To confirm as a correct record the minutes of the meeting of the Board held on 7 July 2011.

The Minutes of the meeting of the Health Scrutiny Board held on 7 July 2011 were confirmed as a correct record and signed by the Chair.

To consider proposals to establish Regional Networks of Trauma Care.

The Board considered a report providing information about plans to establish Regional Networks of Trauma Care, with specific reference to the proposed model of trauma networks within NHS South West.  The report also advised the Board of the process for designating Major Trauma Centres.  Representatives from NHS Devon, South Devon Healthcare NHS Foundation Trust, and South Western Ambulance Service NHS Foundation Trust attended to respond to questions.

The Board was advised that forty-four per cent of trauma cases in the South West occurred more than forty-five minutes travel from the Major Trauma Centres at Plymouth and Bristol.  The Board was informed that Torbay Hospital wished to become a Trauma Unit and that the process of Trauma Unit designation would need to be complete before April 2012 when the networks became operational.  The Board was advised that it was estimated 30-40 lives could be saved annually in the region through the establishment of Trauma Networks and the resulting improvements in the coordination of care.  Members were informed of confirm and challenge events to test the plans of prospective Trauma Units.

In response to questions concerning the public perception of standards of care at Derriford, the Board was advised that all hospitals providing trauma services would have performance measured against national standards as part of the designation process. 

Members questioned the rationale for the threshold of forty-five minute travel time to a Major Trauma Centre, especially in respect of the rurality of the region.  In reply, the Board was advised that the specific time was based on expert opinion rather than clinical evidence.  The Board was advised that particular localities might have a higher threshold under which patients would be taken to a Major Trauma Centre in the first instance.

In reply to questions, the Board was advised that staff training would be specified in the designation documents.

Members questioned the possible affects of the proposals on the ambulance service.  A representative of South Western Ambulance Service NHS Foundation Trust advised that providing definitive care for the patient was the priority, transfers from Trauma Units to Major Trauma Centres could tie up vehicles, and only very small numbers of patients were involved.

Members questioned the extent of the involvement and consultation with the public concerning the proposals.  In reply, the Board was advised that two stakeholder events had been planned and that each Primary Care Trust cluster would have an engagement contact to work with NHS South West, provide a local point of contact and co-ordination.

Resolved:  (i) that the improved quality and safety of service anticipated for patients be noted; and

(ii) that the involvement of clinicians and service managers in the development of proposals thus far and the intention to involve patients and the public in the plans for service improvement be noted.

To consider the latest developments concerning the proposed developments at the Brixham Hospital site.

To consider an update report on the Occombe House service proposals.

The Board considered an update report on the activities undertaken in relation to Occombe House services since July 2011.  The Chief Executive Officer, Torbay Care Trust, informed that Board that the process of conducting Best Interest Decisions for the residents of Occombe House was underway and all were expected to be completed by early October.  The Board was advised that the Best Interest meetings would consider the question of the optimal and preferred living arrangements of residents of Occombe House and whether this included combined arrangements.  The Board was advised of the progress of an Any Willing Provider process.  Members were informed by the Chief Executive Officer, Torbay Care Trust, that families of the residents had some reservations concerning the process.

Members asked when the quality assurance report of Vocal Advocacy would be complete and were advised that this information would be ascertained and provided to Board members.

In reply to questions, the Board was advised that the report on the Occombe House site prepared by Torbay Development Agency cost approximately £2,000. 

At this juncture the Board heard representations from relatives of the Occombe House residents.  The Board was advised of a recent meeting of Marldon Parish Council and heard questions about the decision-making process that had led to the proposals for the Occombe House service.  The Board was provided with a draft agenda for a Best Interest meeting and advised that such meetings were scheduled to last over five hours.  In response to requests and suggestions, the Chief Executive Officer, Torbay Care Trust, indicated that the questions to be considered as part of the Best Interest meetings could be added to by relatives if they wished.

Members questioned the possible duress of the Best Interest process for relatives of Occombe House residents.  The Chief Executive Officer, Torbay Care Trust, agreed with suggestions from Board members that the process being enacted under the Mental Capacity Act should have occurred sooner.

(Note: prior to consideration of the item in Minute 293, Councillor Bent declared a personal interest in the matter as the former Cabinet Member who had requested the compilation of the Torbay Development Agency report on the Occombe House site.)

To consider a report on the above matter.

Please note this report does not contain exempt information.

The Board considered a report outlining the financial challenge for adult social care services.  The report summarised the schemes proposed to achieve adult social care savings and grouped them into five themes: reduction in care home placements; reduced expenditure on domiciliary and day care services; back office efficiencies, stricter contract management and employed front-line staff and in-house units; policy adherence; and reduced expenditure on clients with a learning disability.  The Board was advised that the 2011/12 budget settlement between the Care Trust and Torbay Council had not reflected inflation or demographic growth.  The Board was informed that upcoming discussions between the Council and the Care Trust would include increasing the rate of redundancies at the Care Trust.

A representative from Speaking Out in Torbay (SPOT) addressed the meeting.  He indicated that cuts to adult social care affected the most vulnerable and that they would need time and transitions to handle such change.  The Board was advised of the safeguarding risks accompanying service reductions and the impact of changes outlined.  The Board was informed of a need to ensure tangible alternatives were available if services were changed.

In reply to questions, the Board was informed that users had not yet been consulted on the options for service reductions and that this would be included within the Council’s budget setting consultation.

In response to questioning, the Board was advised that discretionary charges in Torbay were broadly in line with neighbouring local authorities and close to full cost recovery.

In response to questions concerning the local authority’s obligation to meet assessed need and the scope for reductions, the Board was advised that needs would be re-assessed.

Resolved:  that the Mayor be requested to ensure next year’s Budget had a realistic view toward discretionary spend on outside organisations.

(Note: prior to consideration of the item in Minute 294, Councillor James declared a personal interest in the matter due to his employment in a residential home in Torbay.)