - Corporate Director, Adults and Social Care - 0:15:57
I'll bring Tiffany in in a moment around that.
So Tiffany manages adult social care oper - adult social care operations, so I'll bring
her in in a moment around those. You're absolutely right, the CQC report actually said that our
waiting times are within tolerable levels in terms of that, but if you're waiting, that's
still clearly an issue in terms of that. We have peaks and we have to triage is the reality
of the situation, so safeguarding is the area that always takes priority in those assessments
as well. So we have a very tight turnaround for assessments in terms of that initial triage
in terms of that. Care Act assessments can take longer, depending on the complexity.
Again, we prioritise discharges and you will see that in the figures in terms of that.
The other one, and it links to the disabled facilities grant one, is around OTs and we
have a longer waiting list for OTs and again we have to prioritise those as well. So again,
we triage looking at what is urgent, what is non -urgent in terms of that. So falls,
for example, would be prioritised as urgent. So Tiffany, do you just want to talk about
through some of the measures you're putting in place to improve those performance measures?
Absolutely. Thank you for that question. So currently we've got an 11 -week wait for
Ms. Tiffany Adonis-French - 0:17:18
Care Act assessments that are not urgent. Anything that's been triaged, so everything
that comes into us will be screened, so we'll have an initial conversation with the referrer
and just to try and identify how urgent the request is. Once the screening's taken place,
if it's urgent we'll be seeking to get out within seven days, if it's very, very urgent
it be the same day so we do put in place steps to make sure that people are
waiting well and that involves a screening you know quite frequently and
the waiting list for people who are on it to make sure that whilst they're
waiting they are waiting well and if their circumstances have changed we
obviously want to identify that really really quickly so we can address the
issues as swiftly as possible so we've got the yet just roughly about 11 week
wait now at the moment for care act assessments if we are seeing or
supporting somebody who's got a safeguarding inquiry.
Those safeguarding referrals are screened usually on the day,
but certainly within 48 hours.
And again, the same principles apply.
We need to make sure that people are safe.
So we'll move resources around and make sure
that we are seeing people who have urgent need as quickly
as possible.
Hopefully that answers the first of your trio of questions.
OK, so the second one is around Disabled Facilities Grant.
Craig McArdle - Corporate Director, Adults and Social Care - 0:18:40
This fund actually funds the Disabled Facilities Grant, but our team doesn't actually oversee
the administration of the DFG process.
That is done by our housing colleagues, Councillor.
So we'd have to go back in terms of the specifics of your questions in terms of that.
It can do a wide range of adaptations to someone's homes,
from stair lists through to ramps, et cetera,
all those things as well, level access, washrooms, all those things as well.
But the specifics around that we would have to take away
and see whether we've had any inquiries regarding that
because it is a new one on me, unless I need a team, no differently.
So we'll need to take that one away, so not quite as good on that one.
And then in terms of discharges generally, and again I might need Tiffany to pitch in
there.
You're right, we always find the metrics quite confusing as well because it measures different
things in terms of that, but we've seen quite a lot of improved performance over the last
two to three years in this area since we've established something called the Transfer
of Care Hub.
I think Health Watch did a piece of work on that, about how that was working very early
on just to get the user experience as well.
Now those discharges, sometimes there'll be packages of care,
sometimes it will be waiting things about transport,
some of it will be around client choice as well.
So there's various reasons for that.
Those reasons are looked at on a daily basis in terms of that.
Myself and Tiffany do an escalation call today
on a Thursday morning where we're
looking at anything which is stuck within the system
around that, and that could be, again, sourcing packages
of care, et cetera. So that is generally where your point around unmet needs would come in
in terms of that, whether we're waiting for packages of care. Packages of care don't normally
delay discharge too long, to be honest. The main reason is around client choice, where
we're getting that. Or if it's complex and we're placing someone out of area in terms
of that. Anything, Tiffany, you want to add?
Ms. Tiffany Adonis-French - 0:20:48
Yeah, just in terms of just reflecting on Carol's introduction around admission avoidance,
the better care funding also supports admission avoidance we have dedicated
resources in the eight -day making sure that we're supporting people on that
really quick turnaround journey if they don't have an acute need and don't need
to be admitted into hospital in the first place
in terms of packages of care packages of care can be commissioned very very
quickly now all towards anybody who needs a care package from us will be
transferred into al talk at transfer of care hop and we can't get requests on
d p v system very very swiftly and commission cake
jimmy between two and four hours to get people on their way
i think the
pulled results of the better care fund has really really supported us in
driving down al long -lengths of study
and to be chasing the amount of and
you don't know criteria to reside customers that sometimes find themselves
in the acute space
Thank you very much. Tiffany, can I come back on the, because Craig you said client choice
Cllr Shade Adoh - 0:21:57
seems to be the bigger reason. So is there any plans to prepare the clients prior so
that people are aware and when they are on the wards as well, the staff are equally,
how are we working on that one? So we're working really, really hard with
Ms. Tiffany Adonis-French - 0:22:16
our BHT colleagues to ensure that anybody that's been identified as requiring a package
of care or a social care intervention, so that could be a placement or extra care sheltered
on discharge, those conversations are happening really early. So we want people flagged to
us in adult social care so we can start those conversations whilst they are still in patients.
There are occasions when we do get stuck because people have particular views about where it
is they'd like to be discharged to, but we're working really hard to step those clients
down so they can come out of the acute space and into intermediate care facilities whilst
we continue those conversations.
Thank you very much.
Councillor Lachac.
Cllr Shade Adoh - 0:23:02
Thank you, Chairman.
A quick question.
Cllr Lesley Clarke OBE - 0:23:08
3 .7 on page 20.
You've given us two graphs, but they don't correspond with each other.
Is there any reason why you're not doing that?
reason for doing that? If you look at the one on page 20, there are 18 councils there,
and then you look at page 21, there are 16 there, and only five match the table on page
20. Is there any reason why you have done that? I appreciate we are looking at keeping
more people at home. And I do understand the reasons for doing that. But if you're going
to do like for like, surely you do like for like with the tables. Thank you.
Thanks for the question.
Matt Everitt - 0:24:08
So the two charts are looking at the same data for Buckinghamshire and looking at the
same indicator, but there's a difference between the two, which is why the groups don't match.
So one of them is looking at the southeast, so all of the authorities in the southeast
as a benchmarking group.
The other is looking at a peer comparison group. So that would be regardless of where
those local authorities are situated, if they are statistically similar to Buckinghamshire,
then they're in the peer group and we compare ourselves to those. So the reason for doing
that is that gives us a good basis on which to judge our own performance. So we know the
admissions performance, we didn't quite hit the target in terms of last year, in terms
of bringing that number down, but you can see from both of those comparison groups that
the second highest performer in those groups, which evidence is that actually we are performing
well against that indicator, clearly we've got more to do, but compared to other authorities
in the region who will be experiencing similar pressures or across our comparative group
who will be statistically similar to us, we're performing very highly.
Cllr Lesley Clarke OBE - 0:25:13
It still doesn't answer the reason why you use two tables. You should use the same table,
just one table so that we can actually see.
I appreciate one is the long -term admissions to residential and nursing homes per 100 ,000
in the southeast.
But then you then go on to compare it with our peer group, which can't be the same, can
it?
You know, if there are only five matches in the peer group to the long -term admissions
group, it's apples and pears, isn't it?
Well, we were trying to show, because both indicators are the same, is the first point.
Craig McArdle - Corporate Director, Adults and Social Care - 0:25:47
So it's both showing different things.
Because I suppose we wanted to be even more visible in terms of that, to say how we're
comparing more widely, and hence doing that too.
But your suggestion of cutting down on work, Councillor Clark, is a good one.
Cllr Lesley Clarke OBE - 0:26:04
I congratulate you on being the lowest, but perhaps, you know, just use one graph to actually
prove your point.
And I think the other thing is, yes, it looks really good.
But we would like to do apples with apples, not apples and pears or bananas, so to speak.
Not the same people as apples and pears and bananas, of course.
Councillor Thomas -Hogg, please.
Cllr Shade Adoh - 0:26:27
Cllr Thomas Hogg - 0:26:32
If I'm reading this right, on your table, which page is this?
Page, oh it doesn't have page numbers.
I think it's page three.
You've got reduction of emergency admissions for people over 65,
latest performance is 14 ,142.
The target for 2025, sorry?
Big 19.
The target for 2025 to 26 is 15 ,886.
Now you brought the target down, which is good,
but basically you can still, you can make performance worse
and still achieve your targets.
And the same with the reduction in long -term admissions
at the bottom there.
You weren't able to reach your target for 2025,
but now the 2026 target seems to mean
that you're gonna reach it.
So I'm just wondering how you've got to those numbers
and why maybe we aren't being more ambitious with the targets moving forward.
Yeah, happy to answer on that. So firstly, it's probably worth noting that we're
Conrad Eydmann - Head of Strategic Commissioning - OP - 0:28:08
in continuous negotiation with NHS England around the target setting, so these are initially
proposed but they're also negotiated with the ICB across the Thames Valley. So yeah,
Admittedly, our current performance on the top one for emergency admissions would be
achieved even at the lower target level, but we have to recognise that it's not just
the local authority that's the player in that system.
So there are conversations happening with the other local authorities that make up the
Thames Valley area and the ICB in terms of what the target needs to be.
The NHSC approval and confirmation of final targets will be back towards the end of this
So we're still anticipating that.
Cllr Thomas Hogg - 0:28:52
Yeah, I mean, I don't want to go too far down the street because I also have a question
briefly for the chair.
But it would be useful to get an insight into how the ICB wants you to lower your targets.
I just don't quite understand how you can end up basically being able to pat yourselves
on the back, achieve your targets, even though, especially for the reduction in long -term
admissions to residential nursing care, where you were unable to reach your target for 25,
26, but now apparently it's all good.
I just can't get my head around that.
So I think there's some complexities coming into that, Councillor Hogg, in terms of that.
Craig McArdle - Corporate Director, Adults and Social Care - 0:29:37
So when we're setting targets we use a lot of benchmarking information and you'll see
with – let's take the reduction of long -term admissions to residential nursing care because
it comes up on our dashboard indicators at the end as well so we could deal with that
now in terms of that as well.
Actually we are well above regional targets and national targets in terms of that already
so we're performing well.
But at the same time, what we've got is more need and more demand coming in for adult social
care services as the population goes forward.
So what you're doing is we've got more demand coming in, more complexity coming in, and
that's always a pressure in terms of that.
We've also got to be responsive to individual needs as well.
So we've put in systems and processes where we're absolutely sure now people are only
going into residential and nursing care if they absolutely need that appropriately as
well.
So that will have an impact on our out turn as well.
And so as a result of that we've reset our indicators in the knowledge of increased demand
but equally that we know we've got these mechanisms in place as well.
At the end of the day if somebody needs long term residential or nursing care then we will
provide that.
That's what we have to do in the Care Act.
Last question.
Yeah, this one's actually for you.
Cllr Thomas Hogg - 0:31:02
I just want to put on the record that if the organisations involved here aren't using targets
to try and strive for a better future, but you're doing it as a sort of almost like an accounting predictability measure,
then I think that's a shame.
You know, you guys should be striving for better.
But the question that I have for the chair is, and you may or may not know this, but
I'm just wondering whether we've seen any of this planned before, because I know that
it's already gone off to, it's already been submitted to NHS England, and I know it's
gone past the Health and Well -Being Board, but I'm not sure it's ever come before this
committee before.
I don't think we have…
So certainly in…
Craig McArdle - Corporate Director, Adults and Social Care - 0:31:59
Councillor Lough, certainly not in my three years of being in Buckinghamshire, it's
never come before, whether it came previously, I couldn't comment on that as well.
So the normal process is to get through the health and wellbeing board, a sign off of
the actual plan.
But that's down to your work programming in terms of that.
I don't, and I don't think we're artificially depressing targets.
we want everybody to stay at home but realistically not everybody is going to receive care and
support at home. That's the honest answer. I would be lying to this committee if I was
to say otherwise. What I need to do as a Director of Adult Social Services is assure you, assure
my cabinet members that people are getting care in the most appropriate setting.
Cllr Shade Adoh - 0:32:43
That is very true and I do agree with that, that people have to have the best care in
the best setting. What I'm trying to equally, you know, have a better appreciation of is
the target setting. So, because if we set our targets consistently at a level that is
based on what you've just alluded to, you know, the increase in the ageing population,
the services that are available, the partners you have to work with and NHS England.
But is there a way, I'm just trying to draw on what Councillor Hogg has said, on setting
our targets higher, but obviously we don't want to overshoot and not be able to meet
it and therefore create unrealistic expectations.
We have to be mindful of that.
But is there a way we can do that better or differently?
I hope I said that.
Craig McArdle - Corporate Director, Adults and Social Care - 0:33:42
I think it's something we're constantly revising the target setting.
So when it starts, it also links to the medium -term financial plan, because at that point, we're
trying to predict at that point the numbers coming through for the next few years, based
on the demography, based on needs as well.
Also based on what we know the service changes are, if we're opening new schemes, et cetera.
So it's not an exact science that we're doing here, but we have a number of component
parts coming through.
We'll also look at out -term position as well, give us a sort of sense of that and
the levels coming through.
Now the out -term position could also change during the year.
So what we see, because we get actually daily dashboards on the numbers in our care settings,
you can see them going down and then they go back up during the course of the year as
well.
So we're having to take all that into account.
We're also then looking at benchmarking as well, because that's really important.
What we don't want to do really is be an outlier, or if we are an outlier, to understand
the reasons for being that outlier as well.
Sometimes we will be, the number of adult social care concerns is well known by this
committee, etc.
We are an outlier, but we understand the reasons for that as well.
So we're constantly learning.
If people have got better suggestions around how we can do it, we can absolutely feed that
through to it.
But it's not an exact science because we just don't know who's going to need our services.
That's reality of the situation, Chair.
Cllr Shade Adoh - 0:35:10
Thank you very much, Craig.
Two seconds.
So I have got next on here is Councillor Sherwell, please.
Thank you.
Cllr Alan Sherwell - 0:35:26
I can be fairly brief I think because Councillor Hogg essentially asked the basic question that I was going to ask
Which was particularly on the long term admissions because I didn't feel that those
Statistics made any sense
Mr. McCardell has
explained the background to them and they now make sense, but
but I don't find them any use.
And that's not being rude about it.
I understand exactly what you've said
and what you're trying to do with those statistics
and where they've arisen from.
The question really is, how do we get confidence
that what you are saying that you are doing about trying
to reduce long -term admissions into residential care
Is actually happening and working
Because these statistics aren't really designed to do that as you as you said really
And I absolutely accept that the ground is shifting under you all the time
Which makes it extremely difficult?
But it will be nice to have a mechanism for assurance
That why I have absolutely no doubt you are seeking to achieve
is actually being achieved.
That's a statement.
Do you see a question in that?
Cllr Shade Adoh - 0:36:57
Well, I'd only refer the committee back to
page 36 of the PACWare where we've actually got
Craig McArdle - Corporate Director, Adults and Social Care - 0:37:04
this particular indicator which you are tracking
on a quarterly basis because it is one of
Councillor Darby's indicators in terms of that.
You will see that that's red.
Councillor, I'll get in your question in first
in terms of that.
So that's one where we didn't meet our targets last year in terms of that as well.
So we're always constantly trying, as I said, to revise those and address them as
well.
But that is a mechanism for some of the key indicators that this committee's got to
say, actually, is adult social care on track?
This one's really important to us as well because it's also linked closely to the
budget setting process and our budgets as well.
So when those come through, you will see those as well.
That's a correlation between performance and budget.
Thank you very much.
Cllr Shade Adoh - 0:37:48
Can I just add to that?
Cllr Carol Heap - 0:37:52
Just looking at the table in the pack that Craig's referring to, this is up to end of
Q3.
So, four, sorry, four, yes, I can see that.
So, is there some seasonality going on here?
Is this the winter quarter?
And what effect does that have?
That's a full year effect in terms of that.
Craig McArdle - Corporate Director, Adults and Social Care - 0:38:16
Seasonality is difficult in adult
social care to predict because you could have more people
becoming unwell and going into care homes, equally you could have more people
who are deceased as well. So it's a really difficult one to predict.
And I know I've said this before but it's not an exact science.
We've just got to use the data we've got to be as predictive as we're able to at the
moment.
Thank you very much.
Councillor Larissa Townsend, please.
Thank you.
Cllr Larisa Townsend - 0:38:50
Councillor Hogg also covered the question that I was hoping to ask.
Instead, I shall ask another.
In paragraph 5 .4 of your report, you talk about additional allocation of funding to
to reduce the diagnostic time for dementia.
Have you got any specific statistics about how you expect
to reduce those waiting times and by how much?
I'll hand over to Comrade for the specifics.
Craig McArdle - Corporate Director, Adults and Social Care - 0:39:21
Just for context as well, this was an area
that this committee looked at probably about six months ago
and they asked for additional investment.
I think it was when Councillor Wilson was chair as well.
So positively we've responded to that in terms of that able to as well, but I'll
let Conrad give you the more technical answer.
Conrad Eydmann - Head of Strategic Commissioning - OP - 0:39:44
So yes, we have two options, a preferred one which we're currently exploring, which is
to establish primary care -led dementia diagnosis clinics.
So we're meeting with the new PCPC, the primary care provider collaborative, and with
GP fed bucks in order to establish an arrangement that will train up GPs in order to run diagnostic
clinics and that would fund the locum time required to backfill their GP practise time
and that would be under the clinical supervision of Oxford Health Memory Assessment Services
so that's where they get the expertise and guidance from.
The benefit of that particular model is that it increases the capability and knowledge
of your primary care services around dementia.
At the moment, about 40 % of referrals to the memory assessment services don't result in
a dementia diagnosis.
And with your primary care services better equipped to understand whether something's
likely to be dementia or a different diagnosis, it will reduce those, the inappropriate referrals.
So the idea is that over a two -year period, there will be a sufficient volume of additional
clinics to eradicate or significantly reduce the current waiting list.
At the moment, I think it's about 1 ,000 individuals on the waiting list and a waiting time in
the region of about nine months.
So this will go make significant inroads into reducing that.
Are you able to say how significant?
What's the target?
Cllr Larisa Townsend - 0:41:10
Conrad Eydmann - Head of Strategic Commissioning - OP - 0:41:14
It's difficult because we don't know how many new people are going to come and add themselves
to that list at the end.
But essentially, the additional capacity has been funded to be able to complete 1 ,000 diagnoses
over a two -year period.
So that's 1 ,000 diagnoses in addition to the existing capacity of the service.
So that's on top of the existing memory assessment service.
Cllr Shade Adoh - 0:41:42
And if I can, Conrad, when you talk about the waiting list, is that evenly spread across
area box, or are there some areas that you have more on the waiting list?
Conrad Eydmann - Head of Strategic Commissioning - OP - 0:41:56
So, I haven't got the geographical spread of the current waiting list, but we will be
recruiting GPs across each of the neighbourhood areas so that the diagnostic clinic capacity
will be geographically spread across Buckinghamshire.
Cllr Shade Adoh - 0:42:13
It would be good for us to have those figures in time, and I know we've got dementia care
on our programme as well for us to look at.
Thank you very much.
Councillor Michael Collins, please.
Cllr Michael Collins - 0:42:26
Thank you, Chairwoman.
This may seem a fairly minor point, but it's to do with the – when is discharge?
Over the last 24 months, I've had two major surgeries.
It's okay.
General's medicine.
Yes.
Over the last two years, I've had two major surgeries.
Uh, at the end of the, uh, uh, 10, 14 days, the consultant has normally signed me off
by about 8 a .m. in the morning.
Five to six hours later, I then get the administration, I get the paperwork through.
Now, once the report comes through, we can then, the pharmacies are then informed as
to the medication going forward.
I've held that bed for a complete day, preventing the admission of another patient.
So that bed has been, that time has been wasted effectively.
New patients couldn't get in.
So I know for a fact that their bed was not used until the following day.
It's fairly common.
It's common frustration.
And I wonder as far as the administration is concerned on discharge that the administration
process could not be accelerated. I understand the practicalities of it. I've spent a lifetime
around the health service and do understand the problem. But I've held a bed on two occasions
unnecessarily as many other patients do. What can we do? The clinicians are busy. They're
working hard. They need to get the reports out. But there must be some way we can try
and help them and to get that bed clear sooner.
We could really do with somebody from Bucks Health Trust
here to answer that question in detail,
Cllr Carol Heap - 0:44:20
but I do understand what you're saying.
I think some hospital facilities have discharge lounges.
Now I'm not sure if we do in Bucks,
And the I we do and the idea of the discharge lounge is that somewhere when you're when you're definitely
Going to be going home where you can go and wait so that that bed is freed up whilst all the other paperwork and your
Medication is sorted out. So I'm sure that we do have have those
So I think on the specifics it would be helpful to have someone from Buckinghamshire help
Ms. Nicola Newstone - 0:44:58
It would be helpful to have someone from Buckinghamshire Healthcare Trust on this.
It's a slightly different discharge issue from what we described before.
This is specifically around planning a discharge for someone that is going home.
It's around your medication changes, potentially arranging a follow -up in the hospital or with
your GP.
So I think there are definitely things that Buckinghamshire Healthcare Trust have put
in place like a discharge lounge.
So if it's appropriate, someone can go and wait there
while arrangements are put in place.
Different wards operate in different ways.
It might be that someone has been admitted
and they've waited somewhere else to go into their surgery.
And then they will come up to the ward.
So it's not actually delaying that process for admissions
and surgical procedures.
But I'm sure this is something that
is part of the VHT's continuing review of their discharge
processes as part of their urgent emergency
care or their planned care services.
Cllr Michael Collins - 0:46:04
So I was holding APEC, it would be laying a discharge.
That means that no other patient could come in.
I suppose this is a practical issue.
Cllr Shade Adoh - 0:46:36
And I suppose it's a discussion,
hopefully in your relationship and partnership with BHT,
something that can be brought up.
And I know it's not specifically to yourself,
but that's an acute setting.
It's a clinical space.
And we're looking at discharges from adult social care,
you know, from that space.
So I think I would suggest the conversation to be had.
I think, yeah, we can absolutely take that back to BHT colleagues, Council of Collins
as well.
Craig McArdle - Corporate Director, Adults and Social Care - 0:47:06
And they do things called multi -agency discharge events as well about how they actually improve
flow out of the hospital as well.
So Tiffany is regularly involved in those as well, so we can feed that through, Council
Collins.
But disappointed to hear your feedback.
I'm going to turn it over to the chair for a moment of
Thank you, chair.
Cllr Shade Adoh - 0:47:40
I've got two areas I'd just like to raise some questions on.
Cllr Frances Kneller - 0:47:43
Going back to the numbers, I struggle on this element
regarding reduction of long -term admissions.
a target which was 466 which is then which we didn't meet it's come on both
sides now and and then we set a target which appears to be worse than we
started from and the problem I have is that in reality I know Craig mentioned
about demographics but I'm sure all my fellow councillors will know elderly
folk who stay in their homes as long as they can and then an event happens which results
in them coming into hospital and the reality is that they can't go back home. Their circumstances
are such that they will need to go into long -term care. So just by circumstances I'm just
thinking here, are we not in a position where we will never meet the target and the target
will continue to be at a level and we actually get worse with it. So that was one. So if
you can explain whether I have misunderstood this, but I think demographics are against
us purely by the elderly people in our communities. The other one which I was a little bit bemused
by was average length of discharge delay, which is I don't really understand what it
and I'm not quite sure what the value of it is because it's 0 .996 of a day was the latest
performance and it's better than targets. Obviously anything that's better than target
is worth having. But again, I'm not sure whether something under one day has a lot of value
and in fact what actually is the discharge delay factor behind this? That's my first
question if you want to answer that bit.
Yeah, am I, my other, oh I've got, sorry it was all about the numbers, sorry.
And the other one was reading the paper, it seems that most of the activities are focused
on old people or people with issues such as dementia or that there is delayed discharge.
I'm interested to know what's happening about younger people who may have care needs.
I was thinking, for example, to address prevention around, say, mental health and self -harm.
There just seems to be, is the priority dementia and delay discharge or are we having an inclusive
service here?
Thank you.
So, the first one around demographic changes, I think you're absolutely right.
Conrad Eydmann - Head of Strategic Commissioning - OP - 0:50:31
I think it is something that we're working against in terms of that.
we're working against complexity all the time as well.
Craig McArdle - Corporate Director, Adults and Social Care - 0:50:35
But we do still remain convinced that being at home
for as long as possible is the best outcome for people.
So it's a real trade off in terms of that,
but you're right.
And I think we set the target this year,
which we're now red on,
because we were very aspirational
and we wanted to really better that.
But the reality is more people came through the door
and needed more assessments.
And we think they're appropriately placed
in terms of that as well.
We're also, because of the county we're in,
we experienced quite a lot of people coming in as self funders for us as well and then their funds
run out as well and they're then counted as permanent admissions for us in terms of that
as well. We were doing a piece of work this year, Councillor Nella, just to try and get better
information and advice out to people around that as well because we think people sometimes actually
and to care privately too soon.
And they could be supported at home for longer.
And that's our aim as well.
So we're doing a piece of work this year
to really move on that as well.
So that will be part of our revised information and advice
offer and prevention as well.
Some of the performance indicator definitions,
well, they're all prescribed mandatory by our NHSE
colleagues.
I would probably share some of your views on those as well, but we have to report them
in that way in terms of that.
The better care funding, and this answers your third point, is only a very partial element
of adult social care funding.
So it is very much originally the guidance was around really improving hospital flow
and getting partners to work around that,
re -ablement, supporting carers, etc.
So it's very much designed around that as well.
So it's only a partial element of the adult social care budget.
So this committee will know the adult social care budget
is circa 220 million, etc.
and this is a very small component part of that.
So actually a lot of our spend goes on younger disabled adults,
whether that's with mental health issues,
whether that's with physical disabilities
or learning disabilities as well.
Learning disabilities is a big priority for this year.
Our Better Life strategy, which we're refreshing at the moment,
will come through in due course,
and that has a real focus on learning disabled people
and people with autism as well,
and getting our teams to work differently with them as well.
And Tiffany's team's just been through a big service review
to bring back LD specialisms into social care,
because we think that was sorely missed
in terms of how we work with people with learning disabilities.
more generally. I think I've answered it but I might not have.
Cllr Shade Adoh - 0:53:33
Thank you very much. So if I can go to Councillor Worsle please. Thank you
Cllr Julia Wassell - 0:53:43
I know it's a bit repetitive, but looking at the targets again, reduction of long -term
admissions to residential nurse care people aged 65 and over.
I mean, Craig McArdle, you did say that ideally people would stay in their own homes.
Do you feel there's unmet need that could, in an ideal world, be met by more radical
initiatives, say if we had a big workforce who wanted to become live -in carers or something
like that?
Is there any way we could, you know, if there weren't any restrictions, enable people to
The other thing is that if you look at per 100 ,000 population and Bucks has this affluent
self -funding population, is that adjusted?
Is this figure adjusted to allow for that or is it just looking at any general population?
So I'll answer the latter question first, is this will be people who are using adult
Craig McArdle - Corporate Director, Adults and Social Care - 0:55:04
social care services, not self -funders, Councillor Wysol.
So that's it.
And that's across the piece, across the country in terms of that, because we won't
always – well, we don't know who's in care homes who are funded privately, and that's
part of adult social care's – one of our killer's heels, if we're being honest
with you in terms of that.
In terms of the more fundamental around unmet need, we all know that there's increasing
demand for adult social care, both nationally and locally, and the system needs some significant
fundamental reform.
And Baroness Casey has started her review of adult social care.
We're expecting some headline findings at the end of this year, which will be some interim
solutions to be put in place.
She's already signalled things like a new National Safeguarding Board, which we think
is very welcome in terms of that.
She's got a big focus on dementia care as well and motor neuron disease as well.
So those are some priorities in terms of that.
But we think the Casey review will be the start of that process to try and reform adult
social care into a more radical option.
We've got to caveat though is the interim findings are coming out in 2026 with the full
findings not coming out to 2028, and the terms of reference of the Casey Review are very
clear that those initial funding, those initial recommendations published in 2026 have to
be accommodated within the existing funding formula set down by the government as well.
So we think that the ones in 2028 are going to be the key one.
Baroness Casey is also proposing a big conversation around social care.
She hasn't used those words, but a conversation around social care, national conversation
around social care this summer as well.
So I think that will be a good opportunity for this committee and others to get involved
in that to really feed through those sort of views, Councillor Russell.
Sorry, can I just come in just as a bit of an addition, Councillor Russell.
Matt Everitt - 0:57:16
So that point around adjusting for self -funders, as Craig's outlined, this is people that
that we're funding in social care.
But that's why, and I appreciate we need to simplify this
going forward, that's why we have that second chart
in the pack that shows the peer areas,
the areas that are statistically similar to Buckinghamshire.
So they will be areas that demographically
have a similar makeup to Buckinghamshire,
have a similar proportion of self -funders,
similar challenges and everything else.
So our performance in that chart's really important
to see how we benchmark against areas
that will be experiencing similar challenges
and difficulties to us.
Councillor Ogg, please.
Cllr Thomas Hogg - 0:58:03
Yes, I'd like to sort of underline the point that Councillor Collins made as well and make
sure that what you're tracking is accurate to what you are defining for your metrics.
So this question is about metrics.
I always believe that what gets measured gets managed.
You've got 56 .97 million pounds
going into largely preventative investment,
but I haven't been able to find anywhere
which talks about where that's going.
And one of the things I always worry about,
Keir Starmer wants to pay the Chagos,
to Mauritius for the Chagos Islands,
he puts it into the defence budget, defence budget increases and then he can say the defence
budgets increase.
Um, as I'm always a bit, uh, sceptical of, of these high level numbers, I'm worried that
the 56 .97 million could be, uh, used instead to manage current demand, deal with inflation,
um, rather than the preventative measures which it's supposed to go in, uh, go for.
So I'm interested to know how it's being spent,
and I'm interested to know what metrics
you're putting in place to find out whether it's working,
whether the prevention is actually helping
your bottom line.
Craig McArdle - Corporate Director, Adults and Social Care - 0:59:39
So in terms of the funding,
it goes into a number of directions.
actually the adult social care sustainability is really important so we can actually use
that on packages of care as well and that's a legitimate use of the Better Care Fund in
terms of that. As I said it's only a very small amount as you will know as councillors
as well we raise an awful lot through the adult social care precept which we charge
full amount for each year in terms of that so as I said this is a very small component
part of our overarching adult social care budget in terms of that as well.
We also have charging as well, which comes into it, Councillor Hogg as well, so that
does it as well.
We have to also, there's something now called the notional allocations that government's
putting because they, like you, they're saying, well, is the money actually going
in adult social care?
So we have to report back to government on these things called notional allocations.
So they've done some modelling to say how much a local area I should be putting in,
and then over the MTFP cycle how much it's grown by, and we're absolutely in lines
with in terms of that as well.
So funding wise we think we're absolutely using the grant correctly.
It's only a small component part of it, and you know, council tax presets and things like
that are really, really important to us as well.
But we also have to fund things through the whole lot, such as the national living wage
increases, et cetera, as well.
And that goes through our MTFP process and budget scrutiny process, where it has a good
airing around that.
In terms of the metrics about how we're being successful, that's tracked by quite a few
things.
We have to do quite a lot of statutory returns, as you probably know, in terms of that.
Some of those key ones which we track are reablement, where we've done really well in
In terms of that, getting people packages of care reduced.
We track it through our budget boards.
We track it through our indicators here as well.
So it is tracked quite heavily in terms of that.
I think we have to do in total probably about seven or eight statutory returns each year
in terms of that around packages of care and what we're doing as well as our local ones
as well.
As a service as well, we track it, as I said, the budget and the activity on a daily basis
as well.
We have daily dashboards as well where we're able to track that in terms of that.
Outcomes, as well, there's each year, as well, just to get service users' feedback.
We have to do surveys, as well, and they're called ASCOF measures, and we have some outcome
framework measures which we track, as well, in terms of that, as well.
So there's not one golden bullet in terms of that.
There's lots of information that we have to put together to give a holistic picture.
Cllr Thomas Hogg - 1:02:27
Just a quick follow -up, then, which would be like a request when you share these reports
with this committee.
Instead of just providing high -level numbers, if you're able to also provide how the money
is connected in your minds to the outcomes via metrics, that would be helpful so that
It's very easy for us to see how you are planning on holding yourselves to account
and how we are able to do so too based on the metrics.
Yeah and if you've been through the budget scrutiny process, and I don't know if people
Craig McArdle - Corporate Director, Adults and Social Care - 1:03:03
have here in this room as well, we actually go through that and we set out the modelling
in great detail about how we do that to build up the costs as well and some assumptions
in terms of that as well, but it's a complex piece of work.
I'm sure we have the time to go through it.
Cllr Shade Adoh - 1:03:24
I'm just looking at, we're looking at what the Better Care funding is doing, and on page
21, the allocation overview is stated there.
What I would like to know is how has this funding improved outcomes for residents?
In your view, what has been the greatest achievement last year in terms of demonstrating improved
integration of health and social care?
Okay, so I think it's probably worth – it's difficult to reference just one year because
Conrad Eydmann - Head of Strategic Commissioning - OP - 1:04:07
because this is an ongoing fund and it builds and develops on existing systems and capabilities
across health and social care.
I think the main achievements for this particular funding and the way that it's divided up
has been around community service capability and capacity.
So we have seen that lower than expected target for admissions into hospital and the delayed
discharges. And that has to be attributable to our capability to keeping people away from
hospital and being able to provide earlier and more appropriate interventions.
And then the other part to this, I think, is the sustained system that we have around
key services, such as re -ablement, our home from hospital services, and the fact that
this funding makes provision for hub beds to allow immediate discharge. It makes provision
for enabling people to get out of hospital very quickly, even if that's a further ongoing
assessment.
Essentially what this resource does is it keeps a very complex system moving, the mechanics
of which if something goes wrong very quickly escalates into a crisis that will affect all
parts of the system.
I think if we were to say, oh, I identify one key achievement for this resource, it
would be the fact that that system maintains and continues to function, despite the pressures
that we see during peak times such as winter pressures, etc.?
Cllr Shade Adoh - 1:05:39
You can't, so for you to make that judgement of what is, that this funding is sustaining
the system, what system?
Because you've talked about re -aboment, so there is an improvement, it's keeping people
out of hospital.
So, those are things that, you know, benefit in residence.
Why can't you be able to, therefore, determine that in this year we have stopped this many,
we have done this much?
Does that make sense?
Yes.
So, I mean – And, therefore, you know what to expect for
next year?
Conrad Eydmann - Head of Strategic Commissioning - OP - 1:06:16
I suppose because the breadth of what this fund is so broad, we'd need to – we can
drill down into very specific.
So, for example, we could work out the number of reablement packages that have been funded
by the amount of the resource that goes towards reablement services.
And we know on average the number of hours of reduction that those reablement packages
achieve in terms of the number of hours of continuing support that service users require
having completed their six weeks of reablement.
So in any aspect of what this resource funds, we will be able to drill down and actually
identify the outcomes of the metrics to any one of those specific services.
But to give an example, 25 million goes into broad community services with Buckinghamshire
Healthcare Trust.
So there are community nurses, there's district nursing, there's the community neighbourhood
teams.
Any one of those services we could look at specific outcomes and work out the proportion
of resource that pays for services that results in those outcomes.
But with the time allowed, it would be really difficult to try and break that down into
one key headline, I think every single service that this resource is benefits and could deliver
measurable outcomes that we can track.
Ms. Nicola Newstone - 1:07:39
The only bit I would add to that is the better the care fund is also part of our total like
system ecosystem. So, for example, we have figures that show like in the healthcare trust
has had significant reduction in admissions and also in bed days for those admissions.
Now, that's not all down to the Better Care Fund, but it is we know there is a significant
contribution from things like reablement, the home first service, the hub beds that
enable that step down and rehabilitation.
So, it's also part of a wider system.
Now we might not be able to exactly give the percentage of those improvements we've made,
but this is making part of that.
Cllr Shade Adoh - 1:08:24
So just following on from that, do you see the increased provision of neighbourhood care
Cllr Lesley Clarke OBE - 1:08:29
actually help with resources and your figures in the future when it comes into play properly?
Conrad Eydmann - Head of Strategic Commissioning - OP - 1:08:48
Yes, that's the ambition, but most importantly I think neighbourhood care and neighbourhood
services create better opportunity for personalisation, so you're able to work with health and social
care professionals who are very bespoke to your particular area within Buckinghamshire,
so it's as much about positive outcomes from a patient and service user experience point
of view as it is in terms of measurable outcomes in terms of need and health and social care
needs being met and addressed.
Thank you very much.
If I can go to Councillor Mehta, please.
Cllr Shade Adoh - 1:09:22
Thank you, Madam Chair.
Cllr Nidhi Mehta - 1:09:26
So I was reading page number 18, 1 .2, where it says the funding will be used to support
discharge prevention, intermediate care,
reduce hospital admissions,
and adult social care sustainability.
So I was trying to understand,
and I think for my clarity,
and people who are watching us online,
I was trying to understand
what prevention actually means for you.
I'll give you a scenario.
So I have few residents in my ward who have Parkinson's,
and you can understand how difficult the life becomes.
and one of them wanted to get some funding to have a, you know, ground floor toilet done
and they were denied that.
So I'm just trying to understand when it comes to prevention, would something like this be
used for getting a toilet done or, for example, a disabled parking space done or am I getting
it all wrong.
Adaptations is funded through the Better Care Fund, but if the disabled facilities grant
Craig McArdle - Corporate Director, Adults and Social Care - 1:10:44
part of that, clearly I don't know the individual circumstances of that case, but that is there
to facilitate, as I said before, things like level access, showers, lifts, et cetera, as
the case may be in terms of that.
That is still through an assessment process.
It has an occupational therapy assessment, et cetera, just to make sure that it is used,
but that is an appropriate use of it.
I don't think car parking bays are, because I think it has to be within the curtledge
of the property, as my understanding, the disabled facilities grant process.
Yeah, so what has happened about the car parking, if I may mention?
Cllr Nidhi Mehta - 1:11:20
They do not have a designated space for their own car parking.
and you know how everybody, almost every household has like two or three cars these days.
So what happens is because they do not have a designated space, he has to walk...
Councillor Mehta, I would suggest that this is taken out of here.
Cllr Shade Adoh - 1:11:42
Okay, no that's fine. I'll get back to you.
And probably something that you may want to walk in, Councillor Mehta, about this specific concern.
Yeah, happy to take specific concerns.
Craig McArdle - Corporate Director, Adults and Social Care - 1:11:57
I would say though the Bettekeffen is not there to fund parking spaces, etc.
But there is a council process around that as well and I can connect you outside the
meeting to the appropriate person.
Okay, thank you.
Cllr Shade Adoh - 1:12:15
.
.
Are you asking me specifically about Home First?
Ms. Nicola Newstone - 1:13:43
I mean Tiffany can probably answer some of this as well.
I mean the Home First service is multi -agency so it brings together, we have pathways that
support people to go home that have come together so they work together through our transfer
of Care Hub in a way that didn't happen before and it is absolutely that having
people that work together both in the same space and also closely
communicating so our home first service is jointly looked at through Buckinghamshire
Healthcare Trust, our local authorities social care colleagues as well as home
care providers.
services.
Cllr Shade Adoh - 1:14:45
The Home First service is made up of multi -agency essentially.
Ms. Tiffany Adonis-French - 1:14:51
I call it a blended service.
So it's designed to make sure that it's the services wrapped around the patient or
a resident to ensure that they get the best discharge arrangements in place.
We do have a set of metrics that come out very frequently as indicators telling us how
well we are performing.
So we have some key performance indicators that we are measured against.
It's also about the customer experience, isn't it, and making sure that through surveys
and other things we get tangible feedback about perhaps when things haven't gone so
well, things that we can push back into the system, make revisions and learn from.
Cllr Shade Adoh - 1:15:34
Ms. Nicola Newstone - 1:15:37
Yes, there's a range of metrics that are looked at, both in terms of people that go into the
service, the impact for those people, levels of care that are regularly looked at, as well
as the capacity of the service.
Very much.
Last question to yourself, Councillor Collins.
Cllr Michael Collins - 1:15:56
Just to change the subject very slightly, uh, Chairman, um, anticipation of need. We
have, um, a mixed, uh, group of people, multi - multi -ethnicity groups. I've got quite a few
families within my ward who ethnicity says they would look after their elderly folk.
It's part of their duty.
Now, with the change in demographics
and with the ethnicity coming into it,
there must be a difficulty to anticipate needs
with both the cultural and the demographic needs
of the varying communities.
How do you sort of compensate for that?
We have very close neighbours who look after
not only grandmother, but great -grandmother,
and the family, it's their responsibility.
It's their culture, they do it.
How do we anticipate those variations in need as we go forward with the changing demographics
and changing ethnicity across the county?
Craig McArdle - Corporate Director, Adults and Social Care - 1:17:07
The honest answer is we don't have that granular level detail, Councillor Collins, but there
is huge recognition across the country, regardless of ethnicity, about the valuable role of carers
in terms of that.
Because if informal carers stopped caring, then the whole country would try to halt quite
quickly.
That's reality of the situation.
So we know the numbers of carers through the sensors and things like that, so we get that
sort of data going through.
But the reality is carers do such a valuable role for us in keeping people at home in terms
of that. And importantly, some people, and the point you're making is, again, I don't
think it's always due to culture, ethnicity as well. Some people don't even recognise
that they are a carer in those circumstances. And part of our job, the carer service job,
is to really promote that about what is a carer, your rights, your entitlements as well,
and crucially your avenues for support as well to keep doing that caring role as well.
So the honest answer is we don't model to that granular level of detail, but carers
of the huge bedrock and neighbours and friends, etc.
Because that's where good care starts.
It starts in neighbourhoods with friends, etc., and family.
And we don't take into that account, but we really recognise it and are grateful for it.
Thank you very much.
Cllr Shade Adoh - 1:18:26
And I think summary for me is to take back.
It's about target setting.
I think that's come across through here.
And looking at what next.
and when do you get the information back from NHS England on the next steps for the better
care fund and also I think something that the committee has to talk about should we
be having this come to the better care fund people will not just go to health and wellbeing
but also come here but something we will have to talk about and we will let you know about
it.
I have to say thank you very much for your time.
Or is there any summary you want to give us?
If not, thank you very much.
And I know you're still staying for the next session,
apart from Nicola.
You're staying as well.
That's good.
You're enjoying it.
That's lovely.
Thank you.
Thank you very much.
I'm just going to say about two minutes break
while I find a way that we can reduce this air conditioning.
Because I'm not going to freeze today.
It is cold.

7 Better Care Fund

Cllr Shade Adoh - 1:19:35
Welcome back, everyone.
Hopefully this session would equally be as interrogating as the first one.
And I can see Chris choco -like.
Really?
Okay.

8 Integrated Community Equipment

No, maybe not.
So for this one we are looking at, so this is the integrated community equipment.
The same presenters for this item, I'm glad that Nicola you're staying with us.
If I can again ask to provide a brief summary from the Deputy Cabinet Member, Councillor
Carol Hipp of the key points from the report and then we go to questions. And Tiffany will
be leaving at 12. So any questions that we ask specifically for Tiffany, if we can bring
that up or if you let me know then I can quickly come to you so that that question can be answered
before she leaves. Thank you, Councillor. Thank you, Chairman. So in the pack you've
Cllr Carol Heap - 1:21:06
also got the update report on the integrated community equipment service and the progress
that's been made on transitioning to a new service following the insolvency of NRS healthcare
last year who was our previous supplier. So the report follows the the two
previous updates that have already been brought to Hask in July and October last
year following the collapse of NRS. The collapse presented a significant
challenge not only for Buckinghamshire but for a large number of other local
authorities across the country as NRS had been one of only three providers of
community equipment services. So many other local authorities found themselves
in the same situation as us at the same time. So I'm not going to go through all
all of the background on this as this has been covered in previous updates and
it's also included in this current report for context. But I do want to take
this opportunity to thank our officers from a very large number of departments within the Council,
from Commissioning, Procurement, Finance, Legal, Adult Social Care, the Customer Service Centre
and a number of other teams who all came together and worked at pace last summer to make sure that
essential services continued for residents through a period of significant disruption.
So in Buckinghamshire the community equipment service supports around 25 ,000 residents providing
a critical service, distributing and installing the equipment that helps people to leave hospitals
safely and quickly and also to remain independent at home and preventing of
unnecessary admissions to care settings. This service is delivered jointly with
Thames Valley ICB and I'm very pleased to report that the report demonstrates
real progress. We are now effectively back to where we were this time last
year before NRS went into administration. And in fact, part of the service has been
functioning at normal response rates for some months too. So replacement services through
Millbrook for the equipment and SOT who are providing continent services were mobilised
rapidly and are now stable. The backlog of requests has been substantially
addressed and we're seeing good performance across all operational
metrics. Governance arrangements have been strengthened. We are
working very closely with providers to identify and respond to any challenges
as they arise. We're focusing on continuous improvement and we're
planning for the future of the services. This report is candid about the less
learned, we'd recognise the wider structural risks within a market that
now has very few national providers and we're very mindful of this. The report
explains how we have strengthened oversight and contingency planning to
improve resilience going forward. So I myself and the officers here are very
happy to answer any questions on that.
Cllr Julia Wassell - 1:25:02
Thank you, Chairman. I must congratulate you on responding so quickly and working all together
to resolve this. And I know that many other local authorities were impacted. I mean, does
it concern you that really there were only three national companies with a sort of monopoly
on this. And, you know, is there not a risk of this happening again? Should we be looking
at working with neighbouring authorities to run our own service, bring it in -house, or
add some resilience in some way? So I do have concern that you'd think it would be very
successful when there was such a monopoly on that, but obviously not.
The other thing I have noticed is about the return of equipment.
I mean, I know that wouldn't be directly your concern, but it must be a concern to providers
of service that the equipment is returned.
But I often see it lying about all over the place, you know, even in the skips up at household
waste and so on. Thank you. Okay so as to the risk that you speak of of having
Cllr Carol Heap - 1:26:25
such a limited number of suppliers yes I think that is true and we're very
acutely aware of that but we do have contingency planning going on
consistently and also the contracts are being monitored very closely with
monthly meetings.
Yeah, Craig can elaborate a little bit on this, I'm sure.
So yes, I mean, this has brought that into focus,
but the problem with an in -house service,
and some local authorities do have those, you're right,
is that it would take us something like three,
three possibly years to set that up from scratch.
It would be a massive undertaking.
But I mean, that is something I think that we have to keep
in the back of our minds too should that need ever arise.
Would you like to add a bit more?
I think your questions are spot on.
Craig McArdle - Corporate Director, Adults and Social Care - 1:27:23
I think the risk of only having three providers was noted across the country in terms of that.
We flagged back to government through, we were quite active in this space as a local
Authority and we had engaged very closely with central teams in terms of that.
And the community equipment services are not part of what is called the market oversight
regime, which CQC run because they're not regulated services activities.
We think actually having national oversight of this area would have been more helpful.
We have fed that back through to a national review that is still ongoing in terms of that
because I think it gave us greater visibility.
Like, you're right in one sense, if we shrunk the suppliers,
we're now hoping that those suppliers are more sustainable
in terms of that, but we still think there's a risk there
in terms of that, and we're quite open with that as well.
We wouldn't want to go into commercial sensitivities
in this meeting, but we're certainly absolutely
in close conversation with our partners
across Thames Valley at the moment,
and contingency planning and future planning at that footprint feels absolutely the right
way to go forward, Councillor Wassell. So I think your questions were absolutely right
and we're actively working those through at the moment but didn't want to go into too
much commercial sensitivities. In terms of recycling, recycling is really, really important
to us as well. It's one of the things we're really pushing on because the more equipment
we can get back clean and out there, it actually saves money for the whole public sector, public
purse in terms of that. So suggestions that members have got about how we can increase
that. In the past we've done things like recycling campaigns, amateurs and things like that.
So as the service resettles will absolutely be a focus of that as well. The providers
will absolutely rightly say sometimes because you get a piece of equipment in you've got
to clean it etc because you can't just reissue it. So it has to be economically able to be
recycled in terms of that. But I'm with you. I think it's a really important area that
we need to push on. Conrad or Matt?
Yes, so we do have a massive invested interest in recycling and getting equipment back in.
Conrad Eydmann - Head of Strategic Commissioning - OP - 1:29:40
We get a credit note every month for the volume that gets picked up and recycled by the provider.
So just as an example, we've just written to every single care home and home care provider
in the county to say if you see a piece of equipment that's not being used that's
got either an NRS or a Millbrook tag on it, with the consent of the service user, let
us know and we'll arrange to have it picked up and collected.
So we're constantly pushing to try and get those volumes back in and the volumes up because
it really does play to the economy of the services.
And if I could just come back on a couple of points around that risk, just to elaborate
Matt Everitt - 1:30:20
on that slightly further than what Councillor Heap has just updated on.
We absolutely recognise the risk.
We know that we're in the contract that we're in until 2028 and as Craig said without straying
into areas that we can't talk about in a public forum, we're working through that.
We have a formal contract management process once a month that Craig's involved in, that
Nicola's involved in.
We have a fortnightly contract and finance meeting with the provider.
We have an operational group that meets to look through more operational aspects of how
services being delivered and comrade and I meet with the Managing Director of the service
on a weekly basis to talk through trends, talk about how the service is being stabilised,
talk through what's on the horizon, talk through any challenges that they're seeing from their
side so that we're absolutely on the money in terms of any issues surfacing really quickly
and making sure that we jointly respond to them.
Cllr Shade Adoh - 1:31:21
If I look at page 31 .6 .3, and I'm just looking at when we're talking about working together
with the service providers.
So, how is the Council and the ISAB working with the supplier to improve the price certainty,
cost control and value for money?
By what time, by when?
And with so few providers like Councillor Wessel, as I alluded to, how confident are
you that we'll be able to achieve this?
So what that's referring to in 6 .3 is some of those meetings that I just outlined in
Matt Everitt - 1:32:05
terms of the regular conversations we have with the ICB, with other people who need to
be involved and with the supplier.
The reference there to cost control and value for money, we're monitoring this on an ongoing
basis, on a continual basis with the provider.
The challenge that we have as we're sat here now is that the end of last year, the quarter
period of last year wasn't a stable period on which to judge the activity and the cost
because of the residual impact of the NRS collapse and the new provider mobilising.
There was a backlog, there was prioritisation that happened, there was a stand -up of staff
that then impacted.
At the end of quarter one, we will now have three months of solid data of what that service
looks like on a stable basis and that's what we're then using to inform what the future
looks like in terms of what our service offer is, how we're managing the costs, how we're
managing the controls and what we need to have in place.
So we've just, we've literally just got to that point in terms of having some really
robust data that we have confidence in and we can use that to forecast for the year ahead.
Thank you.
Councillor Collins.
Thank you, Chairman.
Firstly, I'd like to thank Conrad because I have a particular issue within my board
Cllr Michael Collins - 1:33:22
at the moment, um, which, um, he's been most helpful and supportive in trying to resolve.
Um, trying to distinguish what is provided free of charge and where there is a cost element.
Um, I'm assuming things like wheelchairs, walking frames, et cetera, are provided free
of charge to a resident in need. Uh, I can understand there are cases in the one that,
that we're looking at at the moment, Comrade is looking at on my behalf, is a lady who's
pretty much a house fan able to walk, but getting a new kind of telephone system, which
now was to have a telephone in different parts of the house.
My understanding is that that is a cost that she or her family will need to be picked up.
But the installation of that is done by the service provider, because she's got one of
alarm badges on, and she won't progress any further because it will interfere with the
badge.
So I'm assuming that that's something that will be free of charge if the installation
is without cost to the family, but the telephone system would be down to the family to fund.
That's the first thing.
And the second thing is I'm always monitoring the recycling centres, particularly down at
and Clinton, and it's not uncommon to see walking aids, walking frames, that kind of
thing down there that have been discarded.
The kind of recycling we are looking at, does it only apply to that equipment that the council
have provided?
So it may well be that the walking aids, for example, the Zimmer frames I'm looking at,
may not have been provided by the council.
But I think it's imperative that the management company who look after the site on behalf of the council are very aware of
this recycling process that's essential but
Kind of just clarify we had a very brief discussion a little earlier
but if if we can get the council to pick up the bill for having a
Multi outlet phone system then it can be installed without cost to the family by our service providers
Yeah, happy to respond. So, yes, if someone's eligible for a council -funded telecare service,
Conrad Eydmann - Head of Strategic Commissioning - OP - 1:35:48
like a pendant alarm, if they then change their phone system within the house, then
the provider for the telecare service will go in and cheque that it's compatible and
make any necessary updates to make sure that the new phone system then communicates and
works with the pendant alarm system as well. So, it's part of their responsibility for
those service users they monitor to go in and provide that additional update and support.
So absolutely.
It's a very good point about the recycling centres.
We would – our contractual company would only be responsible for equipment that either
they or NRS as their predecessor had issued because it's compliant with their quality
standards on the catalogue that they operate.
But you do make a very good point that we can alert our recycling centres to keep an
for that NRS or Millbrook badge on any equipment that comes through and to alert us so that
we can use that as a contact point for pick -ups. Thank you.
Thank you. Councillor Black, please.
Thank you, Chairman. I wonder if this committee could endorse Councillor Heaps' thanks to
everyone who pulled together and provided the service when NLS went down.
Cllr Lesley Clarke OBE - 1:37:02
And was there any indication prior to them going into administration?
Were you able to, or did you hear anything before it sort of all fell foul?
And further, so then do you see with the new ICB and those other councils
individuals that are involved in the Thames Valley ICB producing the service together
as a joint outcome. And the equipment that's returned, how do you see that being serviced?
Do you have somebody, do you have a company that does the relevant servicing of various
of equipment and making sure they're fit for purpose?
I'll start and if I get things wrong my team will tell me, kick me under the table.
Craig McArdle - Corporate Director, Adults and Social Care - 1:38:01
So in terms of spotting signs, Councillor Clark, of NRS's failure, we were absolutely
aware that there were issues with NRS.
It started some time ago.
They were subject to a data breach, which some people will know significantly, and as
a result of that, they lost quite a lot of data.
At that point, we were involved with this.
This is going back 18 months or so now.
And so at that point, we were quite actively involved.
There were then issues with our contract management, which sprung up around us not being happy
with the information they were giving us, lack of management information, some of which
was down to the cyber attack, but equally we were getting sort of signals that things
weren't quite right.
So we were actively monitoring at that stage in terms of that.
And we were also flagging this up to Southeast ADAS colleagues as well, just our neighbours
in terms of that, just to say these are issues as well.
I think the bit that was missing was that sort of national oversight, which took a more
holistic view of this issue in terms of that.
When we first – because it was probably early summer last year when we really got
into it. The whole sector did mobilise quite quickly and Partners in Care and Health brought
all the partners together for those online conversations, et cetera, and they were really
useful forums to see how we could plan together, get that whole intelligence as well. So it
was sudden at the end, but we sort of had indications that NRS was not quite performing
as we would have wished at that particular point in terms of that.
In terms of Thames Valley and whether there's something we'd want to do, we're in a contract
with Millbrook at the moment in terms of that.
I think we want to work with our Thames Valley colleagues in the first instance to see if
there's efficiencies, opportunities to standardise catalogues and things like that, because economies
of scale and where that partnership will go we just can't know and clearly again it might
be commercially sensitive in terms of that.
In terms of the equipment being serviced, that's Millbrook's responsibility so they'll
have depots where they'll go in, they'll return the equipment, clean it, repair it, etcetera
and then get it back out there.
They have a depot within Buckinghamshire.
Just the one in Aylesbury isn't it?
Yeah.
You said about the equipment.
Cllr Shade Adoh - 1:40:50
Do we have or have you been able to identify some of the equipment being used by patients
at home or in care homes that Millbrook is unable to maintain managed service repair?
So, there are certain types of equipment that are used once, usually because the cost of
Conrad Eydmann - Head of Strategic Commissioning - OP - 1:41:16
repair and recycling is significantly higher than replacing.
So, there is a small proportion, but the majority of the items, such as walking frames, wheelchairs,
et cetera, can go through that recycling and repurposing process.
So, it's more or less standard.
So we know for every item on the catalogue, whether it's a recyclable item or whether
it's a single -use item.
And then the volumes of those items used in different settings, whether it's individuals'
homes or in a care home or in the hospital itself, all get monitored and tracked as well.
I mean, in terms of the maintenance as well, because lots of equipment will need to be
maintained.
Craig McArdle - Corporate Director, Adults and Social Care - 1:41:59
And we were hamstrung at the start by the lack of data that came over from NRS.
We were quite lucky because we picked up those wooden sides that we took data sets during
the course of that.
But having that level of data in terms of that, so certainly early on we had lots of
people saying my equipment overdue needs maintenance, et cetera.
But we've now finally getting back on top of that.
Anything you want to say on that, Conrad?
Yes.
So, equipment services run what we call PPMs, it's planned preventative maintenance.
Conrad Eydmann - Head of Strategic Commissioning - OP - 1:42:30
So each item, like a ceiling, track, hoist for example, will have a regular schedule
by which it needs to be maintained.
It's things like pack testing for anything that's electrical.
The company has a list of all the items that are out in the community and the schedule
that they need to maintain around those prevention and maintenance visits as well.
So, a backlog, as you can imagine, accrued during the whole transition period, and they've
cleared their way through that backlog, and now they're back onto a normal schedule
of planned maintenance.
Cllr Shade Adoh - 1:43:08
Complex equipment for complex patients, oxygen, respiratory equipment, you know, what about
those?
Is everything that NIRS used to do with complex patients and their equipment, is that still
something that Millbrook is able to repair if needed?
Because it will still be on the assistant because those are patients from previous.
Yes, so we put in temporary arrangements around some of the complex respiratory equipment,
Cllr Shade Adoh - 1:43:41
But there is a process in place for the life -critical devices.
So you have three devices at any one point in time.
Conrad Eydmann - Head of Strategic Commissioning - OP - 1:43:46
You have one in use, one at the service user's home that's as a backup, and you have one
in the equipment and in stores.
And they maintain that maintenance cycle on all the devices, not just the one that's
in use.
So it's a well -tested process and procedure for the management of life -critical devices.
but Milbrook have picked up all those responsibilities.
I would like to have data on those equipment.
Cllr Shade Adoh - 1:44:17
It would be good to see because it's like a fail -sales
process and I'm thinking how can we be so sure
that every equipment transferred,
particularly for critical patients, at home particularly,
are being serviced, are being repaired by Millbrook or can be repaired by Millbrook.
And you're saying to me that you have that data and that is correct.
Is that what you're saying?
Yeah, absolutely.
That's a quality standard for all equipment services.
Conrad Eydmann - Head of Strategic Commissioning - OP - 1:44:52
Any devices when they came in as our provider that they weren't able to maintain
would have been swapped out for devices that they are able to maintain.
Cllr Shade Adoh - 1:45:05
Zoe McIintosh - Chief Executive, Healthwatch Bucks - 1:45:10
A couple of questions. So communication with people making use of the service and their
carers during this period, how did you go about it and any lessons learnt from that
process? And I know that the previous provider, NRS, had an engagement post. I don't know
whether it was in the service spec or whether that was just something they, a post that
they had, but is there any equivalent in this new service, you know, within the Millbrook
provision?
So, you'll forgive me if I don't have the granular detail.
Conrad Eydmann - Head of Strategic Commissioning - OP - 1:45:44
It was slightly before I joined the authority, but absolutely there was a comprehensive communications
programme put in place, particularly with individuals who had, as you say, some of those equipment
items that required regular maintenance and routine maintenance.
Unfortunately, for a short period, we were reduced to being able to only provide what
was considered critical and urgent equipment items, so the broader catalogue was temporarily
suspended in favour of a much smaller kind of critical short list.
That resulted in a backlog which has since now been cleared, but all the way through,
service users were advised.
So, the Council's website had continuous updates made available that we could direct
people to, particularly service users for continent services, were given all the information
about how their deliveries would change and how those products would continue to be supplied.
We had – our call centre was mobilised to be able to respond in real time to any queries
from the public in relation to equipment. I think at one point they were taking over
90 calls a day on some of these items, as you can imagine, some concern and frustration
potentially among service users.
So it was a comprehensive programme in terms of service user engagement throughout whilst
we were also trying to mobilise the new provision with the new provider.
Sorry, what was the second part of the question?
Zoe McIintosh - Chief Executive, Healthwatch Bucks - 1:47:13
So there was in the NRS, I think it was in the service spec, a requirement for an engagement
lead to work with stakeholders and service users.
Is there an equivalent in the current provision?
So, I'll have to go back and cheque whether that post as an individual has been retained
Conrad Eydmann - Head of Strategic Commissioning - OP - 1:47:29
and transferred into the new model, but there is still the obligation on the provider as
a whole to be able to provide that function, so engagement with our service users, obviously
ongoing and regular engagement with all of our system stakeholders such as hospitals
or occupational therapy teams, et cetera.
But I'm not sure whether that – if NRS met that obligation through having a dedicated
post, I'd have to go back and cheque to see whether a like for like transition has taken
place.
Sorry, because I did a lot of work with, for example, VCSE colleagues, so the carer's
Zoe McIintosh - Chief Executive, Healthwatch Bucks - 1:48:02
service, FactBark, so other kind of VCSE organisations who would have an interest in supporting their
service users with the community equipment service.
Cllr Shade Adoh - 1:48:22
Okay. Thank you very much. Councillor Sherwell, please. Thank you. Firstly, Ben Dor's comments
Cllr Alan Sherwell - 1:48:26
that others have made about how well the service responded to the initial closure. I've had
lots of comments from people in my ward about how well it was handled and it's deeply appreciated
because of course some of these services were critical to people on an hourly basis, on
a weekly basis.
Obviously the organisation has a risk register, and the NHS I think is an area in particular
where there are a number of things where there are limited suppliers.
From that risk register, have we drawn up contingency plans for other providers going
the same way?
And not necessarily providers of particular services we were just talking about, of course.
I mean, I know there's a danger of spending time developing contingency plans for contingencies
that never happen.
But on the other hand, some of these contingencies will be quite critical if they did happen.
So that's my first question.
And my second is back on this equipment business in terms of what information is given to people
about what they can and can't do.
My example there is me.
I had a hip replacement operation back at the very end of November.
I was provided with all sorts of bits of kit, which were really necessary at the time,
which are now sitting in my garage.
And nobody, when I was discharged, it wasn't exactly my priority at the time,
told me what to do with this equipment.
And we're not talking any sophisticated, and we were talking crutches and walking frames. That's that sort of stuff.
But it's worth money and it's sitting in my garage and I admit I haven't tried to find
out where it should go.
But it would have been nice if I'd been told in the first place and therefore wouldn't
even have to think about it.
So if I answer the first bit of that question, so yeah, clearly there's lots of learning,
lots of lessons learned from this.
Matt Everitt - 1:50:51
What we do have in place for significant, you know, for large contracts, critical contracts
that we have across the Council is provider failure regime or protocols that sit in the
background.
So that would cover things like how we early identify the risk with that, how we plan for
temporary service interruption, how we plan for permanent provider failure, how we would
then need to coordinate across the Council and use the Council resources or partners,
how we would do the communication, how we'd escalate those arrangements.
So that is in place in the background if we need it in those significant instances.
On a day -to -day basis, we've implemented and got a lot of controls around how we're managing
contracts, how we're making sure that we're monitoring financial out turns, financial
viability, how we're using things like the new contracts management handbook that's in
place to really quality assure those contracts that we've got in and those providers that
we've got in, how we're making sure that we've got business continuity plans within those
providers and that they're testing those on an annual basis that we're meeting them regularly
to discuss.
So we've got a lot of controls in place should a situation like this start to occur, but
the really key bit, as Craig outlined earlier, is that early identification and then, you
know, and planning and responding as quickly as we possibly can.
I'll hand to Conrad for the second point.
Yes.
Conrad Eydmann - Head of Strategic Commissioning - OP - 1:52:17
So I think the priority on advising people receiving equipment on how they can get that
picked up and recycled kind of fell off the radar during the transitional period because
so much else needed to be sorted out at the time.
But it is a very good point and it's something we're working with the provider on now, which
is how do we make sure that all of our occupational therapists and physios and others involved
in that discharge process who are issuing the equipment make it absolutely clear that
that can be collected and picked up when it's no longer needed.
So I do take the point that that communication has got some room for improvement, but it's
an absolute priority, mainly because we do get a credit as a result of the volume of
equipment that comes back in and that can be reused.
So it's to everyone's advantage that we prioritise that and increase the volume.
And clearly, the simplest way to do that is make sure people understand from the outset
who they need to call and when they need to do it.
Thank you.
Cllr Shade Adoh - 1:53:19
Would it be a good idea, Conrad, to have, you know, like a sticky onto any of this equipment,
particularly the walkers, the sticks, something on there because it usually has the patient's
name and it could be returned to and that is stuck onto the equipment prior to discharge?
My follow -up?
It should be on there.
Conrad Eydmann - Head of Strategic Commissioning - OP - 1:53:40
So, yes, so the provider, so Millbrook do have standardised issue tags for all equipment
which explains the number to call if either something goes wrong with the equipment or
if they need it to be collected and recycled.
But it's a good point and I will just make sure that that message gets reinforced next
time we have the opportunity for that conversation.
Thank you.
Councillor Lord Townsend, please.
Thanks.
I'd like to revisit the question initially asked by Councillor day about
Cllr Larisa Townsend - 1:54:11
Paragraph 6 .3 of the reports and the fact that you're now trying to move into a better contract essentially with with Millbrook
I'm failing to see what leverage we have in any in any contractual negotiations where there are only two national providers
Feels like they've got us over a barrel a bit there potentially one of those what one
element of leverage could be setting up our own in -house service and I appreciate your
comments before about it's a long protracted process. Is that a work stream that we are
looking into in detail for the future? Is that potential commercial leverage that we
have in those contractual negotiations? And if not, how are we going to ensure that we
get the best deal we possibly can.
Conrad Eydmann - Head of Strategic Commissioning - OP - 1:55:08
So yes, we are looking at all our options going forward. Some of them are more dependent
on having a sufficient lead in time. Obviously, it's quite commercially sensitive, but what
I would say is that even though there are just two providers nationally, they are still
in competition with each other. So, um, given the footprint of both Buckinghamshire and
if we were to work at a Thames Valley level, um, the opportunity that represents for a
provider, uh, I suspect would ensure at least some degree, albeit limited, of competition
that allows us to make sure we're at least getting the best value for money that the
current market is able to offer. Can I just follow up? And I think in the report
You mentioned that the other provider didn't even come forward.
What was the reason for that?
Cllr Larisa Townsend - 1:55:56
So it was because of the amount of time that they had in order to put very quick and rapid
arrangements in place.
Conrad Eydmann - Head of Strategic Commissioning - OP - 1:56:08
So effectively they agreed with them amongst, between the two of them, because of their
infrastructure around where they had warehouses and other contracts and staff available, where
it would make most sense for them to be able to step in and provide that support.
That wouldn't be the case when it comes round to a new round of procuring the services necessarily.
Can I just say something because I don't want everyone to think Millbrook are bad.
Craig McArdle - Corporate Director, Adults and Social Care - 1:56:37
Millbrook have been really, really responsive during this period and if it wasn't for Millbrook
we would be without a community equipment service now.
And they did mobilise at pace, they did mobilise at risk and since then as well the team has
have been absolutely meeting on a regular basis, but have been quite responsive to our
requests in terms of that as well.
I get your point, the market is skewed.
I think we're all aware of that, but I just wanted to re -emphasise that Millbrook, I think,
did an amazing job to stand up across the country so well in terms of that period as
well.
So I just wanted the committee to hear that.
Thank you very much.
And I'm sure that's a good feedback for all of us.
And what we obviously want is continuous improvement.
Cllr Shade Adoh - 1:57:21
And that is something that requires monitoring,
ensuring that it happens, and hearing
from the users of the service.
So I can say my clinical perspective, yes.
They did rise up to the demand.
But obviously, like any other thing,
there's more that can be done.
If I can go to Councillor Collins, please.
Yes, thank you, Chairman.
Who provides the equipment and who pays for it?
Cllr Michael Collins - 1:57:54
Because of my association with rugby, over many years I've built up a very strong relationship
with the spinal unit at Stuttmanville and also the work at the Guttman Centre.
I've always assumed that when equipment is provided at the spinal unit, NHS have paid
for it.
Is that the case?
Isn't, in fact, equipment provided by the county that goes into the hospital that's
provided?
Who picks up the cost of this equipment?
Because I've got, in particular, I've got a couple of tetraplegics.
have got, literally, got three people 24 -7 looking after them, and very expensive equipment,
a former rugby player.
And I just wonder, it's a huge cost there.
In his case, I think he lives in Rutland, and I assume that their county paid for that
equipment, but when that first starts off, who pays for that expensive equipment?
So we have a Section 75 agreement, which means that whilst we're the commissioners, the
Conrad Eydmann - Head of Strategic Commissioning - OP - 1:59:03
the ICB put a fairly substantial proportion of funding into the pot in order to pick up
the resource.
So according to who prescribes the equipment, we then attribute the cost back to either
whether it's funded by health or whether it's funded by the local authority.
I think it's also important to recognise that this is a community equipment service.
So it's not necessarily providing all the equipment needed within the hospital environment,
such as the spinal injuries unit at Stoke Mandeville,
but if somebody were to be discharged from that unit into their own home,
then obviously there would be a cost around things like wheelchairs
and potentially ceiling track hoists and ramps, etcetera.
And within that we would look to see who the prescriber is for that equipment
in order to work out where the cost gets attributed back.
But it is a joint and combined commissioned service between ourselves and the ICB.
Yes.
Is that reference to Section 75?
Yes.
Cllr Shade Adoh - 2:00:12
So we referenced the Section 75 at the beginning of the report.
Conrad Eydmann - Head of Strategic Commissioning - OP - 2:00:15
Cllr Frances Kneller - 2:00:27
So I'm really pleased that the answer I had there, which was really helpful, obviously
in the role that Millbrook is doing and how it's delivered.
My second question was around data collection.
I noticed in the report there was quite a lot of gaps in terms of information that was
held across the piece, presumably both in terms of the individuals and the equipment
and everything that was going on.
Do you think you've now got a fairly robust system in place to both collect and update
and disseminate the information that is needed?
Yes.
Conrad Eydmann - Head of Strategic Commissioning - OP - 2:01:13
So, there were a number of data gaps in terms of the information inherited from NRS.
Those have almost entirely been addressed now, so we now have complete data sets with
Millbrook as the new provider and with SRT as well on the continent services.
And we have business intelligence dashboards that are updated in real time so that we can
log in and then monitor the volumes of equipment and the amount of equipment being recycled
and also the types of equipment as well so that we can start to work out whether there's
particular peaks and troughs.
So I think from certainly from my team's point of view, the quality of information
and the frequency of that information is vastly better than where it was a year ago.
Yeah, if I could just add to that.
So I agree with all of those points.
I think that the other bit I'll just add is that those data dashboards that Conrad's
Matt Everitt - 2:01:59
referred to are shared.
So Millbrook have produced some, we've produced some.
actually we have access to all of the dashboards that Millbrook have produced and can drill
down into the detail. So some of the challenge that we had with the previous provider where
there was, it was slightly opaque, we couldn't access the data, had to build our own dataset.
We're all working off the same set of information, we've all got that transparency and can
see exactly how many people we've got, what the issues, what the trends are and we're
all on the same page in terms of what that information is telling us.
And you own that data, do you rather than Millbrook? Or is it a shared service?
So as the Commissioner, we would be the data controller, they would be the processor, so
it's our data and they're processing it on our behalf.
Lovely. And my other question is back to the equipment. Can I just clarify, the equipment
Cllr Frances Kneller - 2:02:48
that can come back and can be repaired or maintained is just the NRS or the Millbrook,
which is the bit you get a credit for. Is that right? So if at an event we had in Chesham
to encourage people to bring equipment back, obviously there's a home for their equipment,
is there somewhere that something can be done with other organisations or pieces of equipment
had been bought. I mean most people in Chesham know that the charity shop to go to for frames
and crutches and things but obviously we would like to be able to recycle or restore that
if possible and encourage our community to get it back to you.
It's not something we could do within the umbrella of this contract and this service
Conrad Eydmann - Head of Strategic Commissioning - OP - 2:03:46
but certainly something we could take away to look at as a possible community initiative
or opportunity. But certainly Millbrook are bound by the kind of the making use of equipment
that meets their own quality standards and sits on their catalogue.
But obviously as you would appreciate there's lots of stuff that's gone out which may not
have their branding on it but people would like to think that it goes to good use.
Thank you.
I'll come to you, Councillor Hugg, before I ask my question.
Cllr Shade Adoh - 2:04:18
Cllr Thomas Hogg - 2:04:24
I just wanted to underline that I feel really uncomfortable with the position that the Council
has found themselves in with just having two options really to choose from.
I totally understand this is not in your hands, but I guess this is more less of a question
and more just something to say that the next time this committee hears about it, I personally
will be very interested to see how you are mitigating that risk, whether that's contractually,
whether that might be bringing bits and pieces in -house, whether there's something you
might move to a smaller contract, just a little bit of it or whatever.
That's the part that makes me feel really uncomfortable, no matter how good the supplier
is and I've got nothing against them at all.
I think we would fully concur on this side of the table, Councillor Hogg, with your statements.
Craig McArdle - Corporate Director, Adults and Social Care - 2:05:23
What's actually worked quite well in this service, you will see that we've actually
Previously it was all completed by NRS, it's my understanding.
You will now see the continence service is delivered by SRT, which has been a real benefit.
So that bit around actually maybe you do carve things off is your point, is something that
we'll need to keep under review, because we think, I think the SRT performance around
continence in particular has been really good, far more responsive, et cetera as well.
But it is something we're actively working on and actively monitoring as well, share
your concerns fully.
I would just add to that and similarly with the telecare services, those are now being
Cllr Carol Heap - 2:06:04
delivered by Liberty. That is under a subcontract with Millbrook, but this is actually proving
to be a much more comprehensive and better service than we were getting previously from
NRS, Liberty are a real specialist and are using AI and all kinds of exciting things
to help people at home. So that's another aspect as well that's where there's also competition
in the market as well should anything happen with Liberty.
So talking about Liberty, page 30 is where you have this technology enabled care and
Cllr Shade Adoh - 2:06:47
And that is a significant effort to transition the service to Liviti.
So can you tell us more about, because people will be listening, either home care providers
or people living at home, what's the difference and why is there the need to transition?
And what is it doing for people?
What is it about?
What is Liviti Live's in -house monitoring system?
What is that about?
And is it on track to be completed by the end of July?
Conrad Eydmann - Head of Strategic Commissioning - OP - 2:07:28
So the telecare service was previously held by NRS and they subcontracted the monitoring
to a second company.
Since it's now come under Millbrook, the subcontract has shifted over to Liberty as the new supplier,
and they have a much more efficient monitoring system, which is known as their ARC, that
the intention is to transfer all of our service users from the old monitoring system to the
new one.
The reason being that there was a lot of inaccuracies in the data and information that we were able
to inherit from NRS, and once it's been transferred over to Liberty, we'll have an absolutely
ironclad dataset in terms of who's being monitored, what support's being provided, and what those
needs are.
So we're in the middle of that process.
a large number of individuals have already been moved across.
There was no need for those individuals to take action themselves.
It's all done in the background through the transfer of the numbers from one system to
another.
There are a remaining legacy of individuals that we're going to have to follow up in a
lot more detail, simply because the new provider has not been able to raise the call to get
them to contact back or to validate that that equipment is still online and being used.
So that's the work that the team are currently involved with at the moment is going through
those legacy volumes of individuals where they've had a real struggle to either contact
them or to make that transfer over.
But yes, we do expect that work to be completed by the end of July.
Cllr Shade Adoh - 2:09:03
And a lot of people are aware of this transition, this transfer of service?
Yes, everyone was written to and had that explained, including the fact that they didn't
need to take action.
Thank you very much.
Likely to be minuted is that we've been told by officers
they are happy with Millbrook service.
Obviously, it can improve.
And we have raised concerns in the room
as to areas where improvements can take place.
So, and then also there's regular meetings and monitoring
that we've been told happens in order to ensure
that the service provision is met and better
because contract management is usually an issue.
So, you know, it's good to see that.
And then another area of concern raised across the room
is the option of two providers,
which really like Craig said is out of your hands, but a way to meet that or mitigate that risk I think is vital.
But if there are only two people in the market, then we need to mitigate that risk because if an IRS happened, mail bro can happen.
So I think that is the feedback that we will be sharing with you and we hope you take back.
So thank you very much for your time and the next item on the agenda is our Q4, quarter
four performance, health and wellbeing portfolio.

9 Q4 performance - Health & Wellbeing portfolio

I'm hoping we can just go straight into it if everybody's happy.
Yeah, we good?
Are you happy officers?
Cabinet members, you happy?
Okay, right.
So welcome again to yourselves and I don't think you need any more introduction.
So let's just go through.
So what I'll ask if we can focus or talk through the red indicators and the amber ones and
then I'm sure members will have questions to ask.
Over to you.
Do you want us to talk you through, Cheryl, or just go straight into questions?
If there are straight questions, do we do that?
I think people are ready.
I think they're ready.
Zoe?
Can I ask about the carers' assessment indicator?
Zoe McIintosh - Chief Executive, Healthwatch Bucks - 2:11:43
So that's obviously red.
It mentions carers' buck several times as an improvement action as well.
Can you talk us through what the impact of the move to a new provider, what you are expecting
the impact of a move to a new provider will be on that indicator?
I would defer to my carer specialist who has been managing the new service very closely,
Zoe.
Conrad Eydmann - Head of Strategic Commissioning - OP - 2:12:15
In two words, positive impact. I think what we've done with the new service is designed
the best of both worlds. So we've brought together the critical components of the existing
carers' buck service that was provided in terms of face -to -face support, forums, groups,
et cetera, and merged that with some of the more forward -thinking approaches and technologies
that Mobilise provided to the market. It's probably worth saying I think, Matt, you were
involved in the conversations yesterday, but they only went live yesterday, but they've
already contacted or written out or reached out to over 6 ,000 carers across the county.
The referrals are already coming in through the service. I expect very quickly to start
to see the numbers climb in terms of the referrals into adult social care for a formal carers'
assessment. But I think most importantly, the carers who were involved in both designing
and evaluating that new service contract were all of a mind that this is certainly the best
model and the best offer that we've got for Buckinghamshire. So, already within the first
couple of days of that service going operational, we're starting to see really positive impacts
and outcomes as a result of the new approach and new way of working.
So it'll be green next time then?
I have no doubt.
Unless the target changes.
Ooh, ooh, ooh, ooh.
Conrad, if the target changes then what happens, Craig?
We green.
Cllr Shade Adoh - 2:13:54
You have cancelled a hug on your case.
I do, yes.
I feel the glares across the table, Councillor Hargan, already in terms of that.
Craig McArdle - Corporate Director, Adults and Social Care - 2:14:07
I do think it's important because you're absolutely right, Zoe.
Ours is only a small component part of this, actually.
My view is carers should come to us if they want to start your assessment, but if they
just want to approach the carer service, just approach the carer service.
We've got to make it as easy for carers to get an assessment of the sport they need as
possible really and I always think those assessments should be proportionate as
well in terms of that so we've got to have both options going forwards I think
and be more holistic in the way we review a carers assessment. Thank you.
Councillor Townsend please. Thanks I wanted to jump into the new birth visit
Cllr Larisa Townsend - 2:14:51
metric. There's obviously been quite a downturn and the report cites a number
of potential reasons, including a higher than average number of babies in neonatal care,
people moving outside, books, parents declining, but also there's quite a lot made of this
high sickness rates within the health visiting team. I wondered if you had a bit more of
a breakdown as to what you think is the most significant of those reasons. And if it is
high sickness rates, are we looking into the root cause? What are we doing about staff
cover to cover those sick staff. Yeah, that's my question.
Craig McArdle - Corporate Director, Adults and Social Care - 2:15:45
So an exact breakdown is difficult but when I spoke with our Director of Public Health
regarding this we think 80 % of it is made up of the staff sickness in terms of that
and staffing levels more generally.
So that's been the biggest key driver of that fall.
You will see all the way along,
we've never been in this situation before.
So it was quite a big significant drop off
in terms of that.
The provider is BHT,
Buckinghamshire Healthcare Trust.
So we're in active conversations with them
to make sure that there's contingency plans going forwards,
that they're making sure that all vacancies are filled when they come up etc.
And you're absolutely right for them to drill down in terms of their well -being offer to make
sure that people are well supported in terms of that. We are expecting this one to tick up
but we won't be straight back up above it in terms of that but we're already we've seen
in the first few months of this year that actually tip up again in terms of that.
I think this one is quarter three so we've actually got the quarter four one so that
and so I'm able to speak with a little bit of certainty on that as well.
But yeah, you're right, I think we're actively monitoring it with BHT
all the time because it's such a significant drop -off.
But we have also asked them to prioritise as well
those people who we think are at high risk
and need their visit more than others.
And in terms of the cover, are they able to supply cover staff?
Cllr Larisa Townsend - 2:17:18
It's really difficult, yeah, it's absolutely because it's like us when we've got staff
off sick, all we can really do is, there's two things, one temporary staff which is a
limited pool for health visitors in particular, or then B you actually prioritise work and
like us in social care we end up often prioritising work as well. The key is to, I think your
Craig McArdle - Corporate Director, Adults and Social Care - 2:17:38
first point is to get under the skin of what's actually driving the sickness. Is it just
Is it unlucky or is there something more systemic in terms of that?
Councillor Clark, please.
Thank you, Chairman.
Cllr Lesley Clarke OBE - 2:17:59
So my question is on carer assessments.
So how do you ensure the data that's provided by the various care agencies is correct?
And what do you have in place to actively cheque that this data is right?
And the other question is on the percentages of births that receive face -to -face.
I appreciate that you do visit the deprived wards and areas like that and the vulnerable people,
But how do you ensure that some of the people that you're not visiting could also be vulnerable,
particularly when it comes to mental health of some mothers when they've had their postnatal
problems?
So in terms of the carers, so the carers' assessments are made up from statutory assessments,
Craig McArdle - Corporate Director, Adults and Social Care - 2:18:59
so that our data and so it's extracted automatically from our care management system in terms of
that so we have to record it etc and it will go back to an actual physical carers assessment
on the system in terms of that. In terms of the carers books that was through performance
management information that we received and we'll be putting in similar arrangements
with Mobilise to make sure we get that data but you might want to add on that.
Yeah I'll just come back on that point so it's slightly separate to the carers assessments
but that point around how do we assure ourselves that the providers are providing us the right
Matt Everitt - 2:19:31
data, you know, part of that is around the proximity that we have to them and so, you
know, examples like Millbrook that I've already talked about where we have access to their
data and access to the same data gives us that assurance.
Where it's slightly more arm's length in terms of our access to that data, it's about really
robust contracts management and making sure that we're digging through that, scrutinising
that and asking the right questions through that contract managing approach and that could
be face -to -face in those meetings or it could be if we've got some concerns doing some
deep dive audits and some spot cheques to make sure actually that information is correct.
The carers' information that's transferred, we know that we've scrutinised that heavily
so that mobilised have got the right set of information and have then been able to use
that to reach out and as Conrad said, it's over 6 ,800 carers that they've been able
to contact already so there's a huge amount of validity in that data that we've got.
I was going to do the new birth one, but say if you want to come back on the care company.
Craig McArdle - Corporate Director, Adults and Social Care - 2:20:34
All I was going to say is how do you ensure that what you're being told is correct by
Cllr Lesley Clarke OBE - 2:20:39
the care company. And if people do have a concern, who do they come to with that concern?
because I do think some people who have carers are not, the information that's being provided
back to the care company is perhaps not correct.
Yeah, I mean, Councillor Clark, if you've got any specific issues I'm happy to pick
up outside of this meeting.
Matt Everitt - 2:21:04
You know, there is that point around scrutiny that we do through contract management.
There's also a piece around triangulation.
So if a provider is saying one thing but we're getting, you know, feedback and intelligence
through other sources that suggests it's not quite right, then that's absolutely something
that we would then pick up and scrutinise and that may trigger us to then do a deeper
dive, do a spot audit on the data for that provider.
I think in your more generic point there, Councillor Clark, I would encourage anybody
watching who's got concerns around care agencies, then contact the local authority.
Craig McArdle - Corporate Director, Adults and Social Care - 2:21:34
We have commissioning responsibilities and even with self -unders we will absolutely follow
those concerns as well.
I would also say they are regulated by the Care Quality Commission, so please voice your
concerns there as well.
So that's sort of a public message we would probably want to put out there.
Always contact the care agency first if they resolve it.
That feels appropriate.
But there are escalation points within that process as well.
And birth mothers, postnatal?
Cllr Lesley Clarke OBE - 2:22:02
Yeah, as you will see, this is also closely liaison with primary care so that we pick
Craig McArdle - Corporate Director, Adults and Social Care - 2:22:06
up some signs around that as well, but then get into people as quickly as possible.
So you'll see in the data set that actually by day 16 we're much improved and by day 20
as well.
But again if people watching, family, friends, et cetera, they've got any concerns, please
in the first instance approach your GP.
Actually I can just add something to that because I was speaking to the health visitors
Cllr Carol Heap - 2:22:34
who were here yesterday at the conference in the atrium.
and it is the GP's responsibility to notify the health visitors team that a baby has arrived
and then the health visitor will then contact the new mother directly and offer a visit.
And then obviously that's up to the mother as to how they respond to that.
But also there is the health visitors also regularly attend the fact our family
Hubs around the county they have a drop -in
It's a drop -in session and anyone can go there to speak to a health visitor. I'll have a baby weighed or checked
Whenever they whenever it's convenient to them as well
so there's other opportunities to if someone doesn't want to visit within the first 14 days for any reason and
Sometimes there's good reason for that then they can go and see their health visit as soon as they they feel they want to
Counsellor Collins
You think you chairman the new birth rate
new birth visits
Cllr Michael Collins - 2:23:48
You refer to underlying work
workforce issues.
How are these issues being currently addressed?
How proactive are we?
Because there's a big difference in need and actual figures here.
So what are you doing to actually understand why this is a problem?
So as I probably referred to earlier, Councillor Collins, is this service is actually commissioned.
Craig McArdle - Corporate Director, Adults and Social Care - 2:24:19
So the local authorities' role in this is funded through the public health grant and
and we commission it out to Buckinghamshire Healthcare Trust as well.
So they will have recruitment strategies, they will have welfare offers, all those things
for their staff as well in terms of that.
So our job within this process is to absolutely oversee that contract management of the service
as well to make sure that they're actually performing in terms of that.
But BHT will have their own in -house provisions.
Recruitment of health workers generally is tough.
We've got to be honest with ourselves as well.
is across the piece and this is one of those areas where there's national shortages as
well.
So we've got to make Buckinghamshire as good a place as any to want to come and work in
terms of that.
Yeah, as I said, this is a commissioned service.
Cllr Michael Collins - 2:25:11
This is the –
Well, we just got a monitoring role.
Craig McArdle - Corporate Director, Adults and Social Care - 2:25:15
Well, no, we have a commissioning role, which is slightly different from a monitoring role
because we actually specify what services we need, we respond to that there, we have
a specification and then we have a monitoring role and we also then have a procurement role.
Yes, yes.
We're both a provider of services, the local authority, but we're also more significantly
a commissioner of services.
So most care services are commissioned out, they're provided by private providers and
we the local authority role is to commission those services and oversee the quality.
Thank you very much.
Councillor Hogg.
Cllr Thomas Hogg - 2:26:02
So just to confirm, it's the Buckinghamshire NHS Trust that provides the health visitors.
This is actually raising a big red flag for me.
Not that they do that, that's normal.
The red flag that's raised is that I sent
the Buckinghamshire NHS Trust Freedom of Information request
about four months ago about their maternity care.
And the maternity care seems to have improved since 2023,
but one thing has got worse.
And that is the,
their midwives are taking a lot more sick leave than before,
and they're struggling to have the numbers that they need.
Now I'm hearing that health visitors from the NHS Trust
are also, they're going on sick leave
a lot more than before.
This suggests that there could be either something going on
with the trust around working conditions or stress levels.
I mean, if you see stress levels are being reported
at extremely high rates here.
And I'm concerned that while it looks like
it might just be a kind of one or two quarter drop,
that based on that we could be seeing something bigger.
And as the council is responsible for monitoring this,
then I would recommend that you do a bit of a deep dive into that one.
I'm happy to follow that up, Councillor Hugg, with BHT and have that conversation as well.
Craig McArdle - Corporate Director, Adults and Social Care - 2:27:48
When you do your review of maternity, you might want to also focus on that as well.
But yeah, happy to take that away, Councillor Hugg.
Thank you very much.
I think one last question from me.
On page 37
Cllr Shade Adoh - 2:28:07
There's mention when we're looking at improvement actions on carers box
Is carers box not the font are they still?
That's so characters books were
Craig McArdle - Corporate Director, Adults and Social Care - 2:28:24
Went through the procurement process, but and they chose not to bid in terms that so we've got a new supplier as of yesterday
Who's mobilised who's doing it who used to do the digital offer and now doing the whole service area as well
Okay, as of yesterday as of yesterday
This is correct. Yes at that point at the point of writing this this is correct at the point of reading it today
It's not correct. It's not correct
Cllr Shade Adoh - 2:28:42
So if we're looking at, you know plans to promote awareness
How this is a new provider coming yesterday
so obviously there is plan already in place on how to work with them how to make you know, the community aware of that and
How do we help in getting the message out to people when you can definitely be able
to share that information with us?
So I'll bring Conrad in in a moment because I know you want to come in as well.
Matt Everitt - 2:29:19
They're only a day in, they've reached out to a huge number of carers already, they've
reached out to a huge number of partners already, so they've reached out to health partners,
they've reached out to schools, they've reached out to a number of other voluntary and community
sexual organisations. They've also reached out to existing groups that are happening,
as Craig said, previously digital, now it's digital, plus all of the face -to -face options
as well. And they've been in contact with external partners around expanding the group
offer, considering new locations for some of those groups as well. So, yeah, we're only
just over 24 hours into that, but that is moving significantly in the right direction.
Actually, may I just jump in there, because what happened initially was that all carers
Cllr Carol Heap - 2:30:11
that were registered with Carers Bucks were informed a little while ago that there was
going to be a change in the service and why, and were also directed to, I think, the new
service, Mobilise, have got their website up and running now, haven't they? It's been
up and running for a while so people were directed to the website and
reassured that there would be continuity and a handover and everything would
continue so I think I think we covered that pretty well actually.
Yeah happy happy that's good and are we happy in this end yeah thank you very
Cllr Shade Adoh - 2:30:50
much and I believe that we're looking at as commissioners we're making sure we're
managing supervising monitoring making sure that service is delivered as we
have commissioned it and looking at because if the recruitment is an issue
if staffing is an issue it would have you know an effect an impact on service
provision and the care that people receive.
So I think it's an area that you've already alluded to,
you'll be reaching out to partners on that to see how.
And what can we do?
We must always remember that we have this access to residents.
So if there's a way we can support to get information out
for yourselves, please do reach out.
And not just to the, obviously this is health.
And that's a major aspect of people's lives.
So do reach out to members via email, through our offices,
and they can pass that on to members
to take it out to residents at the surgery meetings
so that everybody knows what's happening
and they know where to go to.
So thank you very much for your time today.
We've had you for the whole length of hours
and we appreciate your time.
Thanks a lot.
Thank you.
Right, for members.

10 Work programme

Our next item is our programme and gender item 10 the work programme I
Think we had a
Teams meeting on this one where we agreed
So it's just for us to look at the items that are noted there to take to 1st of October
considering we've already
mentioned that we're sending emails out to
the CEO for BHT on maternity care.
So depends on the outcome or the response of that from them
will determine if we can take issue on maternity to October.
But what we have here for October is Thames Valley
integrated care board looking at the overview
and impact of commissioning intentions for Buckinghamshire.
We're asking the director of public health, looking at the annual report, evaluation of
their report, and then we'll look at the access emergency care review draught report.
So those are meaty items for us to look at.
So if there are any ideas on that that you want to share, please let Liz know so that
we can probably look at that before October.
If there are questions we want answered,
then that can go to them so that they don't come here
and say, oh, if only you had told us before.
So that we are proactive as well in reaching out
so that the questions are asked prior.
And then coming here, they have that answer,
not that they go away and say they're not prepared for it,
they didn't know about it.
So we too need to be proactive.
So those are the areas I'm hoping that we would look at.
Is that OK with everyone?
And then, like I said, if anything comes back
from the response on the CEO and maternity care for Buckinghamshire
residents, we'll share that.
And then, based on all our thinking,
please respond to the email.
Then we'll decide if we'll bring that forward to October.
So the agenda that you're proposing
isn't cast in a climate.
Basically, the lit back about the returns
Cllr Alan Sherwell - 2:34:35
you've had to the trust suggests that there's
something that is worthy of discussion,
Cllr Michael Collins - 2:34:39
we will introduce that into the October agenda.
Yes.
And what element will we refer to the next meeting?
It would depend, because if we look at
the Director of Public Health report,
that needs to come,
because they've already been told about it,
but that is more in -house to us,
but that's the BC one, so we could probably take that,
but I'm sure with the maternity,
All that can be covered in the app, apart from the access to emergency care.
Because we must remember that, particularly with the ICB, we would have had to have that
conversation with them prior, and they would have to tell us who is going to be attending
the meeting on their behalf.
But I'm sure if it's something critical, well, we should get all of them in.
If it is critical that Box is not doing very well, then every arm here, the integrated
the care board, the director of public health, BHT,
they should all come in because it's commissioned,
it's public health matters, yeah.
So I think it should work.
I think by the time we get one or two months down the line,
we're gonna get so much national,
if not international, interest
in the whole business of maternity care.
And there's gonna be a lot of information
that's gonna be coming forward, not just in our county,
but across the bigger picture,
the collapse of maternity care across the board.
So I think we can have a lot that could go into that agenda.
Definitely, but we keep our focus on Buckinghamshire.
That's the main thing.
Cllr Shade Adoh - 2:36:10
Any questions, any contributions before we close?
No?
Thank you very much, everybody.
I hope he's been fruitful for everyone.
Thank you.

11 Date of Next Meeting

And see you in October.
Thank you.