Council and councillors

Apologies were received from Mike Sandys, Mel Thwaites, Hayley Jackson, Dawn Richards, Paul Hindson and Insp. Audrey Danvers.  Dr Kath Packham attended in place of Mike Sandys and Simon Down attended in place of Paul Hindson.

To confirm the record of the meeting of the Rutland Health and Wellbeing Board held on 3 March 2020.

The minutes of the meeting of the Rutland Health and Wellbeing Board held on 3 March 2020 were confirmed as a correct record.

In accordance with the Regulations, Members are invited to declare any personal or prejudicial interests they may have and the nature of those interests in respect of items on this Agenda and/or indicate if Section 106 of the Local Government Finance Act 1992 applies to them.

No declarations of interest were received.

To receive any petitions, deputations and questions received from Members of the Public in accordance with the Virtual Meetings Regulations (s1 2020 392) and the subsequent RCC Procedure Rules agreed at Council on 20 May 2020 and revised by Council on 14 September 2020. (Please see link: Council agenda/revision to Virtual Meetings Protocol)

Councillor Waller submitted a late question to the Board which the Chair accepted but stated that a written reply would be provided. Following the meeting, the director of the Primary Care Network discussed the question with the GP practices in Rutland and provided the following responses, shown in italics.

“St Mary’s Medical Centre in Stamford is to close in December with its patients being transferred to the Sheepmarket surgery.  In addition it is proposed that the minor injuries unit at the Stamford and Rutland hospital, currently closed due to Covid-19, will remain closed permanently.  Many Rutland residents are registered with the Stamford GP practice (Lakeside) and use the unit at the hospital. 

·         What is the likely impact on healthcare of Rutland residents of these developments?

Rutland Residents who choose to register with Lakeside Stamford should expect to receive healthcare that is same regardless of where it is delivered.

·         Do GP practices in Rutland have capacity to take additional patients should Rutland residents decide to leave the Stamford practice? 

Patients have a choice of practice, provided that they live within the practice area. The four Rutland practices are all taking new patients. The practice area for Lakeside Stamford overlaps with that of Empingham Medical Practice and Uppingham Surgery and the majority of patients who do choose to change practice are likely to register with Empingham Medical Practice because the overlap is greater.

·         Can the minor injuries service at Oakham Memorial Hospital manage extra demand if the unit in Stamford is closed?”

 The minor injuries unit at Rutland Memorial Hospital has been open throughout the pandemic, managing the demand since March when the unit at Stamford was closed. The minor injuries unit is commissioned by East Leicestershire and Rutland CCG and provided by Oakham Medical Practice who anticipate that there is sufficient capacity to meet the demand.

Karen Kibblewhite, Commissioning Manager Health and Wellbeing, to update the Board on the progress of the Rutland Joint Health and Wellbeing Strategy (JHWS).

Dr. Hilary Fox, from the Primary Care Network, to update the Board on Active Rutland and the Obesity Strategy as part of the JHWS.

Dr Kath Packham, consultant in Public Health updated the board on the progress of the Joint Health and Wellbeing Strategy (JHWS).

During discussion the following points were noted:

·       Due to the Covid pandemic, the timeline previously discussed had been delayed. This was due to the partners involved being diverted to Covid work and also relevant groups not meeting regularly to be able to respond to the consultation exercise.

·       At the last board meeting in March of this year a draft report listing the priorities of the strategy had been agreed on. These were: Active Communities, Getting people more physically active – a best buy for medicine, Starting well and living well for longer – a whole life approach, Improving health for all, and How will we know if we have made a difference.

·       Dr Packham proposed that the timing for the new strategy be moved forward by a year so that a draft version would be bought before the Board at the meeting on the 30 March 2021 with a final version being signed off in summer 2021.

·       Dr Fox asked whether a completely different approach to the Strategy should be taken considering how much the world had changed in the last few months. In addition the Government had launched a new Obesity Strategy that needed to be a major part of a new JHWS.

·       The draft priorities already set out were still relevant and Dr Packham felt that the healthy weight agenda should be given a separate focus and not rolled into the same strategy, especially given the links between obesity and Covid.

·       Councillor Harvey was mindful of the fact that there were a lot going on in Rutland with consultations on the Local Plan and the UHL reconfiguration, as well as the Covid situation, and agreed that more time was needed to get the best engagement.

·       It had originally been discussed that rather than a single formal consultation, officers would link in and engage with lots of different representative groups and feed into the JHWS as it was being developed.

·       Dr Fox felt that the changes that the local CCG had undergone and the strengthening of the HWB should be part of the Strategy.

·       Because of the importance of physical activity, it was suggested that it might be appropriate for Active Rutland to report into the Health and Wellbeing Board as it would be an important vehicle for the delivery of the JHWS’s aims. Ms Kibblewhite stated that this would be a Council decision however that did not mean that the Board could not draw Active Rutland in closer so that it could have more of an impact and suggested that Robert Clayton, Head of Culture and Registration and Active Rutland be invited to future meetings.

AGREED ACTIONS:

1.    That a refreshed draft JHWS which would take into account Covid and the changes to the CCG would be brought to the January meeting of the Board. In addition there would be a proposal on which groups should  ...  view the full minutes text for item 5.

To receive a presentation on the Delivery Group and its aims from Fay Bayliss, Deputy Director of Integration and Transformation, LLR CCGs and Sandra Taylor, Service Manager, Community Care Services.

A presentation (appended to the minutes) was received from Fay Bayliss, Deputy Director of Integration and Transformation, LLR CCGs and Sandra Taylor, Service Manager, Community Care Services.

During discussion the following points were noted:

·       In terms of the LLR Integrated Care System, Rutland was both a place and a neighbourhood.

·       The Integration and Delivery Group would work with interdependent groups to shape and drive a programme of change in Rutland to deliver the aims of the Rutland Better Care Fund, The Rutland JHWS and the LLR Ageing Well/Home First programme. The Group had 10 members and needed to be small enough to work collaboratively to achieve this.

·       One of the critical pathways of care was the work done with GP practices which had been split into three zones: Uppingham, Empingham and Oakham/Market Overton.

·       Overarching the population health management ‘triangle’ which covered prevention and self-care, multi-morbidity and acute needs at the top, was how to manage and work with the data to improve services.

·       The RISE team was gaining momentum as it was the conduit between primary care and the Council

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Councillor Harvey took over the chair at 14.46pm as Councillor Walters lost video connection due to a storm.

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·       In response to a question from Mr Mutsaars who had asked about community and voluntary sector representation on the group, Ms Bayliss acknowledged that any design of services had to be co-produced and that input from the sector would be sought.

·       The Group would be working on how they catered for patients who wanted to receive care outside of LLR and would develop and strengthen links with the out of county providers.

·       Dr. Underwood felt that this could become even more important if the UHL reconfiguration meant that more Rutland residents would look to Peterborough and Kettering and asked whether representatives from out of area should be invited to the Board.

·       From a Rutland Primary Care Network (PCN) perspective there were out of area links with the Stamford PCN and the Peterborough outpatients redesign group.

·       Rutland Health and Wellbeing Board did not currently have representation from out of area providers but there had been a previously been a representative from Peterborough Community Hospitals (PCH) Dr. Fox observed that the Board did not have representatives from other hospitals and felt that the Board should look to the Commissioners to have links with all these providers.

ACTION:

The Chair of the Board would discuss further the issue of representation from out of area hospitals with supporting officers, Karen Kibblewhite, Head of Commissioning – Health and Wellbeing and John Morley, Director of Adult Social Services.

To receive an update from Rachel Dewar, Head of Community Health Services.

A verbal update on community health services in Rutland during the Covid pandemic was received from Rachel Dewar, Head of Community Health Services.

During discussion the following points were noted:

·       Some services such as continence services, which were identified nationally as a non-registered service, were suspended during the pandemic. As such waiting lists had now grown but the break had provided an opportunity to look at alternative ways in which to deliver the service.

·       Equality of service has meant that in some instances equipment has had to be provided so that patients could take advantage of video conferencing.

·       Most nursing services however required face to face and hands on care.

·       Community hospitals had been zoned and there was a designated Covid 19 ward at the Hinckley and Bosworth hospital.

·       There had been a high number of staff who were shielding, as well as patients, which had exacerbated staffing demands.

·       In some areas it had not been possible for staff to visit the Covid positive patients on their lists or if they did, they had to see them as their very last appointment.

·       Community services had felt acute pressure during the pandemic because of fewer admissions to hospitals and where patients had been admitted, very rapid discharge.

·       Community services had struggled a little in its response to those that were shielding and there needed to be some work done between primary care nursing and community health services in order to create extra capacity.

·       Recently those services that had been suspended had started up again but a second wave of Coronavirus was approaching which had already impacted; for example staff absence was increasing because children had been sent home from school due to a suspected outbreak.

·       Mr Mutsaars had been interested to hear about equipment being provided to patients so that they could access services, and invited Ms Dewar to attend a digital inclusion meeting that was being held on 21 October.

·       Staff had picked up on increasing levels of mental illness with loneliness being cited as a particular problem. On many levels the mental health fallout from Covid would be huge with the second wave being much harder because it would be winter rather than summer and because staff were simply exhausted and had partly got through the first phase on adrenalin.

·       Nationally there had been a real drive to focus on staff’s wellbeing. Staff had been encouraged to take annual leave even if they were unable to go away on holiday.

·       There were plans in place to shield patients should the second wave hit as hard as the first one. Lessons had been learnt from the first time around but there were still some issues around dealing with those patients who were shielding.

·       In regard to community care for shielded patients, Rutland was in a much stronger position than in other LLR areas.

To receive a presentation from Karen Kibblewhite, Commissioning Manager Health and Wellbeing, on the mitigation of identified risks for Rutland Care Homes and Home Care providers during the Covid-19 pandemic.

A presentation (appended to the minutes) on support for Care Providers during Covid was received from Karen Kibblewhite, Head of Commissioning – Health and Wellbeing

During discussion the following points were noted:

·       In August a new care home had opened in Oakham providing an additional 60 beds.

·       The Government had stated that all care providers would be able to access supplies of Personal Protective Equipment (PPE)

·       There was a trainer within RCC who provided additional support around taking PPE on and off.

·       RCC had set up a single point of dissemination for all care providers which was monitored six days a week.

·       All of Rutland’s homes had access to smart phones and tablets so that residents could speak to health professionals as well as families.

·       HMP Stocken inmates had raised funds to buy iPads to help residents of the Wisteria Care Home keep in contact with their families.

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Councillor Walters returned to the meeting and resumed the Chair

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To receive an update from Dr Hilary Fox on the current situation within the Primary Care Network and any identified future risks. To include an update on vaccinations and anti-body testing.

A presentation (appended to the minutes) on GP surgeries and how they had responded during the Covid pandemic was received from Dr. Fox. A report supporting the presentation was received after the meeting and this too has been appended to the minutes.

During discussion the following points were noted:

·         Staffing levels had been disrupted as anyone with a temperature had to be sent home.

·         The GMC had introduced rapid reregistration which had allowed 3 retired GPs to rejoin Rutland practices. As these GPs, by virtue of their age, were in the high risk category they mainly carried out clinical administration work.

·         PPE supplies had become much more reliable and a large amount of scrubs and visors had been donated.

·         All appointments were initially triaged by phone which put increased pressure on the telephone lines.

·         Accurx video consulting was introduced to provide an alternative and this freed up capacity for those who could only access the surgery by telephone.

·         Practices also implemented schemes for safe face to face consultations. This included waiting in cars rather than in the surgery, temperatures being taken and one way systems being introduced.

·         Oakham Medical Practice set up a ‘hot hub’ in a porta cabin on site which had to be disinfected between each visit. This facility would be re-opening soon.

·         There had been well established integrated working between the RISE team, GP and Admiral nurses which meant that patients shielding only had one service contacting them. 

·         Practices had had to hold waiting lists for referrals which created a lot of work as patients continually contacted them to find out what was happening with them. Practices were not routinely informed about progress with the waiting lists.

·         There had not been a significant deployment of volunteers in Rutland via the NHS scheme but there had been many community and neighbourhood groups who had volunteered to collect prescriptions.

·         DHU services had been restored at Rutland Memorial Hospital in the evenings but not yet at weekends.

·         Dr Fox reassured the Board that well organised processes were in place to administer the flu vaccines. There would be smaller clinics but much more of them and a service on Saturday. The real challenge lay in vaccine availability as stocks had had to be ordered before the eligibility criteria increased.

·         CCGs were looking at the delivery of vaccines but it was not yet known whether they would be centrally delivered.

To receive any items of urgent business which have been previously notified to the person presiding.

The Chair had not been notified of any other urgent business.

The next meeting of the Rutland Health and Wellbeing Board will be on Tuesday, 12 January 2021 at 2.00 p.m.

The next meeting of the Rutland Health and Wellbeing Board will be held on 12 January 2021.