Agenda and minutes

Apologies were received from Councillors K. Madge, E. Morgan and B.A.L. Roberts as well as from Mrs. Linda Williams (County Director & Commissioner for Carmarthenshire, Hywel Dda University Health Board).

The Chair wished Councillor B.A.L. Roberts a speedy recovery following her recent operation.

There were no declarations of prohibited party whips.

No public questions were received.

The Committee RESOLVED that the list of forthcoming items to be considered at its next meeting scheduled for the 16th May 2016, be endorsed. 

Councillor H.I. Jones declared a personal interest in that his daughter-in-law works for Social Care Services. 

Further to a request at a previous meeting in 2015, the Committee received an update on the activities and outcomes from the work of the Mid & West Wales Health and Social Care Collaborative (MWWHSCC) and was advised on the new regional partnership arrangements now in place to meet the requirements of the Social Services and Well-Being (Wales) Act 2014. Members noted that Carmarthenshire County Council was the Lead Local Authority for the Collaborative, hosting a small coordinating unit and managing regional grants.

Members were also informed that under Part 9 of the Social Services and Well-Being (Wales) Act, which came into force on the 6th April 2016, the creation of Regional Partnership Boards (RPBs) was required in order to drive forward partnership working and integration. Separate arrangements would be required for each health board area, which meant that a West Wales RPB would be established on the Hywel Dda Health Board footprint and that the existing Mid and West Wales region had been dissolved. Shadow arrangements were in place although the inaugural meeting of the West Wales RPB did not take place on 15th April 2016, as stated in the report.

The following issues were discussed during consideration of the report:

Reference was made to the Well-Being of Future Generations (Wales) Act and it was asked how its requirements, along with those of the Social Services and Well-Being Act, would all tie together. The Head of Regional Collaboration acknowledged that aligning government policies and requirements would be challenging but the strengthening of the links between the new RPB and the new Public Service Board would be vital in achieving this. He added that it was clear that current services were unsustainable in the long term and that the Social Services Act provided the legal framework for continued service reconfiguration. However, as with any transition, existing and new structures would coexist for a period of time and managing this would be an additional challenge. The Head of Integrated Services added that another driver for this work was to build up community resilience and self-care alongside targeted intervention in order to prevent unnecessary admissions into health services.

Concern was also expressed that matters relating to planning or redevelopment might undermine the plans and structures being put in place as part of the new Social Service and Well-Being Act. The Head of Integrated Services noted that the framework in Carmarthenshire allowed for collaborative discussion about pressures and growth areas relating to infrastructure developments, that might put pressure on other services such as education and health. She added that her joint post provided an opportunity to contribute to strategic discussions both within the Health Board and within the Local Authority. She also met with GP Leads on a regular basis.

It was asked how the RPB would manage the promotion and the establishment of pooled funds. The Head of Regional Collaboration noted that  ...  view the full minutes text for item 6.

The Committee received a report on nutritional standards for older people, focussing principally on Local Authority care homes and day centres. The report included an overview of the work undertaken by the Catering Service (Department for Education & Children) in support of the Communities Department as well as answers to the four specific questions, previously raised by Committee members.

The following issues were discussed during consideration of the report:

In response to a question on the scope of the report, the Senior Catering Manager reminded the Committee that this related to the Local Authority’s care homes. The Head of Integrated Services noted that nutritional / catering standards in independent care homes were regulated by the Care & Social Services Inspectorate Wales (CSSIW) although the Authority’s Commissioning Team also worked with the independent sector providers to ensure that the required standards were met. 

Concern was expressed regarding the role of the National Procurement Service (NPS) in the Catering Service’s procurement of food supplies. Reference was made to the Audit Committee and the Policy & Resources Scrutiny Committee’s reservations about the purpose of the NPS and its success in securing savings for the Local Authority. The Strategic Development Manager acknowledged the Committee’s concerns and that the NPS was behind schedule in setting up food related frameworks. This delay had recently led to the expiry of a major food contract and the Catering Service had been forced to seek an extension to the previous contract. However, as the County Council had signed up to the national service, officers would have to work within and comply with the required guidelines.

Concerns were also expressed that the Local Authority might not be able to source food from local suppliers and that having to use suppliers from further afield would increase traffic movement within the county and increase air pollution. The Strategic Development Manager noted that procuring supplies through the NPS would not necessarily mean that local suppliers were excluded. For example, the Authority had a number of different contracts with bread suppliers and that very often contracts for certain commodities were dependent on the supplier market.

In light of the discussion regarding the procurement service, the Chair proposed that the Committee’s concerns be forwarded to the Executive Board Member for Resources. The Committee agreed to the proposal.

In response to a question on the NUTMEG System, the Senior Catering Manager confirmed that the system was weighted according to age to ensure that older people were receiving the correct level of nutrition. The Head of Integrated Services reminded the Committee that this report complimented the Community Nutritional Standards for Carmarthenshire Integrated Services (considered by the Social Care & Health Scrutiny Committee on 16th September 2015). She added that for many older people, 3 meals a day at set times was not the best option and that particular types of meals or snacks spread out across the day were often the best approach. The Head of Integrated Services referred to a recent pilot scheme in Prince Philip Hospital in Llanelli where  ...  view the full minutes text for item 7.

The Committee considered a report that provided an overview, evaluation and update regarding ICF funded services, specifically in relation to the Transfer of Care Advice and Liaison Service (TOCALS) and Rapid Response Domiciliary Care service.

The Committee was reminded that the ICF was initially awarded in 2014/15 to provide the opportunity to assist in the development and testing of new models to deliver sustainable integrated services. One of the criteria for continuation of the funding into 2015/16 was that the projects demonstrated their impact and outcomes around the initial objectives.

The following issues were discussed during consideration of the report:

It was asked how the ‘front of house’ frailty model was working in Prince Philip Hospital in Llanelli. The Head of Integrated Services informed the Committee that the Minor Injuries Unit and Acute Medical Admissions Unit at the hospital sought to avoid admissions by undertaking ‘frailty screening’ at presentation, in order to trigger a detailed and comprehensive geriatric assessment. To date, the approach was working well and was outperforming initial projections. In response to a further query about staffing at Glangwili Hospital, the Head of Integrated Services informed the Committee that there were 3 Geriatricians at both hospitals although there was currently one vacancy in Carmarthen. However, it was important that all clinicians embedded a ‘frailty approach’ in all areas rather than simply referring patients on to the geriatricians.

It was asked whether incidents relating to falls were more prevalent on certain days of the week. The Head of Integrated Services noted that there was no specific day when these occurred and that typically, 20 falls presented at each A&E unit every day. This showed how important preventative work was as well as ensuring that services moved away from the traditional 9-5 Monday to Friday model. Having physiotherapy and occupational therapy services at the front of house was also a key development.

In response to a question about the numbers of occupational therapists, the Head of Integrated Services confirmed that the service had a full complement of therapists across however, there was a need for more and a bid for more ICF resources was being prepared to obtain more physiotherapy and occupational therapy support in the future. GP cluster funding was also another option for securing additional therapists and one occupational therapist had been employed in the Taf/Teifi/Tywi area working from a GP surgery. This intervention had resulted in a reduction in waiting times to see an occupational therapist, of 3-4 weeks. 

The changes to the admission and discharge arrangements at Prince Philip Hospital were welcomed but it was suggested that other changes to services at the hospital had resulted in increasing numbers of out-patients visiting Glangwili in Carmarthen, which in turn had implications for transport and parking. The Head of Integrated Services acknowledged that there was more work to be done at Glangwili, especially in relation to the discharging of patients. It was anticipated that the appointment of additional discharge nurse capacity would help individuals leave  ...  view the full minutes text for item 8.

RESOLVED that the reasons for the non-submissions be noted. 

RESOLVED that the minutes of the meeting held on the 29th February 2016, be signed as a correct record.