Please contact: Lydia Hall
Please email: lydia.hall@north-norfolk.gov.uk
Please direct dial on: 01263 516047
11 April 2016
A meeting of the Overview and Scrutiny Committee of North Norfolk District Council will be held in
the in the Council Chamber at the Council Offices, Holt Road, Cromer on Wednesday 20 April 2016
at 9.30am.
At the discretion of the Chairman, a short break will be taken after the meeting has been running for
approximately one and a half hours.
Members of the public who wish to ask a question or speak on an agenda item are requested to arrive
at least 15 minutes before the start of the meeting. It will not always be possible to accommodate
requests after that time. This is to allow time for the Committee Chair to rearrange the order of items on
the agenda for the convenience of members of the public. Further information on the procedure for
public speaking can be obtained from Democratic Services, Tel: 01263 516010, Email:
democraticservices@north-norfolk.gov.uk
Anyone attending this meeting may take photographs, film or audio-record the proceedings and report
on the meeting. Anyone wishing to do so must inform the Chairman. If you are a member of the public
and you wish to speak on an item on the agenda, please be aware that you may be filmed or
photographed.
Sheila Oxtoby
Chief Executive
To: Mrs S Butikofer, Mrs A Claussen-Reynolds, Mrs J English, Ms V Gay, Mrs A Green, Mr M Knowles,
Mr P Moore, Mrs M Prior, Mr E Seward, Mr B Smith, Mr D Smith and Mr N Smith.
All other Members of the Council for information.
Members of the Management Team, appropriate Officers, Press and Public.
If you have any special requirements in order to attend this
meeting, please let us know in advance
If you would like any document in large print, audio, Braille, alternative
format or in a different language please contact us.
Chief Executive: Sheila Oxtoby Corporate Directors: Nick Baker & Steve Blatch
Tel 01263 513811 Fax 01263 515042 Minicom 01263 516005
Email districtcouncil@north-norfolk.gov.uk Web site northnorfolk.org
AGENDA
1.
TO RECEIVE APOLOGIES FOR ABSENCE
2.
SUBSTITUTES
3.
PUBLIC QUESTIONS
To receive questions from the public, if any
(page 4)
(9.30 – 9.35am)
To approve as a correct record the minutes of the meeting of the Overview and Scrutiny
Committee held on the 16 March 2016.
4.
MINUTES
5.
ITEMS OF URGENT BUSINESS
To determine any other items of business which the Chairman decides should be considered as a
matter of urgency pursuant to Section 100B(4)(b) of the Local Government Act 1972.
6.
DECLARATIONS OF INTEREST
Members are asked at this stage to declare any interests that they may have in any of the
following items on the agenda. The Code of Conduct for Members requires that declarations
include the nature of the interest and whether it is a disclosable pecuniary interest.
7.
PETITIONS FROM MEMBERS OF THE PUBLIC
To consider any petitions received from members of the public.
8.
CONSIDERATION OF ANY MATTER REFERRED TO THE COMMITTEE BY A MEMBER
To consider any requests made by non-executive Members of the Council, and notified to the
Monitoring Officer with seven clear working days’ notice, to include an item on the agenda of the
Overview and Scrutiny Committee.
9.
RESPONSES OF THE COUNCIL OR THE CABINET TO THE COMMITTEE’S REPORTS OR
RECOMMENDATIONS
To consider any responses of the Council or the Cabinet to the Committee’s reports or
recommendations.
10.
NORTH NORFOLK BIG SOCIETY FUND
(page 11)
(9.40 – 10.00)
Summary:
This report provides an update on the operation of the Big
Society Fund during the last financial year. It also proposes that
a review of the grant process in relation to Arts development
and Community Transport is undertaken to align it more closely
to the Big Society Fund grant application process.
Conclusions:
The North Norfolk Big Society Fund has successfully achieved
its expected outcomes following its fourth year of operation. The
current management arrangements, administrative and decision
making process are considered effective. The Fund has enabled
a wide variety of projects to be implemented for the benefit of
communities across North Norfolk.
The value of Arts development and need for Community
Transport services is recognised. A review of the application
process for applying for an Arts development or community
transport grant will be undertaken to consider whether it should
be aligned more closely to the Big Society Fund application
process.
Recommendations:
Cabinet are requested to note the success of the Big
Society Fund and to recommend to Council:
1. That the Big Society Fund grant scheme should
continue at its current level of funding (£225,000) for
another year;
2. That a review of the grant process in relation to Arts
and Community Transport is undertaken to align it
more closely to the Big Society Fund grant
application process;
Reasons for
Recommendations:
To ensure Cabinet is informed about the operation of the Big
Society Fund during its fourth year.
To ensure that NNDC offers a consistent and equitable
application process for all community grants.
Cabinet member(s):
Ward member(s)
Contact Officer,
telephone
and e-mail:
11.
Councillor T FitzPatrick
All
Sonia Shuter
01263 516173
sonia.shuter@north-norfolk.gov.uk
THE CABINET WORK PROGRAMME
(page 18)
(10.00 – 10.10)
To note the upcoming Cabinet Work Programme.
12.
OVERVIEW & SCRUTINY WORK PROGRAMME SETTING AND UPDATE
(page 21)
(10.10 – 11.00)
To receive an update from the Scrutiny Officer on progress made with topics on its agreed work
programme and to receive any further information which Members may have requested at a
previous meeting.
13.
EXCLUSION OF THE PRESS AND PUBLIC
To pass the following resolution, if necessary:
“That under Section 100A(4) of the Local Government Act 1972 the press and public be excluded
from the meeting for the following items of business on the grounds that they involve the likely
disclosure of exempt information as defined in paragraph _ of Part I of Schedule 12A (as
amended) to the Act.”
14.
TO CONSIDER ANY EXEMPT MATTERS ARISING FROM CONSIDERATION OF THE PUBLIC
BUSINESS OF THE AGENDA
Agenda item no._______4_______
OVERVIEW AND SCRUTINY
Minutes of a meeting of the Overview and Scrutiny Committee held on 16 March 2016
in the Council Chamber, North Norfolk District Council, Holt Road, Cromer at 9.30 am.
Members Present:
Committee:
Mr P Moore (Chairman)
Mrs S Butikofer
Mrs A Claussen-Reynolds
Ms V Gay
Mrs A Green
Mr M Knowles
Ms M Prior
Mr R Reynolds (Sub)
Mr E Seward
Mr R Shepherd
Mr N Smith
Officers in
Attendance:
The Chief Executive, the Head of Finance, the Health and Communities
Team Leader, the Economic Development Officer, the Democratic Services
Team Leader and the Democratic Services Officer
Members in
Attendance:
Mr J Rest, Miss B Palmer, Mr P W High, Mrs A Moore and Mr N Pearce.
122. APOLOGIES
Mr B Smith, Mrs J English and Mr D Smith.
123.
SUBSTITUTES
Mr R Reynolds for Mr B Smith.
124.
PUBLIC QUESTIONS
None.
125.
MINUTES
The minutes of the Overview and Scrutiny Committee held on 17 February 2016
were accepted as an accurate record with two amendments; that there was the
addition of ‘one off’ to complete a sentence regarding the rise in cost of beach huts
and that the minutes reflected Mr R Reynolds comments on encouraging jobs in the
west in regards to Egmere.
Overview and Scrutiny Committee
4
16 March 2016
126.
ITEMS OF URGENT BUSINESS
None.
127.
DECLARATIONS OF INTEREST
None,
128.
PETITIONS FROM MEMBERS OF THE PUBLIC
None.
129. CONSIDERATION OF ANY MATTER REFERRED TO THE COMMITTEE BY A
MEMBER
None.
130.
RESPONSES OF THE COUNCIL OR THE CABINET TO THE COMMITTEE’S
REPORTS OR RECOMMENDATIONS
None.
131.
CLINICAL COMMISSIONING GROUP (CCG)
Mr Mark Taylor, Chief Executive of the North Norfolk Clinical Commissioning Group
gave Members a presentation on the work in the district including information on how
the CCG worked, their priorities and savings aims. The presentation is included with
these minutes.
Members were invited to ask questions:
1) Ms V Gay asked about data collection in the area. The CCG CEO replied that the
NHS was poor as monitoring outcomes and that the CCG monitored access. He
said that the CCG did not commission primary care and that the information was
not collated into meaningful information. He added that routine data was collected
on cancer and that every two years this was looked at, comparing the number of
positive diagnosis with the number of referrals from the practice; few referrals but
high diagnosis would cause concern.
Ms Gay clarified that the CCG supported the improvement of primary care but did
not commission it and said that knowing the outcomes would enable better
support. The CCG CEO said that he agreed and that more outcome data was
needed. The Chairman asked whether this could be improved and the CCG CEO
said that it was down to resources and the fact that GPs did not use the same IT
systems. He said that he would provide Members with the information on the
indicators used by the CCG through a web link.
2) Mr E Seward said that 700 new homes were planned for North Walsham and
asked how the surgery would cope and whether section 106 agreements for
capital spend helped and what extra money was provided. The CCG CEO said
that no extra funding was given. He explained that resource allocation was from a
formula; the population at a point in time and the projection of population growth.
He said that there were weights included for factors such as age but then the
funding was allocated and that local population growth wasn’t included. He
acknowledged that it was a huge issue and one there were lobbying for changes
Overview and Scrutiny Committee
5
16 March 2016
in as it put pressures on primary care.
The Chairman asked whether Members could assist in putting on pressure for
changes and the CCG CEO said that it was a matter of funding and that support
from section 106 agreements was helpful but it was the ongoing revenue costs
that were the concern.
3) Mr Seward asked why the Minor Injuries Unit at Cromer Hospital was not
publicised and said that it would take the pressure off of A&E. The CCG CEO
said that he agreed and that the resources at Cromer’s MIU were not maximised.
He said that they were working with the East of England Ambulance Service and
111 on their Directory of Services as the MIU was a long way down the list and
now it was a higher up option so that people would be directed there. He added
that they were developing a phone application that would provide patients with
treatment options and would include information such as the MIU opening times.
4) Mr Seward asked why an out-of-hours information card could not be produced.
He said that in the past he had been told that this would be too expensive. Mrs A
Green said that surgeries did not refer patients to the MIU either. The CCG CEO
said that they needed to promote the services of the MIU for minor injury but
reminded Members that it was not for illness.
5) Mr Seward said that there was a shortage of GPs and asked whether the 19
practices in partnership that made up the CCG were up to full complement. The
CCG CEO said that there were shortages but that North Norfolk was better off
than most areas. He said that there were increasing challenges in recruiting GPs
as doctors were not choosing general practice and that it was an issue to be
tackled urgently. He said that the answer lay with using other professionals like
nurses and health care assistants and sharing resources across practices to build
resilience. He said that they needed to train more doctors and make general
practice more appealing.
6) Mr R Reynolds said that the presentation showed that groups were attended
regularly and asked whether the people higher up took these comments on
board. Mr Reynolds said that the £30bn funding gap was a large concern for
them all. Mr Reynolds said that he had spent time in two hospitals; the NNUH and
the Spire and had received equal care in both but that the Spire was controlled by
a matron and all staff were fully briefed on each patient. He said that at the NNUH
he had seen five consultants in one day and none knew what the others had
done. Mr Reynolds said that the shortage was not only in money but also in
management and efficiencies. The CCG CEO said that the groups did influence
decisions at the top and that the community engagement panel met as public
meetings in open session and that feedback from patients influenced how they
moved forwards.
7) Ms M Prior said that she had received a similar experience to Mr Reynolds and
that communication was lacking and an obvious issue to address. She said that
through lack of communication and inefficiencies, money was lost and that a
matron system was an answer for consideration. The CCG CEO said that he
agreed and that it was useful feedback. He said that all hospitals were subject to
inspection and that the latest NNUH report was in the press that day and included
inspection of hand-overs and efficiencies. He said that there was increasing
specialisation in medicine meant that more people were involved with a patient’s
care.
Overview and Scrutiny Committee
6
16 March 2016
8) Mrs A Claussen-Reynolds said that she was the Council’s representative at
NHOSC and that it was a leading light in the five groups of which it was a part.
She said that last year a pre-hospital improvement board was set up with the
CCG CEO leading it. There was a lot about medication waste – with an outcry on
the amount of wasted medication and the costs they incurred and that
medications not required could not be returned, even if they were unopened. The
CCG CEO said that there was a bath full of the amount of medication wasted with
the cost of each drug labelled. He explained that the bath had been moving
around GP surgeries in the district to encourage people to ensure that their
medications were needed and not just left on repeat at their surgeries. He
acknowledged that this happened more in care homes where one staff member
would order the medications for the residents. The CCG CEO clarified that
medication could not be returned as there was a safety issue.
9) Mr N Smith said that the 600 new homes in Aylsham was a large amount for a
small area and that the doctors in Aylsham were concerned about the
coordination between districts. Mr Smith said that the changes at Aylsham in the
Broadland district would impact on Erpingham in North Norfolk more so that
issues in Cromer. Mr Smith, in regards to the wasted medication, said that he
was completing holiday insurance and asked his doctor about one of his
prescriptions to be told that he no longer needed to take it and that it had been
forgotten. Mr Smith said that in mental health that the people at the top had little
knowledge of what was happening at the bottom and that doctors were
prescribing drugs for illnesses that benefitted more from talking therapies. He
added that a team of listeners was going to be set up but that it was not deemed
to be cost effective and instead people were being left on medication rather than
talking through their problems. The CCG CEO said that his background was in
mental health and that there was a rise in demand of mental health services for
common illnesses such as depression and anxiety. He said that the Norfolk
Foundation Trust had had a challenging four to five years but that it was
improving but that it had a lot of work to do. The CCG CEO said that the CCG
worked from a clinician’s viewpoint and that mental health was in the national
spotlight
10) Mr J Rest asked if Iceni healthcare worked and the CCG CEO replied that it was
a new organisation, formed by GP contracts to bid for contracts and that it was
too early to judge but that it had potential.
11) Mr J Rest asked whether charging for missed appointments would be effective.
The CCG CEO said that it probably would be but that it would not happen.
12) Mr J Rest asked whether care homes were aware of the beds at Kelling Hospital
as doctors did not make home visits to care and residential homes - that patients
were taken to the NNUH. The CCG CEO replied that they were aware of the beds
at Kelling but that it was important to keep reminding them.
13) Mrs A Moore said that the North Norfolk CCG’s area had a huge population of
visiting tourists and that it must put a lot of pressure on the services and asked
whether a recharge to the patient’s own CCG happened. The CCG CEO said that
holiday makers registered as temporary patients and that their home CCG did
pay for their treatment.
14) Ms M Prior asked whether money could be claimed back using EU cards and that
the NHS was entitled to claim the money spent back from the patient’s home
country. The CCG CEO said that this was a reciprocal agreement within the
Overview and Scrutiny Committee
7
16 March 2016
European Union and that this recharge was arranged at a national level.
The Chairman thanked the CCG CEO for attending the meeting.
132.
BUDGET MONITORING REPORT 2015/16 – PERIOD 10
The Portfolio Holder for Finance, Mr W Northam, had written an introduction that the
Chairman read to Members. Mr Northam had written that the underspend was
expected to be £876,500, that the base budget for 2015/16 included savings and an
additional income of £220,000 and that the report recommended several capital
items monies for slippage into 2016/17. Mr Northam had written that an additional
£35,000 for 4a Market Street in North Walsham was due to higher landscape and
purchasing costs.
Mr R Reynolds said that he supported the report and commented that due to the
Council’s efficiencies and the work of officers they were in a good financial position
and that there was good forward planning. The Chairman said that he had nothing
but praise for the team in finance.
Mrs A Moore said that there were several vacancies across the authority and asked
whether the underspend was due to those vacancies. The Chief Executive
acknowledged that there were vacancies but that not all of the posts would be filled:
IT – struggling to recruit but two new people had started with staff specifically
to support the planning business process review changes and that the ‘golden
hellos’ incentive had made a difference.
Planning – recent success in filling empty posts but that there were still some
agency staff due to the volume of work and that the posts were substantive
bar one.
Finance – that an advert for finance manager had gone twice and that two
sets of interviews had been held but that they had not recruited any of the
applicants and that they would now consider how the post would work within
sharing arrangements with Great Yarmouth Borough Council.
Revenues & Benefits – that the management post had been held vacant but
had now been taken out as a permanent saving. The turnover in the
department was due to the type of work and that temporary staff were being
recruited in anticipation of universal credit and that overall, performance had
improved, that the work was not easy and that the staff were incredibly
professional.
The Chief Executive added that the staff who had left Revenues and Benefits were
still employed by NNDC in different departments.
Mrs S Butikofer asked what the money from public conveniences, plumbing and
drainage was being earmarked for and asked whether the two conveniences without
hot water would be looked at. The Chief Executive said that she would check. Mrs
Butikofer said that they wanted to improve the status of West Runton beach but there
were no hand washing facilities.
Mr E Seward said that the Council was not short of money and that if they wanted a
qualified accountant in a competitive market, they would have to pay for one. He
Overview and Scrutiny Committee
8
16 March 2016
asked about second homes money coming to an end as outlined in the community
and localism part of the report. The Chief Executive said that the funding would be
removed in 2017/18 but that as per their agreement with Norfolk County Council, the
amount would be reduced but that there was no agreement in place following the
current administration.
Mr Seward said that the last period 6 report had shown an underspend of £126,000
and that the jump to £876,000 surplus was a large one. He said that the budget
proposal had shown a £400,000 surplus and said that if the money did not need to be
spent that was fine but that the Council was not a bank and that they were there to
provide services and asked where the money was going to go.
Mr Seward PROPOSED and Mrs S Butikofer SECONDED the following
recommendation for Cabinet:
That they consider earmarking £100,000 from the surplus to provide the necessary
resources for the new enforcement team which is being established.
Ms V Gay supported the motion saying that enforcement was at the heart of the
reputation of the council and showed how seriously planning was viewed. Mr R
Reynolds said that it was too early for such a proposal and that officers should be
able to continue as they were. Mrs A Claussen-Reynolds agreed with Mr Reynolds
and Ms M Prior also expressed her support for him.
The vote showed 3 in support of the recommendation, with 5 against and 2
abstentions.
The Chief Executive said that they monitored the enforcement output and indicators
and that if the new team was struggling to meet the standards set then they could
look at their resources and that the information could be brought to Committee. Ms
Gay said that they could address this when they set their work programme for
2016/17.
Mr Seward said that in his ward there had been two enforcement issues in the past
fortnight and that they were small matters but did not help the Council’s reputation.
Mr Reynolds said that enforcement was working and the deliberate felling of trees
resulted in the individuals being fined £10,000 per tree. The Chief Executive said that
enforcement had not been working and that the new structure needed the time to see
how effective it was.
Mrs A Claussen-Reynolds asked whether the variance in the industrial estates was
due to a shortfall of income and the Head of Finance said that she would circulate the
information.
The Committee ACCEPTED the report.
133.
THE CABINET WORK PROGRAMME
The Democratic Services Team Leader said that the work programme had been
amended following the publication of the papers. She informed Members that the
Inward Investment report and street naming and numbering reports had been moved
back. She also informed Members that the boundary review would take place at the
May Cabinet meeting and that she would circulate a revised version.
Overview and Scrutiny Committee
9
16 March 2016
The Committee NOTED the Cabinet Work Programme.
134.
OVERVIEW & SCRUTINY WORK PROGRAMME AND UPDATE
The Democratic Services Team Leader said that as a result of the previous month’s
questions on affordable housing, a second visit to Victory Housing had been
arranged for the 8th June. She said that there would be an additional meeting of the
Committee on the general reserve date 13th April specifically on devolution with the
Managing Director of New Anglia. She added that all questions raised at the previous
meeting had been circulated and that the travellers sites update requested would be
circulated.
The Democratic Services Team Leader reminded Members that the April meeting as
scheduled was the opportunity to set the 2016/17 work programme and asked
Members to submit topics for discussion. She said that Coast partnership had asked
whether they could attend the meeting in July and Members agreed that they could.
The Democratic Services Team Leader asked Members whether they would like the
Housing Strategy to come to the Committee for pre-scrutiny before the report went to
Cabinet and Members agreed that this was appropriate.
Ms V Gay said that she would like to add two topics to the work programme for next
year:


Enforcement update
Disabled facilities grants
The Chief Executive said that in three months there would be reports on both topics
and the Committee agreed that both reports would be scrutinised at the June
meeting.
The Committee NOTED the Overview & Scrutiny work programme.
The meeting concluded at 11.26pm
_____________________________
Chairman
Overview and Scrutiny Committee
10
16 March 2016
Agenda Item No____10________
North Norfolk Big Society Fund
Summary:
This report provides an update on the operation of the
Big Society Fund during the last financial year. It also
proposes that a review of the grant process in relation to
Arts development and Community Transport is
undertaken to align it more closely to the Big Society
Fund grant application process.
Conclusions:
The North Norfolk Big Society Fund has successfully
achieved its expected outcomes following its fourth year
of operation. The current management arrangements,
administrative and decision making process are
considered effective. The Fund has enabled a wide
variety of projects to be implemented for the benefit of
communities across North Norfolk.
The value of Arts development and need for Community
Transport services is recognised. A review of the
application process for applying for an Arts development
or community transport grant will be undertaken to
consider whether it should be aligned more closely to
the Big Society Fund application process.
Recommendations:
Cabinet are requested to note the success of the Big
Society Fund and to recommend to Council:
1. That the Big Society Fund grant scheme should
continue at its current level of funding (£225,000)
for another year;
2. That a review of the grant process in relation to
Arts and Community Transport is undertaken to
align it more closely to the Big Society Fund
grant application process;
Reasons for
Recommendations:
To ensure Cabinet are informed about the operation of
the Big Society Fund during its fourth year.
To ensure that NNDC offers a consistent and equitable
application process for all community grants.
11
LIST OF BACKGROUND PAPERS AS REQUIRED BY LAW
(Papers relied on to write the report, which do not contain exempt information and which are not
published elsewhere)
Cabinet Member(s)
Ward(s) affected
Cllr. Tom FitzPatrick
All
Contact Officer, telephone number and email:
Sonia Shuter 01263 516173, sonia.shuter@north-norfolk.gov.uk
1.
Introduction
North Norfolk Big Society Fund
A district with vibrant communities and where healthy lifestyles are accessible
to all is identified as a key priority in North Norfolk District Council’s (NNDC’s)
Corporate Plan 2015 – 2019. The Corporate Plan confirms our commitment to
support local residents and their communities by continuing to operate the Big
Society Fund to meet local needs and aspirations
The North Norfolk Big Society Fund was established in 2012 to help build
strong communities in North Norfolk. Its aim is to help communities to develop
new and innovative projects which will improve their social and economic
wellbeing.
A review of the third year of operation of the North Norfolk Big Society Fund
was presented to Cabinet in March 2015. It concluded that the Fund was
achieving its purpose and has helped a wide variety of valuable community
projects to be implemented, helping to establish and nurture the ethos of ‘the
Big Society’ in North Norfolk.
It was recommended and agreed by Cabinet to continue the Big Society Fund
grant scheme at the current level of funding (£225,000) for another year
The purpose of this annual report is to provide an overview of how the grant
fund has been used and to review its effectiveness.
Arts Development and Community Transport
NNDC’s art development budget of £36,510 is used to make funding awards
to a number of strategic arts organisations that provide arts and cultural
services in North Norfolk. These organisations often use this funding as
leverage to secure funds from a variety of external sources ensuring the value
of the District Council investment is increased significantly.
Unlike the Big Society Fund there is currently no formal publicly advertised
application process for applying for arts development funding. The decision as
to which organisations receive a funding award is made by officers and
notified to the Portfolio Member. The majority of the funding awards have
12
historically been given to the same strategic arts organisations. Requests for
one off arts development grants are submitted throughout the year by a range
of organisations and are funded subject to budget and identified outcomes. A
monitored Investment Agreement with identified outputs and outcomes is put
in place for any organisations in receipt of arts development funding.
NNDC’s community transport budget of £17,000 is used to make funding
awards to a number of community transport providers that provide community
transport services in North Norfolk
Currently there is no formal publicly advertised application process for
applying for a community transport grant. The decision as to which
organisations receive a funding award is made by officers. Funding awards
are given each year to the same community transport organisations upon
receipt of agreed monitoring information.
Whilst the main focus of this report is the annual review of the Big Society
Fund. Information about arts development and community transport funding
has been included to enable Cabinet to recommend to Council that a review
of the process for awarding this funding is undertaken. If agreed a subsequent
report with recommendations would be presented to Cabinet in October.
2.
North Norfolk Big Society Fund Grant Scheme
During its fourth year of operation the Fund has continued to be managed and
administered internally. The grant process includes:

Publicity and promotion of the Big Society Fund

Advising and supporting organisations throughout the application process

Effective communication with Members at all stages of the grant process

Preparing and presenting reports to the BSF Grant Panel

Monitoring of applications awarded funding to ensure projects are
completed in accordance with Fund Terms and Conditions

Managing on going PR and media interest, supporting projects with
publicity and promotion, new releases, opening events etc.
The continued internal management and administration of the fund has
enabled the Council to:

Proactively promote the Big Society Fund as an NNDC initiative

Significantly increase NNDC’s engagement with Town and Parish
Councils, as well voluntary and community groups throughout the whole
of the grant process from pre-application to project implementation and
completion

Provide officers with a greater understanding of the need for projects, the
challenges encountered by applicants and offer appropriate advice and
support
13

Increase local Councillors’ opportunities for engagement in community
initiatives operating in their wards

Maintain effective and regular contact with community organisations
awarded a grants, ensuring their projects progress in accordance with
grant Terms and Conditions

Increase the Council’s role in publicising community projects supported by
the Fund – helping to raise the profile of the community organisation and
the grant-funded project. This helps reinforce NNDC’s role as a
community leader and is a highly effective way of promoting the grant
scheme to attract appropriate future applications.
Overview of proposals submitted / approved 2015/16
The politically balanced, Panel that considers the BSF grant applications is
appointed annually by Full Council and is chaired by the Portfolio holder for
the Big Society. Four Panel meetings have been held so far this financial year
(in June 2015, September 2015, November 2015 and March 2016). This year
35 organisations have made grant applications, totalling £279,013.85, 3
applications were ineligible to be presented by the Panel, 3 applications were
not awarded a grant, 2 applications were deferred pending further information
and 27 were approved (amounting to grant awards totalling £154,438.42)
Last year 61 organisations made BSF grant applications, 16 applications
were ineligible to be presented to the Panel, 8 applications were not awarded
a grant, 1 application was deferred and 36 were approved.
Whilst the number of applications to the Big Society Fund has reduced in the
last year this is predominantly due to a significant reduction in the number of
ineligible applications being made. Organisations are requested to contact
NNDC and discuss their potential project prior to submitting an application.
This has resulted in a reduction in the time spent processing ineligible
applications. In 2014 / 15 26% of applications submitted were ineligible to be
presented to the Panel. In 2015 / 16 this has reduced to 8%. Similarly the
support and advice given to eligible applications prior to submission has
reduced the number of unsuccessful applications. In 2014 / 15 only 59% of
applications were successful. In 2015 / 16 this increased to 77%.
Since the Fund started in 2012, 67 parishes have received at least one BSF
grant. Proactive work has been undertaken in the last year to encourage
Parishes that have not previously been awarded a BSF to apply. In the last
year 5 Parishes who had not previously received funding made a successful
grant application.
14
Type of Organisation Applying to Big Society Fund 2015-2016
Village
Hall/Playing
Field
8%
Voluntary
Organisation
3%
Community Club
11%
Community
Group
17%
Parish Council
26%
Company
Interest
Company
3%
Parish/
Community
Church
3%
Not for profit
Company
Limited by
Local Charity Guarantee
3%
23%
National Charity
3%
The vast majority of successful grant applications continue to relate to improvements
to village halls or other community buildings, play equipment, sport and recreational
facilities. These generally match the purpose of the fund as they are able to clearly
demonstrate benefit to the wider community.
Number of Successful Applications (by Theme Supported by
the Big Society Grant Fund 2015-16
Sports &
Recreation
13
Facilities &
Services
10
Cultural
Initiatives
4
15
Value of Grants Awarded 2015-16
£10,000 £15,000
6
Totalling
£77,999.00
Less than £5,000
14
Totalling
£32,787.49
£5,000 - £9,999
7
Totalling
£46,651.93
Review of the application process and procedures
A number of applications were being submitted for projects whose aim met
the objectives of the BSF but the purpose for which the grant would be used
e.g. staff salaries, core revenue costs was not supported. With the agreement
of the Chair of the Big Society Fund minor amendments have been made to
the Prospectus in the last year to help clarify eligibility.
In response to feedback from grant applicants the BSF application and end of
grant forms are now available electronically.
The Big Society Fund was examined as part of an internal audit of
Community support activities in November 2014 resulting in an “adequate
assurance”. The internal audit did however give rise to one recommendation:
“A detailed policy should be produced and approved that supports the
monitoring of grant expenditure that allows the Council to reclaim
grants in situations where the terms and conditions of the grants have
been breached. If the grant is spent in breach of the terms and
conditions agreed, there is a risk that the Council is unable to recover
the grant already spent.”
In response to this, in August 2015 a Big Society Fund Grant Recovery Policy
was written which has been approved by Internal Audit and is now being used
for all approved grants.
3.
Summary
The Big Society Fund is widely promoted across North Norfolk through a range of
medium and continues to achieve its aim of helping build strong communities in
North Norfolk and demonstrates NNDC’s priority in the Corporate Plan for a
district with vibrant communities and where healthy lifestyles are accessible to all.
16
Feedback from Members who attend project opening events and the End of
Grant reports submitted when a project has been completed clearly demonstrate
the value and benefit of the BSF and the difference funded projects are making to
their local communities.
The importance of the BSF is highlighted by many organisations who continue to
report that access to grant funding has reduced both locally and nationally. As an
example the Norfolk Community Foundation manages thirty seven grants
applicable to the North Norfolk area but currently only nine are open for
applications. Therefore the BSF which offers grants of up to £15,000 is probably
the most significant generic fund available within North Norfolk.
4.
.Financial Implications and Risks
Funding to implement the recommendations set out in this report is already
accounted for in the Budget.
5.
Sustainability
The provision set out in this report take account of sustainability and are
aimed around supporting the overall sustainability of local communities.
6.
Equality and Diversity
The recommendation to review the application process for arts development
and community transport grants to bring it in line with the BSF would result in
a more equitable, open and transparent process.
7.
Section 17 Crime and Disorder considerations
There are no crime and disorder implications
17
North Norfolk District Council
Cabinet Work Programme
For the Period 01 April 2016 to 31 July 2016
Decision Maker(s)
Meeting
Date
Subject &
Summary
Cabinet
11 Apr 2016
North Norfolk Big
Society Fund
Annual Update
Scrutiny
20 Apr 2016
Cabinet
11 Apr 2016
Scrutiny
20 Apr 2016
Council
May 2016
Cabinet
27 Apr 2016
Scrutiny
18 May 2016
Council
22 Jun 2016
Cabinet
18 May 2016
Scrutiny
18 May 2016
Council
22 Jun 2016
Cabinet
Member(s)
Lead Officer
Agenda Item 11
Status / additional
comments
April 2016
09 May 2016
Nicola Turner
Housing Strategy &
Community
Development
Manager
01263 516 222
Emma Denny
Democratic Services
Team Leader
01263 516010
Boundary Review –
submission on
Council size
Housing Strategy
John Rest
Nicola Turner
Team Leader –
Strategy
01263 516222
Inward Investment
Strategy
Nigel Dixon
Michelle Burdett
Economic Growth
Manager
01263 516233
Key Decision – a decision which is likely to incur expenditure or savings of £100,000 or more, or affect two or more wards. (NNDC
Constitution, p9 s12.2b)
* Schedule 12A of the Local Government Act 1972 (As amended by the Local Authorities (Access to Information) (Exempt Information) (England) Order
2006)
18
North Norfolk District Council
Cabinet Work Programme
For the Period 01 April 2016 to 31 July 2016
Decision Maker(s)
Meeting
Date
Subject &
Summary
Cabinet
Member(s)
Lead Officer
Cabinet
06 Jun 2016
Out-turn report
Scrutiny
15 Jun 2016
Karen Sly
Head of Finance
01263 516243
Council
22 Jun 2016
Cabinet
06 Jun 2016
Street Naming &
Numbering – fees
and charges and
review of policy
Rachel Parkin
Property Information
Team Leader
01263 516013
Status / additional
comments
June 2016
*affects all wards
Cabinet
06 Jun 2016
Scrutiny
15 Jun 2016
Cabinet
06 Jun 2016
Scrutiny
15 Jun 2016
Council
22 Jun 2016
Helen Thomas
Policy & Performance
Management Officer
01263 516214
Performance
Management –
Annual Report
Debt Management
Annual Report
Revenues & Benefits
Manager
01263 516081
Key Decision – a decision which is likely to incur expenditure or savings of £100,000 or more, or affect two or more wards. (NNDC
Constitution, p9 s12.2b)
* Schedule 12A of the Local Government Act 1972 (As amended by the Local Authorities (Access to Information) (Exempt Information) (England) Order
2006)
19
North Norfolk District Council
Cabinet Work Programme
For the Period 01 April 2016 to 31 July 2016
Decision Maker(s)
Meeting
Date
Subject &
Summary
Cabinet
Member(s)
Lead Officer
Status / additional
comments
Cabinet
06 Jun 2016
Scrutiny
15 Jun 2016
Treasury
Management
Annual Report
Council
22 Jun 2016
Cabinet
06 Jun 2016
Communications
Strategy
Tom FitzPatrick
Sue Lawson
Communications &
PR Manager
01263 516344
Cabinet
04 Jul 2016
Tom FitzPatrick
13 Jul 2016
Sean Kelly
Head of Business
Transformation
01263 516276
6 monthly update
Scrutiny
Business
Transformation
Update
Cabinet
04 Jul 2016
Financial Strategy
Wyndham Northam
To be confirmed
Scrutiny
13 Jul 2016
Karen Sly
Head of Finance
01263 516243
Council
20 Jul 2016
Tony Brown
Technical Accountant
01263 516126
July 2016
Key Decision – a decision which is likely to incur expenditure or savings of £100,000 or more, or affect two or more wards. (NNDC
Constitution, p9 s12.2b)
* Schedule 12A of the Local Government Act 1972 (As amended by the Local Authorities (Access to Information) (Exempt Information) (England) Order
2006)
20
Appendix B
Working Style of the Scrutiny Committee
Independence
Members of the Scrutiny Committee will not be subject to whipping arrangements by party groups.
Member leadership
Members of the Committee will take the lead in selecting topics for scrutiny and in questioning
witnesses. The Committee will expect members of Cabinet, rather than officers, to take the main
responsibility for answering the Committee’s questions about topics, which relate mainly to the
Council’s activities.
A constructive atmosphere
Meetings of the Committee will be constructive, and not judgmental, accepting that effective
scrutiny is best achieved through challenging and constructive enquiry. People giving evidence at
the Committee should not feel under attack.
Respect and trust
Meetings will be conducted in a spirit of mutual respect and trust.
Openness and transparency
The Committee’s business will be open and transparent, except where there are sound reasons
for protecting confidentiality. In particular, the minutes of the Committee’s meetings will explain
the discussion and debate in a balanced style, so that they could be understood by those who
were not present.
Consensus
Members of the Committee will work together and, while recognizing political allegiances, will
attempt to achieve consensus and agreed recommendations.
Impartial and independent officer advice
Officers who advise and support the Committee will give impartial and independent advice,
recognizing the importance of the Scrutiny Committee in the Council’s arrangements for
governance, as set out in its Constitution.
Regular review
There will be regular reviews of how the scrutiny process is working, and a willingness to change
if it is not working well.
Programming and planning
The Committee will agree the topics to be included in its published work programme and the
extent of the investigation to be undertaken in relation to resources, and the witnesses to be
invited to give evidence.
Managing time
The Committee will attempt to conclude the business of each meeting in reasonable time. The
order of business will be arranged as far as possible to minimize the demands on the time of
witnesses.
21
Agenda item 12
OVERVIEW AND SCRUTINY COMMITTEE WORK PROGRAMME 2015/2016
Period April – July 2016
April
North Norfolk Big
Society Fund
Annual Update
Tom FitzPatrick
Nicola Turner
Annual
Judy Oliver
Emma Denny
New item
John Rest
Nicola Turner
New item
Wyndham Northam
Karen Sly
Wyndham Northam
Helen Thomas
Wyndham Northam
Revenues & Benefits Manager
Wyndham Northam
Tony Brown
Nigel Dixon
Michelle Burdett
Cyclical
May
Road Safety and Reduction –
Norfolk County Council & Norfolk
Constabulary
Boundary Review –
submission on
Council size
Housing Strategy
June
Outturn Report
Performance Management Annual
Report
Debt Management Annual Report
Treasury Management Annual
Report
Inward Investment Strategy
July
22
Cyclical
Cyclical
Cyclical
New item
Coastal Presentation by Norfolk
Coast Partnership
Business Transformation update
Financial Strategy
Property Investment Strategy
Enforcement Board Update
Tom FitzPatrick
Sean Kelly
Wyndham Northam
Karen Sly
John Rest
Nicola Turner
Judy Oliver
Nick Baker
Cyclical
Cyclical
Cyclical
Cyclical
TBC
Asset Strategy
John Rest
Duncan Ellis
Dementia and related mental
health issues
Regulation of Investigatory
Powers Act- Policy
Public Transport
Nick Baker
Angie-Fitch Tillett
23
Date tbc – policy under
review
___________________________________________________________________
Norfolk Health Overview and Scrutiny Committee
Briefing
14 April 2016
_________________________________________________________
Contents:
LOCAL
1.
Continuing healthcare – data requested by NHOSC on 25 Feb
2016
2.
Queen Elizabeth Hospital psychology provision Quality
Innovation Productivity & Prevention initiative – additional
info requested by NHOSC on 25 Feb 2016
3.
Norfolk and Norwich NHS University Hospitals NHS
Foundation Trust – Care Quality Commission report
4.
Electronic prescription service
5.
Community pharmacy – briefing from Norfolk Local
Pharmaceutical Committee
6.
Great Yarmouth & Waveney CCG – withdrawal of gluten-free
foods on prescription from 1 April 2016
7.
Sustainability Transformation Plan for Norfolk and Waveney
8.
Maternity services provided by the Norfolk and Norwich
University Hospitals NHS Foundation Trust
9.
Local NHS and planning authority liaison
10. Norfolk Community Health and Care NHS Trust – chairman steps
down
11. Friends and Family Test – latest results
Page 2
Page 3
Page 4
Page 5
Page 6
Page 8
Page 9
Page 10
Page 12
Page 13
Page 14
NATIONAL
12.
NHS whistle-blowing consultation – primary care
Information sources
Page 14
Page 14
Questions:
Questions on any item in this briefing can be raised direct with the named
contact. If there are any matters arising from this information that warrant
specific aspects being added to the forward work programme or listed as future
information items, Members are invited to make the relevant suggestion when
the forward work programme is discussed at the next Norfolk Health Overview
and Scrutiny Committee (NHOSC) meeting.
24
1
LOCAL
1. Continuing healthcare – data requested by NHOSC on 25 Feb 2016
Rosa Juarez, Continuing Healthcare (CHC) Quality Innovation Productivity and
Prevention (QIPP) Project Manager has provided the following update on behalf of
the three central Norfolk CCGs and NHS West Norfolk CCG. The briefing includes
information on the numbers of live appeals against CHC decisions, as requested by
NHOSC on 25 Feb:-
A brief update on developments with the NHS CHC policy and guidance being
introduced by Norwich, North Norfolk, South Norfolk and West Norfolk Clinical
Commissioning Groups regarding provision of NHS Continuing Healthcare.
1.
Background
1.1. On 25th February 2016, Norfolk Health Overview and Scrutiny Committee received a presentation from the Rachael Peacock, Nick Pryke, Rosa Juarez and
Laura McCartney-Gray on behalf of the four CCGs, Norwich, North Norfolk,
South Norfolk and West Norfolk, regarding work on an open and transparent policy, guide and procedures documents for delivering NHS CHC to patients who
have been assessed as eligible for it under the national framework.
1.2. The CCGs have now all signed off the CHC Policy and published the final versions of the following on CCG websites:
•
•
•
NHS CHC Policy
Procedures regarding CHC for NHS Staff
Guide for patients and carers
1.3. The CSU and CCGs intend to put the new arrangements into effect from 1 April
2016.
2. Working with Adult Social Care
2.1. Adult Social Care and the CCGs have met to discuss the detail of the new policy.
It has been agreed that this will be undertaken in greater detail at the time of the
review in October 2016.
2.2. Adult Social Care staff have also been offered a training/briefing session on the
CHC Policy in late April / early May 2016.
3. Implementation of the NHS CHC Policy
3.1. Implementation of the NHS CHC Policy is on track, however, CCGs have decided to defer the implementation of the following aspect of the “Standard Decision Making Framework and Governance Arrangements for CCGs When Commissioning and Reviewing NHS CHC Packages” until CCGs review the application of the policy:
“A CCRP will ensure all domains are considered at the point where there is a
more than 5% difference in the options for care being considered”.
25
2
3.2. This is due to the fact that CCGs have agreed that the application of the domains
is best practice and requested that CCRPs and the CSU apply these in all cases,
regardless of whether there is a 5% difference in the options for care being considered.
3.3. A standardised template has been developed to support CCRPs in considering
each domain in all cases.
4. Evaluation of the Standardised Process for CCRP Decision Making
4.1. CCGs have committed to evaluating the impact of the new arrangements for the
standardised process for CCRP decision making within six months of implementation.
4.2. CCGs have engaged Norfolk Healthwatch to undertake an impact analysis of the
CCRPs’ activity during the first six months of implementation. Healthwatch will
contact stakeholders and patients for feedback on the process during this time.
5.
Safety Netting for Patients Receiving CHC Funded Care
5.1. CCGs have been in dialogue with Caroline Fairless-Price regarding this issue.
6. Open CHC appeals
6.1 The NELCSU Appeals & Retrospective CHC Team process appeals on eligibility
decisions. There are currently 18 live appeals on eligibility decisions for the whole
of Norfolk. These are at various stages of the Appeals process. The stages are
varied and can be as follows:
•
•
•
•
•
•
•
Awaiting consent from Appellant
Awaiting Appellant’s challenge to eligibility decision
Awaiting Multidisciplinary team comments back
Awaiting records
Awaiting peer review
Awaiting sign off
Awaiting face to face
6.2 Following these stages, the Appeal process closes. However, Local Resolution
continues in the following scenarios:
•
•
•
A retrospective review may be completed
Case goes on to independent review panel at NHSEoE
Referred to current assessment team for new current assessment of
needs.
6.3 Appeals on placements or type of care provided are classed as a complaint.
These are processed by the NELCSU Enquires and Complaints Team. There are
currently no open CHC complaints regarding placements or type of care provided.
________________________________________________________________
2. Queen Elizabeth Hospital (QEH) psychology provision Quality
Innovation Productivity & Prevention initiative – additional info
requested by NHOSC on 25 Feb 2016
26
3
On 25 February 2016 representatives of the Clinical Commissioning Groups
(excluding Great Yarmouth and Waveney) attended NHOSC to discuss their
commissioning intentions and plans for 2016-17. The report from West Norfolk
CCG mentioned a Quality Innovation Productivity and Prevention (QIPP) initiative
regarding ‘QEH Psychology Provision’. Members asked for further information
about this.
Aidan Fallon, Interim Director of Strategy and Transformation, West Norfolk CCG
has provided the following briefing:‘The Clinical Health Psychology service at QEHKL provides psychological support to
patients with physical illness. West Norfolk CCG partly commissions this service
under a ‘block’ funding arrangement and partly through our overall tariff
payments. The ‘block’ funding, as the name suggests, is a historic fixed sum of
money carried forward each financial year. We want to work with QEHKL to
understand, better, the scope of service provision in order to:
1) ensure that patients are receiving the optimum quality of service; and
2) optimise value for money
QIPP is essentially about maximising quality and productivity and this is the reason
why this initiative in included in our QIPP programme for 2016/17.
It is important to note that we have yet to hold detailed discussions with QEHKL
regarding this service and the value for money efficiencies attributed to the initiative
are currently an estimation. Actual efficiencies could be more or less than the
estimated £100k earmarked.
I hope this addresses the query, however, we would be pleased to provide an update
regarding this initiative, once we have concluded more detailed discussions with
QEHKL.’
_______________________________________________________________
3. Norfolk and Norwich NHS University Hospitals NHS Foundation Trust –
Care Quality Commission report
The Care Quality Commission (CQC) carried out a comprehensive inspection of
Norfolk and Norwich NHS University Hospitals NHS Foundation Trust (NNUH)
between 10 and 13 November 2015 and unannounced inspections on 20 and 25
November 2015. The inspections covered Cromer hospital and the Henderson Unit
at Hellesdon Hospital (used as a ‘step down’ facility) as well as the NNUH’s main
site.
The CQC has rated NNUH as ‘requires improvement’. Its stated key findings were:•
Staff were overwhelmingly caring in delivering care to patients. We witnessed
some outstanding examples of care being given to patients and their relatives.
27
4
•
•
•
•
•
•
•
•
•
There were shortages of nursing staff that impacted on care provided
throughout the hospital.
There were some areas where there were medical vacancies which impacted
on care. Most notably in the palliative care team and in the critical care
complex.
Incident investigation and root cause analysis was not always completed by
those with extended training.
The security on the children’s ward needed to be improved to ensure their
safety.
There was a lack of understanding by staff around patients’ ability to consent
to care and treatment.
The consultant body was cohesive, loyal to the hospital and proud to be
working at the trust.
The service to patients having a heart attack was extremely good.
The communication with parents in the neonatal unit was very good. These
included well written booklets.
The number of one stop clinics within the out patients department was
responsive to the needs of patients.
NNUHT was rated ‘good’ overall for urgent and emergency services and critical care;
all other areas were rated ‘requires improvement’. It was rated ‘outstanding’ for
caring and effectiveness in urgent and emergency services. The areas with the most
aspects requiring improvement were Maternity and Gynaecology, End of Life Care
and Outpatients and Diagnostic Imaging. No areas received an ‘inadequate’ rating.
The full inspection report is available on the CQC website:http://www.cqc.org.uk/provider/RM1
_________________________________________________________________
4. Electronic Prescription Service
The NHS is rolling out a new Electronic Prescription Service (EPS) which gives
people the chance to change how their GP send their prescriptions to the place
where they choose to get their medicines or appliances from. It means that people
who get repeat prescriptions will not need to go to the GP surgery to pick up the
prescription but can go straight to their nominated pharmacy to pick up their
medicine. Pharmacies should be able to get prescriptions ready for collection before
people arrive, reducing waiting times.
Patients who do not wish their prescriptions to be sent electronically can still receive
paper prescriptions. The NHS considers EPS to be reliable, secure and confidential.
In Norfolk the roll-out of EPS is complete in the Great Yarmouth area, well underway
in Norwich and about to start in South and West Norfolk.
Further information is available at http://psnc.org.uk/dispensing-supply/eps/patientnomination-of-a-dispensing-site/epsr2-patient-communication-materials/
28
5
___________________________________________________________________
5. Community pharmacy
The Chief Officer of Norfolk Local Pharmaceutical Committee has provided the
following briefing:Introduction
On 17th December 2015 the Government announced a number of plans for
community pharmacy. The proposals included a £170m reduction in funding for
community pharmacy in 2016/17. Since publication of the letter it has also become
clear that as many as 3,000 pharmacies may close, that key payments for pharmacies
will be phased out, and that there may be a drive towards a commoditised medicines
supply service with an increased focus on warehouse dispensing and online services.
The national pharmacy organisations believe the proposals pose significant threats to
both the community pharmacy network and patient care, and we are working together
to seek support.
Pharmacies are a valuable and valued resource
• People in England make 1.6 million visits to community pharmacies every day.
• As well as dispensing medicines community pharmacy teams help people to
stay well and out of the GP’s surgery, to get the most benefit from their medicines, and to manage their health conditions.
• Pharmacies are easy to access and form part of the fabric of local communities.
Pharmacy teams regularly go the extra mile for patients, the public and the
NHS. The NHS spends £2bn per year on GP consultations for conditions which
pharmacy teams could treat.
• 96% of the population can reach a pharmacy within 20 minutes by walking or
using public transport.
• More than 1 billion prescription items are dispensed by community pharmacies
every year.
• Pharmacies delivered more than 3.17 million medicines use reviews to help
people to understand and take their medicines correctly in 2014/15.
• Community pharmacies help us to stay well and prevent unnecessary visit to
the GP’s surgery and A&E. For example, pharmacy services supporting frail
elderly people after hospital discharge have reduced re-admittance by 63%.
• Community pharmacy can and should do much more. A community pharmacy
minor ailments service could save the NHS £1bn per year through reduced GP
appointments.
The Government’s plans threaten patients’ access to pharmacies and pharmacy
services
• The Government wants pharmacies to close. The Health Minister has suggested that up to 3,000 pharmacies – a quarter of pharmacies in England –
could be forced to close under its plans.
• The Government says it wants a ‘clinically-focused’ community pharmacy service and to optimise the use of medicines. Community pharmacy is always open
to discussions on changes that demonstrably support these objectives.
29
6
•
The network underpinning the supply of medicines is complex and fragile. The
Government has proposed a blanket cut in funding that will have unpredictable
consequences. It has not yet confirmed the full extent of the cuts for future
years.
The implications for patient care have not been properly considered and may be
damaging
• The Government has not conducted an assessment of the impact of its proposals on patient safety, or on the quality of care and must commit to doing so.
None of the detailed information required for a constructive discussion has been
published.
• The Government must explain how proposed changes will deliver a clinicallyfocused community pharmacy service and optimise the use of medicines.
• There is strong evidence that pharmacy can relieve the considerable pressure
on GP surgeries and A&E. Trials of a community pharmacy discharge service
saw a 63% drop in hospital re-admissions for frail patients. The Government
must demonstrate how changes will help to relieve those pressures.
• The Government must provide detail on how it will ensure access to pharmacy
services in remote or deprived communities. Central funding for ‘Essential
Pharmacies’ was ended in 2015.
• We do not yet understand the implications of hub and spoke dispensing models.
It is too early to quantify any potential efficiency savings. Any changes designed
to facilitate hub and spoke models must safeguard the quality, efficiency and
accessibility of pharmacy services.
• GPs have expressed concerns about the plans – the NHS Alliance has called
them ‘astonishing’ and ‘extremely short sighted’.
Next steps
To protect patient care, community pharmacy organisations would like to see the
following things happening.
1. The Government must provide more detail
Community pharmacy is happy to discuss changes to the network that will improve
patient care. Pharmacies can do more for patients and save money for the NHS. That
discussion must be based on a clearer picture of the Government’s plans, and a
mutual commitment to changes that will deliver a clinically-focused community
pharmacy service and optimise the use of medicines in the best interest of patients.
2. We must prevent disruption to patient care
The plans have created huge uncertainty and anxiety, which puts patient care at risk.
The consequences are unpredictable. The Government must commit to explaining
fully how its proposed changes will deliver a clinically-focused community pharmacy
service and optimise the use of medicines in the best interests of patients.
3. The Government must then entre constructive discussions
Community pharmacy continues to talk to the Government about its plans, and
welcomes a collaborative discussions in the best interests of patients – but this must
be based on full disclosure and a mutual commitment to changes that will deliver a
30
7
clinically-focused community pharmacy service and optimise the sue of medicines in
the best interests of patients.
How can you help?
Here are some practical steps that you can take now to help. As negotiations develop
over the coming months, pharmacies may continue to ask for your support.
Local authorities, commissioners and health professionals
Commissioners and providers of local health services can help by considering the
impact of the proposals on their local health network and patients. The Local
Pharmaceutical Committee may be able to help in these discussions. Health providers
and commissioners could then ask NHS England to explain the plans to them in more
detail, and to outline what impact they think they will have.
___________________________________________________________________
6. Great Yarmouth and Waveney CCG – withdrawal of gluten-free foods on
prescription from 1 April 2016
NHS Great Yarmouth and Waveney CCG provided the following briefing:NHS Great Yarmouth and Waveney CCG have made the decision to stop
prescribing gluten free foods in line with other CCGs in the area.
In the last 12 months the CCG spent £79,000 on prescriptions for gluten-free foods
and this money will be re-invested in other health services. The move will affect just
233 people who currently receive food via prescription in the Great Yarmouth and
Waveney area.
NHS Great Yarmouth and Waveney CCG previously restricted the number of gluten
free foods available on prescription in June 2014 to only bread and flour, now the
CCG has decided to stop prescribing all gluten free products from prescription. The
decision was taken because products provided on prescription are priced at a
premium, with gluten-free flour, for example, costing the NHS £9.95 compared with
£1.70 in the supermarket, and bread priced at £3.80 compared with £1.70.
The change, which has been fully supported by GPs through both the CCG’s clinical
executive committee and the prescribing leads forum, will be introduced on 1 April
and comes after several other local CCGs also withdrew funding for gluten-free
foods.
Gluten free food was initially prescribed when the availability of such foods was low
and therefore obtaining these products from community pharmacies via prescriptions
improved access to them. However, with the increased awareness of coeliac disease
and gluten sensitivity as well as a general trend towards eating less gluten, gluten
free foods are now much easier and accessible to purchase from supermarkets and
online.
Any decision to withdraw a service is not taken lightly and we appreciate that some
people will be disappointed. However, it is our responsibility to provide the best value
31
8
for money for all of our patients, and to meet that duty we need to make sure we
commission cost-effective services which will have the greatest impact on the largest
number of people.
The CCG will now write to every patient who receives gluten-free food on
prescription to make sure they are aware of the change and explain the reason
behind it.
For further information, please contact:Lorraine Rollo
Head of Communications and Engagement
NHS Great Yarmouth and Waveney CCG
Email: lrollo@nhs.net
Tel: 01502 719582
___________________________________________________________________
7. Sustainability Transformation Plan for Norfolk and Waveney
New NHS planning guidance ‘Delivering the Forward View: NHS Shared Planning
Guidance 2016/17 – 2020/21’ was published by NHS England on 22 December
2015:https://www.england.nhs.uk/ourwork/futurenhs/deliver-forward-view/
It asks for ‘every health and care system to come together to create its own
ambitious blueprint for accelerating its implementation of the Forward View’ and to
produce two separate but interconnected plans:1. A new local health and care system ‘Sustainability and Transformation Plan
(STP)’ to cover the period from October 2016 to March 2021; and
2. A plan by organisation for 2016-17. This will need to reflect the emerging
STP.
The STP is the place-based systemic plan for planning health and social care across
the county and should cover integration with local authority services ‘including, but
not limited to, prevention and social care, reflecting local agreed health and
wellbeing strategies’. NHS England expects STPs to be submitted in June 2016 and
they will be subject to formal assessment in July. This is an important milestone in
implementing the NHS new models of care outlined in the Five Year Forward View
(5YFV).
The Norfolk and Waveney geographic ‘footprint’ will be covered by a single STP. A
system-wide executive group has been established to oversee the development of
the Norfolk and Waveney STP. Across England each STP ‘footprint’ will cover on
average more than an million people.
Each STP area is expected to nominate a person who will be responsible for
overseeing and co-ordinating the STP process. NHS England announced the
leaders for 41 areas on 30 March. Norfolk and Waveney is one of just three areas
where the leader is yet to be confirmed.
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The Health Service Journal on 16 March 2016 reported that the STP ‘footprint’ will
also act as form of ‘credit union’ for the CCGs. Currently, they are expected to set
aside 1% of their funding each year for one-off costs. In 2016-17 they will not be
permitted to invest any of this money until the Treasury is satisfied that it is not
needed to offset provider deficits anywhere in the STP ‘footprint’. In case of provider
deficits the CCGs will be expected to leave the money unspent so that their
underspend balances out the provider overspend.
___________________________________________________________________
8. Maternity services provided by the Norfolk and Norwich University
Hospitals NHS Foundation Trust
In February 2016 a member of NHOSC raised some issues about midwifery
services in central Norfolk. The N&N, as provider of the services, was asked to
comment. The two questions raised and the N&N’s answers (in italics) are
shown below:(a) There is a perception amongst midwives that the number of second and
third degree tears during child-birth have increased.
Does the hospital keep records of the number and severity of tears? If so, could you
we see the statistics for recent years and could you give an indication of whether
they bear out this perception?
N&N response - I am unsure where the perception that the number and severity of
perineal tears has increased at the NNUH has come from other than to say that
nationally the detection of 3/4th degree tear rates has improved as all trusts have had
extensive training and it is now a proactively positive thing to diagnose such a tear to
ensure the woman receives the right kind of aftercare and follow up. This is
something that is discussed through the national network frequently and as such I do
not think the NNUH are any different to anyone else with regards to that. Also it is
important to note that the current national average figures are now seen as out of
date / old data as they refer to a period of time prior to the new techniques in
improving detection, when the next set of national statistics are released they will be
more representative of the current practice and therefore seen as more appropriate
data. Through the national network I can share that most trusts feel that there has
been a rise in 3/4th degree tear rates reported but also feel that these are equally
due to better detection. We do not collect the statistics for 2 degree tears as these
are thought to be a normal physiological part of the birth process. I am happy to
report that despite the perceived national increase in 3/4th degree tears the current
national average is around 5%, here at the NNUH our 2015/16 year to date figure is
currently 3.19% and as such does not raise any concern internal re the numbers of
cases seen, that said all cases are reviewed and investigated thoroughly to check if
anything could have been done differently to prevent such a tear occurring. In April
2015 the NNUH started to use a new maternity information system known as E3,
unfortunately I am unable to locate any information regarding previous years 3/4th
degree tear rates at this time. Please feel assured that we believe our 3/4th degree
tear rates have not increased nor are they of an unacceptable level.
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(b) We have heard of several occasions where mothers to be had to wait for a
room to become available in the delivery suite, when labour was already in
advanced stages.
Are there records of occasions where an expectant mother’s access to the delivery
suite has been delayed because the rooms are full?
N&N response - When women are admitted to the labour ward here at the NNUH all
women are first seen by a triage midwife and assessed in order of priority in a similar
way as triage occurs in an A&E dept. Although this is explained to the women before
they attend and also again on arrival, women who are not deemed as being a priority
case or not in labour may have to wait to be seen, following initial triage which
occurs within 15 mins of attending. With that in mind it is easy to see why this
perception may have occurred for women who are not thought to be in labour or who
have attended for reasons that deem her not to be high priority. Any woman
attending and assessed via triage (as noted above within the first 15 mins of arrival)
as being in established labour is transferred immediately to a birthing room however
sometimes women present to the triage dept. or the labour ward clearly already in
established labour they go straight to a birthing room therefore missing the triage
process out.
____________________________
Members may be interested to note that the Care Quality Commission (CQC)
rated the N&N’s maternity and gynaecology services as requiring improvement in
all areas except ‘caring’, which was rated as good (based on its inspection in Nov
2015).
The CQC found that:•
•
•
•
Investigation of incidents were often delayed due to the reliance on
clinical staff to complete the initial investigations (for which no time was
allocated away from clinical duties).
Both nursing and medical staffing levels were lower than expected. Due
to sickness and absence levels there was a ratio of 1 whole time
equivalent midwife to 34 births, which is significantly lower than the
national average.
Consultant obstetric cover in the delivery suite was 60 hours a week
which was significantly worse than The Royal College of Obstetrics and
Gynaecology guidance of 198 hours for a unit of this size.
There were 21 closures of the Maternity Unit between October 2014 and
September 2015 (maternity units ‘close’ when they are full and expectant
mothers are diverted to other hospitals).
However, the CQC also found that:•
The specialist, midwife-led ‘Birth reflections’ clinic was provided to support
women who wanted to come to terms with their birth experience was an
example of outstanding practice.
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•
•
The normal births, overall caesarean section and instrumental delivery
rates were all better than the national average.
Women were very positive about the care they received and felt they were
supported to make informed choices.
The following actions were recommended, relevant to the maternity and
gynaecology services:The NNUH ‘must’:•
•
•
Ensure that there are adequate medical, nursing and midwifery staff to
care for patients in line with national guidance.
Ensure that incidents are investigated in a timely way by trained
investigators, grated and reported in line with current national guidance.
Ensure that medicines are stored and administered in line with national
guidance.
The NNUH ‘should’:•
•
•
•
Review the provision of information technology for community midwifery
teams.
Develop an action plan to address the lack of improvement in completion
of discharge information in the specific safeguarding children paperwork
for use within the maternity department.
Review the provision of adequate seating in the antenatal clinic.
Reduce the number of cancelled gynaecology clinics.
___________________________________
Members may also be interested in the NHS England commissioned maternity
review ‘Better Births’, which was published on 23 February 2015. The report is
linked to the delivery of the NHS Five Year Forward View and proposes different
models of care, with innovations including Personal Maternity Care Budgets for
women. It is expected that four sites across England will trial the conclusions of
the review from Sept 2016 to Sept 2018 and that NHS England will make
available to them a total of £8m over three financial years. The report is
available on NHS England’s website:https://www.england.nhs.uk/wp-content/uploads/2016/02/national-maternity-reviewreport.pdf
__________________________________________________________________
9. Local NHS and planning authority liaison
One of the recommendations of the NHS Workforce Planning in Norfolk scrutiny
task & finish group in 2015 was:That Public Health, Norfolk County Council, takes the lead to co-ordinate liaison
between local planning authorities (LPAs) and the local NHS to
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i)
Create a county wide protocol to ensure that the LPAs consult effectively
with the NHS
ii)
Ensure that the NHS has the necessary information to be able to respond,
based on evidence of growing needs modelled on the LPA geographic
area.
Public Health formally accepted the recommendation from NHOSC on
15 October 2015 and has been working to develop the protocol. Dr Boaventura
Rodriques, Consultant in Public Health Medicine, Norfolk County Council,
provided the following update on 30 March 2016:‘The protocol was endorsed at the Norfolk and Waveney Chief Officers’ Network
meeting held on Wednesday 27 January 2016. There was a general agreement to
adopt the protocol with suggestions to raise its profile and scope.
The above is in addition to West Norfolk CCG and South Norfolk CCG presenting to
their respective Governing Boards for approval.
The protocol remains a live and iterative engagement document between healthcare
commissioners (CCGs and NHS England) and local planning authorities with Norfolk
County Council (NCC) Public Health (PH) acting as a central or a link organisation
providing professional expertise. We have already been involved regarding a major
development in West Norfolk. However, it is up to the healthcare commissioners,
statutorily, to determine the exact provision of primary care facilities. It is likely that
they will take a cumulative approach to primary health care (such as GP surgeries)
planning by a larger area rather than by each development, to ensure that such a
provision is sustainable.
The protocol has two essential elements. The first is a modelling tool to forecast
broad healthcare facility needs. The other is a check-list for each housing
development to ensure that it promotes health living that would reduce ill-health and
thereby long term demands on healthcare facilities. Norfolk County Council Public
Health and Planning Services will jointly be hosting a workshop to finalise the checklist. The workshop will take place on 28 April 2016, 14.00 to 16:00 at Norfolk County
Council, County Hall, Norwich.’
For further information, please contact:Dr Boaventura Rodrigues
Consultant in Public Health Medicine
Email: boaventura.rodrigues@norfolk.gov.uk
________________________________________________________________
10. Norfolk Community Health and Care NHS Trust – chairman steps down
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Norfolk Community Health and Care NHS Trust issued a press release in
February to announce that Ken Applegate, its Chairman since 2010, would be
stepping down from his role in May 2016.
The NHS Trust Development Authority has started a formal recruitment process
for a new chairman.
___________________________________________________________________
11. Friends and Family Test – latest results
Healthwatch Norfolk regularly publishes the results of local NHS organisations’
Friends and Family Tests on its website. The latest results up to January 2016 are
available through the following link:http://www.healthwatchnorfolk.co.uk/friends-and-family-test/
_______________________________________________________________
NATIONAL
12. NHS whistle-blowing consultation – primary care
In the ‘Freedom to Speak Up’ review published in February 2015, Sir Robert
Francis concluded that there is a serious issue with whistle-blowing in the NHS
that ‘requires urgent attention of staff are to play their full part in maintaining a
safe and effective service for patients’. He recommended that whistle-blowing in
primary care (GP services) should be reviewed separately.
NHS England has drafted a whistle-blowing policy specifically for primary care
and launched a national consultation on 1 April. The consultation, which is open
to all, will run until 6 May 2016.
Further information is available on the NHS England website:https://www.engage.england.nhs.uk/consultation/wwhistleblowing
_______________________________________________________________

Information sources
Website addresses for the main sources of health care information are published
in this Briefing each month:Department of Health
www.gov.uk/government/organisations/d
epartment-of-health
NHS England
www.england.nhs.uk
Care Quality Commission
www.cqc.org.uk
National Institute for Health and Care
Excellence (NICE)
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www.nice.org.uk
NHS Choices
www.nhs.uk/Pages/homepage.aspx
Local Government Information Unit
www.lgiu.org.uk
(you need to register to use this site)
Norfolk Insight (including Joint Strategic
Needs Assessment)
www.norfolkinsight.org.uk
Centre for Public Scrutiny
www.cfps.org.uk
NHS Great Yarmouth and Waveney
Clinical Commissioning Group
(HealthEast)
www.greatyarmouthandwaveneyccg.nhs.
uk/
NHS Norwich Clinical Commissioning
Group
www.norwichccg.nhs.uk
NHS North Norfolk Clinical
Commissioning Group
www.northnorfolkccg.nhs.uk
NHS South Norfolk Clinical
Commissioning Group
www.southnorfolkccg.nhs.uk
NHS West Norfolk Clinical
Commissioning Group
http://www.westnorfolkccg.nhs.uk/
For further information about any of the items in this Briefing, please contact:Maureen Orr
Democratic Support and Scrutiny Team Manager
Tel: 01603 228912
Email: maureen.orr@norfolk.gov.uk
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