BATH & NORTH EAST SOMERSET
                           LOCAL INVOLVEMENT NETWORK

                                           LINk Committee
                                           Meeting: 6 December 2011
                                             10.00am -12.00noon
                           The Owners’ and Trainers’ Room, Bath Racecourse,
                                      Lansdown, Bath. BA1 9BU

    Present: Committee Members
             Diana Hall Hall                                    Jill Tompkins
             Theresa Hegarty                                    Ben Rogers
             Jayne Pye                                          Pat Jones

                 Mike Vousden                                   Carole Pullen
                 Jo Leighton                                    Bridget Moylett

                 Others in Attendance
                 Howard Wreford-Glanvill                        John Whapshott
                 Adrian Inker                                   Ann Harding
                 Sam Lindberg                                   Mary - Jane Middlehurst
                 Julia Griffith                                 Derek Thorne

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                 Janet Cowland                               Susan Bowen
                 Connie Wright                               Margaret Douglas
                 Hilary Elms                                 Joan Travis
                 Diana Elliott                               Veronica Parker
                 Judy Marsham                                Judith Goldsmith
                 Pat Mawhood                                 Benita Moore

105-11           Committee Members’ Declarations of Interest
                 LINk Committee Members present confirmed that they
                 had no interests that conflicted with the business to be
                 conducted at the meeting.

106-11           Concerns from Members of the Public
                 There were no concerns expressed to the Committee.

107-11           Minutes of Meeting of 1 November 2011 and Matters
                 The minutes of the LINk Committee’s meeting of 1 November 2011 were
                 approved as an accurate record.
                 Minute 097-11: - The Committee agreed to seek clarification regarding:
                  - Whether Dementia training is given to RUH bank and agency nurses
                 - The care support available when treating different nationalities at the RUH
                 Minute 099-11: - Diana Hall Hall advised that the LINk had raised the
                 issue of the future of Hillview Lodge at the Wellbeing Policy Development
                 and Scrutiny Panel. The LINk had been assured that an impact
                 assessment was to be carried out. Jill Tompkins explained that a meeting
                 is planned for 6 January to be attended by those who attended the earlier
                 AWP engagement meeting, in order to clarify the issues previously raised.
                 Jill Tompkins will clarify what the next steps are to be taken by AWP and
                 report back to the Committee. The LINk agreed to raise the issue at the
                 next Wellbeing Policy Development and Scrutiny Panel meeting and to
                 firmly propose that an impact assessment needs to be carried out to follow
                 correct procedure.
                 Minute 101-11: - Mike Vousden noted the letter written to NHS South of
                 England about the impact on Joint Commissioning in B&NES of the
                 formation of the new B&NES and Wiltshire Cluster. Mike said that at the
                 last Wellbeing Policy Development and Scrutiny Panel meeting, the Panel
                 had recommended that the formation of the Cluster should be deferred

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                 until April 2012 "to allow the complexities of future working arrangements
                 to be properly established…” The Panel had also stated that it "did not
                 support the conclusion of the NHS Management Board that the key
                 principles of model 2 PCT cluster governance must be adopted by
                 December 2011. The Panel did not agree with the ‘top down’ approach
                 from the NHS Management Board, when a local decision of April 2012
                 had been mutually agreed between both NHS Bath and North East
                 Somerset and NHS Wiltshire.”
                 Derek Thorne confirmed that NHS B&NES and Wiltshire are working in
                 partnership and have a single CEO, Jeff James. The creation of a single
                 Board to govern both organisations is still under discussion.
                 Minute 103-11: - Diana Hall Hall congratulated Derek Thorne on the
                 Health and Wellbeing Network Healthy Conversation meeting on 16
                 November at Fry Club and Conference Centre. GP’s presented on
                 their role as commissioners, and planning priorities were also on the
                 It was noted that the Enter and View visits to the Royal United Hospital
                 Accident & Emergency Department to gather information on their
                 working with the Great Western Ambulance Service (GWAS) would go
                 ahead in January 2012. This is part of a piece of work being
                 coordinated by the GWAS Joint LINks’ Working Group.

108-11           Presentation: - NHS 111, Non Emergency Telephone
                 Speaker: Julia Griffith, NHS B&NES
                 Julia explained that the new NHS 111 national non-emergency telephone
                 service will be free whether you use a landline or a mobile. Calls are
                 transferred to a call-centre local to where the person is calling from and
                 they will be given advice regarding non urgent health care problems. If
                 needed, callers will be signposted to another service and if a call is deemed
                 urgent, callers will be transferred to 999 without a break in contact. NHS
                 111 will replace the GP Out-of-Hours telephone number, and also the NHS
                 Direct telephone number. The service will be live across the country by
                 April 2013, and will provide a single point of access, to simplify access to
                 urgent health care, enabling people to access the right service first time and
                 encourage self care. Local clinicians have been involved in the creation of
                 the NHS 111 decision-making software called ‘Pathways’, to maximise its
                 effectiveness. In the future there is the potential to link up with the local
                 authority and social services. The services will be managed on a PCT
                 Cluster basis.
                 [Presentation notes are available on the BANES LINk website].

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                 Questions followed: -
                 Julia confirmed that the call-handling for Out-of-Hours dental services, the
                 dental helpline and emergency dentist will be provided by 111. Howard
                 Wreford-Glanvill asked whether NHS 111 will replace 999. Julia replied that
                 it will be in addition to 999. Ann Harding asked whether 111 will be
                 responsible for all GP appointment booking, and Sam Lindberg asked
                 about the possibility of GP practices relying on the 111 service to take
                 appointment bookings and as a result making less staff available to take
                 booking calls at the Practice. Julia replied that when people want to book a
                 GP appointment they should always call their GP Practice first, the 111
                 service is available as an additional option if they are unable to get through.
                 GP peer reviews will encourage Practices to ensure that patient telephone
                 calls are dealt with promptly and efficiently.
                 Adrian Inker asked if there will be a national and local campaign to ensure
                 public awareness of the service, and also highlighted the importance of
                 public trust in the service. Julia confirmed that there will be a national
                 advertising campaign. Julia said that the data from the pilots and the Out-
                 of-Hours service will inform and help the 111 service to be reliable and
                 effective. For example, one idea would be to have a local back-up service
                 to take up some of the calls when high call volumes are expected, such as
                 during a swine flu epidemic.
                 Pat Jones asked if a mobile phone will enable you to make a 111 call even
                 if you have no credit. Julia replied that she will seek a definite answer to
                 this question and report back to the LINk.
                 Ben Rogers asked how the information will be disseminated to those who
                 may have difficulty understanding or accessing the information. Julia
                 advised that the campaign will be national and that it is within the contract
                 specification that the service will be made accessible to all.
                 In discussion about the record of NHS Direct, it was noted that some
                 felt that this service used protocols that were too risk-adverse in
                 referring callers, and that this resulted in unnecessarily increased
                 workloads for other parts of the NHS. Julia noted that the protocols for
                 NHS 111 had been written by clinicians, doctors and nurses, and that
                 this would lead to appropriate advice and care being given to callers.

                 Howard Wreford-Glanvill asked if there is a time-limit within which calls
                 would have to be answered. Julia replied that she thinks there is a
                 limit of 20 minutes to deal with the call, but she will check this and
                 inform the Host office. Julia explained that they are also monitored on
                 the number of abandoned calls, which must be less than 5%.

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109-11           Working Towards Local HealthWatch
                 John Whapshott & Derek Thorne (B&NES Council & NHS B&NES)
                 Derek Thorne provided an update on the progress of Local
                 HealthWatch, and advised that B&NES are in a strong position, with a
                 clear idea of how Local HealthWatch will look. The draft specification
                 is currently being considered by the Local HealthWatch Reference
                 Group, of which Jayne Pye is a member, and will be finalised by the
                 Council's Cabinet in January 2012. B&NES wants Local HealthWatch
                 to do three things: engage, inform, and assist people to resolve
                 issues. Local HealthWatch will bring together and coordinate the
                 public, the Third Sector, the health and social care providers, Patient
                 Participation Groups in all the GP practices and the Health and
                 Wellbeing Board. The aim of this will be to mobilise and represent the
                 customer voice on health and social care services in B&NES, by
                 providing one point of contact. Significantly, Local HealthWatch will
                 have two places on the Health and Wellbeing Board, sitting alongside
                 the strategic leaders with equal status, participating in decision making
                 and shaping the health and social care strategy, giving Local
                 HealthWatch more power than was held by LINk.

                 The Local HealthWatch specification will require that both adults and
                 children are represented. The specification asks that the provider is
                 innovative in its communication and uses modern social media to
                 maximise the population engaged with. It is anticipated that Local
                 HealthWatch will perform the role of helping the public make choices
                 around their health and social care services. This will require Local
                 HealthWatch to understand data-sets such as NHS Choices and Well
                 Aware to inform and signpost people. In terms of assisting the public,
                 Derek said that Local HealthWatch would take up causes for
                 individuals and groups, and then carry them through to the
                 commissioners and providers of health and social care services to
                 seek improvements in quality.

                 Derek also went through the document Agenda item 6, Development
                 of Local HealthWatch Function by the LINk, December 2011 – March

                 John Whapshott advised that B&NES are ahead of other Local
                 Authorities in their Local HealthWatch procurement process, and has
                 supplied other Local Authorities with its Local HealthWatch
                 specification. The funding for Local HealthWatch will be within the
                 range of £60-£120,000 per year and the amount will be finalised
                 before going to tender.

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                 John explained that the tendering process will begin by February 2012
                 at the latest. Pre-qualification questions will be completed by all
                 bidders, and those who get through this stage will be invited to tender,
                 followed by a presentation interview, with the final decision to be
                 made, and the HealthWatch provider in place by July 1st 2012. A
                 smooth transition from LINk to HealthWatch is important so that
                 HealthWatch will carry on the good work that LINk is doing and the
                 legacy information will aid this. Local HealthWatch will start to operate
                 in October 2012.

                 Jill Tompkins noted that the Host's current contract finishes at the end
                 of March, and that this has negative implications when trying to plan a
                 workload. Jill noted that other Local Authorities have extended the
                 contract to September 2012, which seems to be working well and
                 asked why B&NES can not do the same, to give staff more stability
                 and so that the work programme can be carried out and completed
                 effectively. Members of the Committee and Host urged that a decision
                 as to the future support for the LINk be reached as soon as possible
                 for the benefit of all concerned.

                 Howard Wreford-Glanvill asked for assurance that the current LINk
                 Host will be required to pass all its paperwork and data to the new
                 Local HealthWatch provider. John confirmed that this would be the
                 case and that the new provider is required to have local knowledge.
                 Mike Vousden noted that adherence to Data-Protection Act and
                 confidentiality principles will need to be a priority. Mary-Jane
                 Middlehurst asked if there are people in place on the commissioning
                 and selection panel. John responded that the panel has not yet been
                 decided and agreed to take the Committee’s concerns over this back
                 to the Council. Ann Harding expressed her view that the LINk should
                 be represented on the commissioning panel that chooses the new
                 Local HealthWatch provider. Howard added that the LINk Committee
                 have the best awareness of the qualities needed by the new provider.
                 A discussion was had about the need for Local HealthWatch to have a
                 corporate body, and that many people have been confused by this
                 term. It was clarified that a corporate body is defined as a legal entity.

                 Mike Vousden noted that, for comparison with the funding being
                 proposed for Local HealthWatch, the current amount of funding
                 currently available for the LINk is around £109,000. Derek Thorne
                 said that it is important to remember that Local HealthWatch will be a
                 new entity that it will not necessarily replicate the existing systems of
                 the LINk. Jill asked how solid the tender for Local HealthWatch can
                 be when the parameters have still to be provided by Government.

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                 Derek said that in order to put B&NES in a strong position that it was
                 important to formulate the specification to the needs of B&NES now,
                 and not wait for further details to emerge. Derek said that he does not
                 think that the core principles, objectives and intent will need to be
                 changed following the release of these details, and that the
                 specification being proposed for B&NES will be capable of ready
                 adaptation to any further detailed requirements.

110-11           LINk Representatives’ Reports
                 There were no reports received from the LINk's formal representatives.

111-11           Chair’s, Deputy Chairs’ and Host’s Items
                     (i) Long-Term Conditions – Jayne Pye
                     Jayne advised that over 100 responses were received in response
                     to the Long-Term Health Conditions Survey and that these will
                     soon be available to view on the NHS B&NES website.

                    (ii) Re-ablement Tender – Jayne Pye
                     Jayne Pye reported that she had been asked to sit on the
                     commissioning panel for the Re-ablement tender with GP Simon
                     Douglas and two other commissioners. The Re-ablement project
                     will take between 1 year and 18months. The voluntary sector, third
                     sector and statutory sector would be asked to work together in
                     partnership. Jayne will be visiting and speaking to individuals that
                     should have had the work done for them or with them, and ask for
                     their feedback.

                     (iii) Home Improvement Agency Commissioning – Jayne Pye
                     Jayne visited Care and Repair who are involved in the Re-
                     ablement tender and noted an issue to bring to the LINk’s
                     attention. Jayne explained that there is new Home Improvement
                     Agency commissioning under consultation that includes the
                     funding given to Care and Repair to provide services such as DIY
                     and home adaptations. Jayne advised that the contract is
                     changing and that the service may in future be provided Avon-
                     wide, which may mean that the B&NES Care and Repair may not
                     be chosen to provide the service.

                     This poses concerns because the people who use the Care and
                     Repair services are mostly vulnerable people who rely on a
                     trustworthy person to come in to their home and value the extra
                     services provided by Care and Repair, such as the social support

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                     and advice. The Committee voiced concerns that those in need
                     may not receive this level of care from the new provider.

                     Jayne Pye proposed that LINk needs to find out more about the
                     new contract specification, and ascertain the level of care and
                     support the new provider will be required give. Diana Hall Hall said
                     that we need to represent the vulnerable and find out more.

                     Pat Jones noted that Somer Housing, Age UK and Care and
                     Repair all have similar services, but that the costs are all different
                     and that this can be confusing and complicated, especially for older
                     people and the vulnerable.

                     The Committee agreed to contact Graham Sabourn to seek
                     clarification regarding the contract specification.

                     (iv)Pharmacy Application – Midsomer Norton
                     The application from Midsomer Dispensing Ltd for inclusion in the
                     Pharmaceutical list of Bath and North East Somerset PCT, under
                     the pharmacies opening for 100 hours or more per week
                     exemption category at 98 High Street, Midsomer Norton, Radstock,
                     BA3 2DE, was noted by the Committee.

112-11           Work Programme - Update
                     (i) Disabilities Working Group - Jayne Pye
                         Jayne noted work carried out in specific sections.
                     (ii)Carer’s Working Group - Joan Travis
                         Joan sent her apologies. The Care Provision Options Survey will be
                         placed in the December newsletter. The survey is aimed at carers
                         and potential carers and asks about their experiences and
                         knowledge of care service provision in B&NES.
                     (iii)Autism Project – Jayne Pye
                          Jayne provided an update, explaining that the role of the LINk
                          and the National Autistic Society is to facilitate the setting up of
                          a B&NES Adult Autism Group and not to run the group. Jayne
                          introduced Mary-Jane Middlehurst, of the B&NES Council
                          Family Information Service and a LINk Member, as the
                          temporary chair of the group in this development stage. Mary-
                          Jane has alot of experience and knowledge of the statutory
                          authorities in relation to autism. Mary-Jane explained that a
                          follow-up meeting was held to take forward the discussions that
                          began at the 24 October Autism Meeting, and that it was

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                          important to show the families that attended the initial meeting
                          that things were being progressed.

                          Discussions are being had around when the best time would be
                          to hold the next meeting so that it would fit in with the meetings
                          to be held by the Adult Autism Strategy Group and the
                          Aspergers Practice Development Group. Jayne is representing
                          LINk at the Aspergers Practice Development Group and also at
                          the B&NES Autism Strategy Group. A focus for the meeting is
                          to be decided, in order to proceed effectively and not to be
                          repetitive of the first meeting. Mary-Jane advised that the initial
                          meeting contained issues such as where the individuals were in
                          terms of diagnosis, employment, housing and benefits. Mary-
                          Jane highlighted the importance of a smooth transition for
                          young people into adulthood as a key issue to focus on. If a
                          young adult has a statement of special educational needs and
                          is in school, that transition starts at 14+.

                          A B&NES Adult Autism Strategy Consultation Meeting is
                          planned for early spring 2012 and it was suggested that a
                          meeting for the B&NES Adult Autism Group could happen
                          immediately before this consultation meeting, at the same
                          venue. This could mean that those who attend the first meeting
                          have the opportunity to attend the following meeting if they
                          wish. The National Autistic Society is liaising with
                          commissioners, Mike McCallum and Andrea Moreland, to
                          discuss this option. Jayne Pye explained that there is a lot of
                          data that needs to be collected, such as how many people
                          there are in B&NES with an Autism Spectrum Condition, where
                          they live, and what problems they are experiencing, before any
                          meaningful action can be taken. Jayne proposed the creation
                          of a database of people who are interested in the B&NES Adult
                          Autism Group. Jayne also noted the importance of staff training
                          and awareness in primary and secondary care settings.

                          Sam Lindberg of ICAS said that they as an organisation would
                          like to liaise with Mary-Jane to discuss how they can ensure
                          they are accessible to people with ASC.

                     (iv)Quality of Care in Care Homes - Jill Tompkins
                         Jill Tompkins arranged a meeting of interested Enter and View
                         trained members to discuss and decide the way forward.
                         Jill reiterated that the aim of the informal visits is to find out
                         what is being provided and the quality of service and not to look
                         into complaints.

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                          Pat Jones said that we should not duplicate what the council
                          do. It was noted that LINk has a statutory power to complete
                          Enter and View visits, and that the Wellbeing Policy
                          Development and Scrutiny Panel does not have the same right.

113-11           Any Other Business
                 Theresa Hegarty encouraged LINk members to attend the standard
                 meetings such as the forthcoming Quality Accounts meetings at the
                 RUH, stating that they are a good opportunity to represent the views of
                 the public.

                 Jayne Pye said that the LINk had not liaised with the CCG over the
                 PPG’s for a few months and that this work project will soon be

                 Pat Jones said that she had been told by a B&NES resident that there
                 are not any routine breast services in Bath and that she had to go to
                 Bristol. It was pointed out by Adrian Inker that if a disabled B&NES
                 resident needs a routine breast scan that they would need to go to
                 Bristol due to a physical access issues at the RUH screening centre,
                 although if you are referred directly by your doctor, you would be able
                 to use the services at the RUH. Pat advised that the lady is not
                 disabled and the Committee asked Pat for more details from the lady
                 in question so that the LINk can look into this further.

                 Concerns were raised regarding NHS services being privatised and
                 the suggestion was made that that private providers do not have easy
                 to access complaints procedures. Derek Thorne stated that every
                 provider has a contractual responsibility to have a complaints
                 procedure. He added that if a patient wishes, they can ask the
                 Commissioner to present their complaint on their behalf. Sam
                 Lindberg explained that if a provider is providing an NHS service that
                 ICAS can advocate on their behalf. The Committee asked for the
                 factual details so that this matter can be looked into. Derek Thorne
                 suggested that the LINk could contact each independent provider and
                 ask for their complaints procedure and also ask if they send this out
                 with their initial appointment paperwork.

                 Ann Harding asked if hospital Physiotherapy treatment is now being
                 charged for. Pat Jones replied that the first 8 weeks are free but that
                 the following sessions cost £3. Ann said that she knew of a case
                 where the person in question was charged for sessions immediately
                 post operation. The Committee asked for details to look into the
                 matter further.

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                 Carole Pullen announced that the December newsletter will contain a
                 small piece on Complaints and that there will be a complaints feature
                 in the March newsletter.

114-11           Date of Next Meeting
                 10 January 2012, 10.00am–12 00 noon at The Somerdale Room, Fry
                 Club and Conference Centre, Keynsham, BS31 2AU.

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