Agenda and draft minutes

Apologies were received from Councillor Merfyn Parry.

Councillor Brian Blakeley declared a personal interest in agenda item 5 as his wife worked for the NHS.

There were no urgent matters.

To receive the minutes of the Communities Scrutiny Committee held on 17 May 2018 (copy enclosed).

10.05am – 10.10am

The minutes of the meeting of the Communities Scrutiny Committee held on 17 May were submitted.

There were no matters arising.

RESOLVED that the minutes of the meeting held on 17 May 2018, be received and approved as a correct record.

To receive a joint presentation from representatives of the Welsh Ambulance Service Trust (WAST) and Betsi Cadwaladr University Health Board’s (BCUHB) GP Out of Hours Service on their performance and the work currently being undertaken jointly to improve the care pathway for patients

10.10am – 11.10am

The Chair welcomed representatives from the Welsh Ambulance Service Trust (WAST) and Betsi Cadwaladr University Health Board’s (BCUHB) GP Out of Hours (OOH) Service to the meeting to give a presentation on how both services were working together to improve outcomes for patients through the delivery of a clinically appropriate response rather than focussing on meaningless time targets.

Through the medium of a PowerPoint presentation WAST representatives explained the transformation programme which had taken place in the ambulance services in Wales in recent years.  They highlighted a number of the positive developments that had taken place as part of this transformation programme and shared their experience of implementing the Clinical Response Model (which determined the most appropriate response to deploy to an emergency callout). They recounted the lessons learnt as part of the implementation process and their future aspirations for improving the care pathway for patients.  

Members were also given an overview of the position of the Clinical Response Model in context of the wider organisational and system change within the health service in Wales.

WAST was commissioned by all health boards in Wales to provide an ambulance service to transport patients to their establishments and to deliver appropriate health intervention services en-route to those establishments.  Across Wales the Service dealt within the region of 1,300 emergency calls a day.  The Service - which was Government funded - was free at the point of need. 

Similar to other health and social care services and partly due to demographic changes, it was under constant pressure as the demand for its services was continually increasing.  That increase in demand had highlighted for the Ambulance Service the need to change the operating environment within which they worked. The focus was diverted away from meeting non-meaningful time targets, to improving the experience for the patient when they arrived, to treat them with a view to improving the outcomes for them in the long-run. 

The new Clinical Response Model was at the heart of the transformation programme.  WAST was the first Ambulance Service to adopt this model, however services in both England and Scotland were now following WAST’s lead.    During the presentation WAST representatives:

·         described the ‘designing ambulance into unscheduled care’ process and the agreed Red, Amber, Green (RAG) prioritisation procedure - which was designed to be clinically focused, prudent and safe for all patients;

·         advised that whilst as a Service they had various targets set for specific tasks or areas of work, the only target they were measured against on a national basis by the Government was the 8 minutes target set for responding to a call allocated ‘Red’ status – the highest level emergency;

·         advised that reducing demand for the Service was extremely difficult.  Data evidenced an increase in demand year on year, with future projections also estimating a year on year increase in demand on the Service for the foreseeable future.  Consequently a plan was needed to try and better manage the demand;

·         explained that the Clinical Response Model trialled and adopted in Wales included working with partners - i.e. Health Boards, GPs, Social Services, Police, Fire and Rescue Service etc. - to effectively and appropriately support people who called the Ambulance Service on a regular basis (Frequent Callers). 

For example clinicians were now located in Police and Fire & Rescue Services’ Control Centres to help manage calls received at those centres with a view to appropriately prioritising the Ambulance Service’s response to those calls.  The ‘Hear and Treat’ approach, during which appropriately qualified paramedic and nurse clinicians would undertake telephone assessments  and determine the most appropriate method of treatment for the  ...  view the full minutes text for item 5.

To consider a joint report by the Works Unit and Streetscene Manager and Streetscene Manager (North) (copy attached) which informs members on the residual capacity within the council’s cemeteries, and it outlines the risk areas with regards to future burial capacity.   The report also seeks members’ views on proposed cemeteries fee increase, and outlines the current maintenance regime (and management policies) for all council controlled cemeteries.

11.20am – 12pm

The Lead Member for Housing, Regulation and Environment introduced the joint report (previously circulated) by the Works Unit and Streetscene Manager and the Streetscene Manager (North) which updated members on management matters relating to County Council owned cemeteries, including residual cemetery capacity across the county and potential risk areas with regards to future burial capacity.  He explained further that the report and associated appendices sought the Committee’s views on a proposed increase in burial fees at county-owned cemeteries, whether a task and finish group should be established to consider future capacity in the cemeteries, and also outlined the current maintenance regime and management policies for the cemeteries.  The Lead Member advised that currently Denbighshire charged the lowest burial fees in North Wales, hence the reason for proposing a 5% increase in the fees.  Even if the 5% increase was approved Denbighshire would still be one of the authorities which charged the lowest burial fees in the region.

The Head of Highways and Environmental Services drew members’ attention to Appendix 5 of the report which contained the results of a feasibility study undertaken in 2004 by a Scrutiny Task and Finish Group on a proposal to develop a new cemetery for Rhyl.  The feasibility study had been undertaken at that time due to the limited number of new plots available at the town’s cemetery.  However, due to the costs associated with developing a new cemetery the recommendation had been not to proceed with the proposal.  Since then the town’s cemetery had been closed to new burials.  The remainder of the Council-owned cemeteries across the county had capacity at present to accommodate new burials.  Burial capacity ranged between in excess of 1,000 plots at Coed Bell, Prestatyn to 55 at Llanrhydd, Ruthin.

Responding to members questions the Lead Member, Head of Service and officers:

·         advised that the burial fees outlined in Appendix 2 to the report were the fees charged on Denbighshire residents.  Burial of non-Denbighshire residents were permitted in the county’s cemeteries, however the fees charged were doubled for non-residents.  Nevertheless, individuals and families were willing to pay the additional cost;

·         confirmed that the Council did not have sufficient capacity to undertake the ground maintenance work at the county’s lawn cemeteries, hence the reason it was contracted out to an external contractor.  There was currently a short-term contract with an external contractor for grounds maintenance for the cemeteries in place for the current year.  Officers were presently exploring the possibility of incorporating the cemeteries ground maintenance contract with that for the highways verge grass cutting contract from March 2019;

·         acknowledged some members’ desire to have the grounds maintenance work undertaken in-house.  However the Council did not at present have the capacity to undertake this work, and in the current public services financial climate it was unlikely to be in a position to undertake this work in-house for the foreseeable future, unless revenue funding was diverted to the Service from ‘frontline’ services;

·         confirmed that the current ground maintenance contract specification did stipulate the standard of cutting required, the need to clear excess cuttings, liabilities for damage to headstones etc. All aspects contained in the contract specification were regularly monitored as part of the Council’s contract monitoring process;

·         advised that the Council’s Cemetery Regulations contained details of the regulations and specifications in relation to memorials permitted at Council-owned cemeteries.  This stipulated that no tributes or adornments were permitted lower down on the grave than the base of the headstone and that solar lights were not permitted in cemeteries.  Families were made aware of these rules when purchasing a burial plot and informed  ...  view the full minutes text for item 6.

To consider a report by the Scrutiny Coordinator (copy enclosed) seeking a review of the committee’s forward work programme and updating members on relevant issues.

12pm – 12.15pm

A copy of a report by the Scrutiny Co-ordinator, which requested the Committee to review and agree its Forward Work Programme and which provided an update on relevant issues, had been circulated with the papers for the meeting.

A copy of the Members Proposal Form had been included in Appendix 2.  The Cabinet Forward Work Programme had been included as Appendix 3, and a table summarising recent Committee resolutions and advising on progress with their implementation, had been attached at Appendix 4.

Members were reminded that the August recess was approaching but any scrutiny proposals forms received up to mid August would be considered at the Scrutiny Chairs and Vice-chairs Group on 6^th September.

The Communities Scrutiny Committee in September had two weighty items scheduled – the proposed new Waste & Recycling Model and the implementation of Welsh Government’s free childcare offer in Denbighshire. Given the potential public interest in both items the meeting would be webcast.

It was agreed that the report on Tourism, Events and Destination Management be deferred to the Committee’s October meeting.

RESOLVED – subject to the above to approve the appointments and the Committee’s forward work programme.

To receive any updates from Committee representatives on various Council Boards and Groups

12.15pm – 12.30pm

None.