Apologies were received from Mr D Minnery and Mrs C Motley. 

Members were reminded that they must not participate in the discussion or voting on any matter in which they had a Disclosable Pecuniary Interest and should leave the room prior to the commencement of the debate.

The following members did not have a disclosable pecuniary interest but wished the following to be noted:

Mrs Shineton – Member of Independent Community and Health Concern

Mrs Huffer -  worked at a doctors surgery where Keele University were based for its work on osteoarthritis (agenda item 7)

Mrs Kidd – her daughter worked at Robert Jones and Agnes Hunt Orthopaedic hospital (agenda item 7)

To confirm the minutes of the meeting held on 29 June 2015

The minutes of the meeting held on 29 June 2015 were confirmed as a correct record.

To receive any questions, statements or petitions of which members of the public have given notice.  Deadline for notification is 4.00 pm on Wednesday 22 July 2015. 

A public question was received from Mrs M Cosh, Senior Citizens Forum, in relation to the Better Care Fund Reference Group, its objectives, the future of the Group and plans for improving joint working between NHS and Local Authority care.  A response was tabled (a copy is attached to the signed minutes) and it was confirmed that the next meeting of the Reference Group would take place in the next week. 

To receive any questions, statements or petitions of which Members of the Council have given notice.  Deadline for notification is 4.00 pm on Wednesday 22 July 2015. 

A Member Question from Mrs T Huffer in relation to Ludlow Hospital was brought up at the end of the meeting. 

To review the transfer out from the Council of two accommodation services for adults with learning disabilities (Shared Lives and the Community Living Service) to external providers at the end of  year one of the contract. 

Providers and service users will attend the meeting and a report is attached.

The Chairman particularly welcomed Managers, Carers and service users from Midland Heart and Positive Steps, the Community Living and Shared Lives services.

The Head of Social Care, Efficiency and Improvement introduced the report before Members (a copy is attached to the signed minutes) and explained that these two accommodation services for adults with learning disabilities had previously been Council provided services.  The Community Living Service transferred to Midland Heart and Shared Lives service to Positive Steps during summer 2014. 

Community Living Service – Midland Heart

Members heard that Midland Heart customers received levels of support from a few hours a day, to overnight or up to 24 hour support.  Services were currently focused on Shrewsbury and Oswestry based in supported accommodation. It had established an Excellence Panel and individuals had been helped to access a range of community activities.  A designated Community Fund had been established to help support people on limited funds to achieve some of their aims, ambitions and aspirations.

Emma Main, Operations Manager, outlined the ‘Mythbreaker’ holidays which were open to all Midland Heart customers.  The holidays provided groups of people who historically had not had contact with each other to meet and participate in adventure based activities.   One of Midland Heart’s customers present at the meeting reported how much he had enjoyed the holiday and had experienced horse riding, abseiling and a zip wire.

Another Midland Heart customer talked about how well his voluntary work was progressing and his carer reported on dramatic progress in his independence skills.  His previous 15 hours of care had now dropped to just 5. 

Members were pleased to hear such positive feedback directly from service users and carers.  They went on to ask a number of questions including:   

-        If the service was likely to grow beyond Shrewsbury and Oswestry for Shropshire residents;

-        how long it generally took for someone who had been used to day centre care used to independent activities; 

-        Whether there were targets within the Council for future delivery;

-        Whether a physical building was needed to work from;

-        How Midland Heart could increase its offer in Shropshire;

-        Were there any issues accessing physiotherapists or occupation health services.

The Head of Social Care Efficiency and Improvement explained that Community Living service was based on where people lived in supported accommodation, of which there was a limited amount available in rural areas.  She also explained that there were no targets set as the service had transferred as a whole in 2014 and the Council was responsible for commissioning services where they were required. Any future developments would be subject to a procurement process and Midland Heart did participate in that but it was a very competitive market. 

The Operations Manager explained the market was competitive because a shared property could provide a care base which was easier to grow from.  110 hours of care made a good care base and would offer more efficiencies if a staff team were based in one  ...  view the full minutes text for item 16.

The Chairman of the Committee has asked Shropshire CCG to share its thoughts and proposals for orthopaedic surgery in Shropshire and the suggested engagement activity with the public around these proposals.  A report is attached and Dr Julie Davies, Director of Strategy and Service Redesign, Shropshire CCG will give a presentation at the meeting. 

 Dr Julie Davies, Director Strategy and Service Redesign, Shropshire Clinical Commissioning Group, introduced the paper before members and gave a presentation on the CCG’s proposals to change the pathway for patient referrals for hip and knee replacement surgery. (a copy of the report and presentation are attached to the signed minutes) She explained:

·       the context for the proposals;

·       benchmarking information – which showed the CCG was an outliner in spend compared to other similar CCGs;

·       The case for change and reducing the variation in procedure rates;

·       The details of the proposal;

      and

·       plans for further patient and public engagement.

In considering the information presented to them, the Committee commented, asked questions and raised issues relating to:

·     The availability of alternative options, such as physiotherapy, as it was understood there was a shortage of physiotherapists in Shropshire;

·     The need to recognise that Shropshire had more agricultural and forestry workers and therefore the figure for hip and knee replacements should be expected to be higher;

·     Whether cancellations of scheduled operations, including at hospitals outside of the county, contributed to pressure at Shropshire’s hospitals;

·       Whether putting an operation off until later might increase the clinical risks, as a patient would have aged in that time;

·       Whether peer CCGs used a similar cut off score

·       Information about the review carried out in 2014

·       Whether hip and knee surgery being seen as routine was an issue

·       The potential impact of the move in Worcestershire to carry out all orthopaedic surgery at the Royal Alexandra Hospital in Redditch

In response, Dr Davies reassured Members that comparisons had been made with comparative CCGs in terms of work and ethnic mix, age, deprivation and rurality. 

She acknowledged the challenge around provision of physiotherapists which would need to be factored into any decision made.  A complete physiotherapy review was planned to help balance and ensure resources were in the right place.

She reported that some peer CCGs had adopted similar scores although others did not use the same scale.  If the CCG did decide to change the threshold, it would be kept under review on an annual basis. Members noted that there would always be clinical exceptions to the scoring procedure. 

In terms of cancellations of scheduled surgery, this was constantly under consideration and a booking and scheduling review under way.    However, this was not a particular issue at Robert Jones and Agnes Hunt hospital as it did not deal with emergency cases.

Dr Davies confirmed that hip and knee surgery was viewed as being fairly routine. However, it did involve risks and she acknowledged that these risks could increase as patients got older.  The Director of Public Health reported that in general, the less surgery people had, the better they were.  He also highlighted that delaying initial surgery meant less chance of replaced joints wearing out.  Research conducted by the University of Birmingham on ageing in conjunction with clinicians had demonstrated the disadvantages of surgical intervention unless it was really needed. 

Dr Davies also emphasised that proposals were  ...  view the full minutes text for item 17.

To consider the draft updated terms of reference attached and endorse the proposed changes.  The changes reflect the Department of Health Scrutiny Guidance published in 2014:  ‘Guidance to support local authorities and their partners to deliver effective health scrutiny’.  These changes were endorsed by the Telford and Wrekin Adult Care Scrutiny Committee on 2 July 2015. 

The Committee noted that this item would be presented at the September meeting. 

The Committee’s current work programme is attached for comment.  The Cabinet Forward Plan is available from the link below

http://shropshire.gov.uk/committee-services/

The Committee received the proposed work programme.

20  Member Question Time – Ludlow Hospital

Councillor Tracey Huffer expressed concern that a ward had been shut at Ludlow hospital with just a week’s notice and without any consultation.  Concerns had been raised with her about who had made the decision, the rationale behind it, whether it would be permanent, why there had not been any consultation and whether it would threaten the sustainability of Ludlow Hospital.  She was also concerned that the closure would lead to single sex wards and that the ability to meet winter pressures would be compromised. 

It was agreed that the Chairman would write to Shropshire Community Health Trust on behalf of the Committee seeking clarification of the rationale for the changes and how they would impact on local service provision.