The Adults and Health Select Committee recommended that Adults, Wellbeing and Health Partnerships (AW&HP) produce an information booklet on Discharge to Assess, that Frimley Health NHS Foundation Trust be clearer about who is leading the new hospital programme, and that the new Joint Health Overview and Scrutiny Committee terms of reference be endorsed.

Discharge to Assess

Healthwatch Surrey gave a presentation to the committee on their findings around discharges from acute hospitals in Surrey.

They reported that GP access remains a serious concern for service users and that whilst the introduction of cloud telephony for GP practices in Surrey is working well where it has been implemented, there are still areas where residents are experiencing difficulties in making contact with their GP.

Healthwatch went on to describe how the new NHS App is confusing some service users, how the Pharmacy First scheme is causing difficulties for both patients and pharmacists, and how there are serious problems with children's mental health care in Surrey.

The main topic of the Healthwatch presentation was Discharge to Assess. They described how people are still experiencing problems with assessments not taking place in a timely manner, and how carers and family members are not being properly consulted. They reminded the committee of the four recommendations they had previously made in 2021 following a review undertaken in conjunction with Action for Carers Surrey:

1. Carers should be properly identified.
2. There should be a single point of contact for communication.
3. Communication pathways between professionals should be improved, including how wards contact carers.
4. The discharge process should be properly explained, including provision of a discharge guide and continuity of professional care.

They welcomed the production of the 'Hospital Discharge Guide: A practical guide to all the support you are entitled to as a carer when the person you care for is being discharged from hospital', which has been produced by Action for Carers and can be found on their website.

Councillor David Harmer asked about the low levels of provision of reablement in Surrey, which the Executive Director for Adults, Wellbeing and Health Partnerships described as a key ambition for the council. She explained that the satisfaction rates for reablement are high, and that it can prevent the need for more expensive long-term care packages and also reduce the pressure on acute hospitals, but that at present, the service is too small to meet demand.

Councillor Frank Kelly asked about the mental health of carers in Surrey. The Independent Carers Lead for Surrey Heartlands ICS described some of the key issues experienced by carers, and how the ICS and the Council are working to support them, including:

• Difficulty in identifying who carers are, with estimates of the true number being much higher than the 100,000 that were recorded in the 2021 Census.
• Working with voluntary sector partners through the Better Care Fund.
• The use of the Innovation Fund to allow the development of new solutions that have been co-produced with carers.
• Provision of emergency plans for carers to ensure the person they are looking after can be cared for if the carer themselves becomes ill.
• Pilot projects to improve mental health support, the outcomes of which will be reported to the new Carers Partnership Group.

Councillor Frank Kelly also asked about the robustness of the Council's vetting procedures for care providers. The Executive Director of AW&HP explained that they are taking an active role in ensuring the probity of care providers, especially given the concerns that have been raised about the international recruitment of care workers. The committee requested further information on the processes involved.

Councillor Rebecca Jennings-Evans asked about the availability of internet connectivity for patients, especially given that it is a key requirement for many health-based self-management technologies. She also asked about support for residents who are not able to engage digitally. The Executive Director responded that this is an important concern that the council is currently scoping. She noted that good internet connectivity is not a given for many residents in Surrey, and explained that the council is in the process of phasing out analogue assistive technologies like pendant alarms. She also pointed out that older people, in particular, may not be able to engage digitally, even if their children are able to help them. She agreed to bring a written response on the subject to a future meeting.

Councillor Rebecca Jennings-Evans also asked about the work being done by the NHS and the Council to support recruitment and skills development in Surrey. The ICS Development Director described the work being done by the newly established Surrey Heartlands Health and Social Care Academy and listed several initiatives that were already in place, including:

• The provision of training places for care workers.
• Level 2 team leader training funded by Nescot.
• Joint bids with the Council to support volunteering.
• Use of the 'Working Well' programme to help people on long-term sick leave to return to work.
• Support for Surrey Choices' 'In Surrey, For Surrey, By Surrey' scheme.
• The rollout of the Oliver McGowan mandatory training.

The committee requested a written report on skills and recruitment.

Councillor Riasat Khan asked about the use of technical measures such as monitoring services and how the council ensures they are deployed in a timely and sensitive way. The ICS Development Director, the Director of Delivery for East Surrey Place, and a Surrey Downs Frailty Consultant described the work that is being done using WHZAN Blue Boxes in care homes, remote monitoring for patients at home, and remote monitoring through virtual wards. The Frailty Consultant also noted that technology is not always the solution and that human contact and proper clinical assessment will always be important.

The committee made the following recommendations in relation to Discharge to Assess:

1. AW&HP should produce a simple information booklet and ensure it is properly distributed.
2. AW&HP should provide an update on how they are managing demand for acute beds.
3. AW&HP should provide information on the vetting of care organisations, including training for carers.
4. AW&HP should provide an update on what changes are being implemented to the transformation work in response to the report from Healthwatch Surrey on Discharge to Assess processes.

A new hospital to replace Frimley Park Hospital

Frimley Health NHS Foundation Trust gave an update on their work to replace Frimley Park Hospital.

Councillor Edward Hawkins expressed disappointment with the low level of engagement by the Trust, noting that they had received only 3,399 responses to their survey, despite having a customer base of around half a million people. He was also concerned that only 25% of the Trust's staff had responded to the survey. The Director for Partnerships and Engagement responded that they were committed to doing more and that the engagement process was still at an early stage.

Councillor Karve asked how the Trust were addressing cultural and language barriers in their engagement work and how they had engaged with ethnic minority groups. The Director for Partnerships and Engagement responded that reducing health inequalities is a core ambition for the Trust and that they are working with various community groups, including faith leaders, the voluntary sector, and interpretation services. They conceded that their work with ethnic minority groups had not been as successful as they had hoped and explained that they would be redoubling their efforts, including working with Surrey Minority Ethnic Forum and the Surrey Coalition of Disabled People. Councillor Karve also asked to see the questions that had been used in the engagement survey.

Councillor Mallet asked about the emphasis placed on bus transport in the engagement, pointing out that there was a need to reduce the reliance on car travel for ecological reasons. The Interim Programme Director replied that they are looking at how they can improve public transport links. Councillor Mallet also expressed concerns that only 1% of survey respondents felt the appetite of the landowner to sell was an important consideration.

Councillor Mallet then raised concerns about the timeframe for the project, pointing out that the Trust had previously said that they would be laying the first brick within 15 months. The Interim Programme Director conceded that the 2030 deadline was challenging, but that they were confident they could meet it.

Councillor Mallet then criticised the engagement exercise itself, describing it as limited, and suggested that the Trust should instead visit the Queen Alexandra Hospital in Portsmouth.

The Chair picked up on Councillor Mallet's point about the need for a future-proofed hospital, asking what consideration had been given to how the NHS is changing and how medicine is developing. The Director for Partnerships and Engagement explained that they are committed to taking a whole-systems approach, including use of technology and development of care pathways that allow patients to be treated closer to home.

The Chair expressed concerns about the challenges at the existing Frimley Park Hospital site. He noted the difficulties with traffic congestion and lack of parking, and the pressure that this is putting on local residents. The Chair asked what would be done to alleviate the problems in the interim period before the new hospital is built. The Director of Partnerships and Engagement acknowledged the problems and explained that they would continue to work with partners. The Interim Programme Director explained that they are looking at a phased approach to moving services, and how this could help to reduce pressure on the existing site.

Councillor Davis-Harmer asked if the Trust was confident that the existing site would be safe until the new hospital opens. The Interim Programme Director explained that they are working with specialist advisors and the Health and Safety Executive to ensure the safety of the existing site, especially given the presence of RAAC.

The Chair expressed concerns about the sustainability of the new hospital, noting the potential impact on net zero and biodiversity. He reminded the Trust that they would be expected to show a 10% biodiversity net gain. The Interim Programme Director explained that sustainability was a key consideration for the project and that they were committed to building a net zero hospital that makes use of modern, environmentally friendly technologies. The Chair also cautioned the Trust against an over-reliance on new technologies, citing the problems with RAAC.

Councillor Mallet suggested that the Trust would need to look at a Green Belt site.

Councillor Mallet asked if an architect had been appointed. The Interim Programme Director responded that they have a full professional team in place, including an architect.

Councillor Hawkins asked how the project was being managed. The Interim Programme Director responded that they have a robust governance system in place, including a programme team that reports to the Trust Board, which then reports up to the Department of Health and Social Care.

The Chair raised concerns about access for disabled people and the need to consider health inequalities. He said that access to disabled parking at Frimley Park Hospital was a serious concern and that the Trust needed to take into account the needs of people with mental health problems and those on low incomes, who may not be able to afford public transport.

Councillor Kelly asked about the relationship with the armed forces, given their presence at the existing site and the recent decision by the Army to expand their activities at Pirbright. The Director of Partnerships and Engagement replied that they have an excellent relationship with the armed forces and that they would continue to work with them.

The committee made the following recommendations to Frimley Health NHS Foundation Trust in relation to the new hospital:

1. The Trust should continue to make their plans public and consider how they are going to continue to engage the community.
2. The consultation process should continue throughout the development of the new hospital.
3. The Trust should review what has been done so far and how it will be monitored.
4. The Trust should ensure that services are maintained.
5. Communications should be timely and provide details about the choice of site, and any foreseen issues.
6. The Trust should be clearer about the leadership and management arrangements for the project.
7. The Trust should improve public and staff consultation, especially for lower paid staff and low-income groups.
8. The Trust should provide information on how they will resolve potential transport issues such as car parking, car access and public transport.

Joint Health Overview and Scrutiny Committee

The committee discussed the proposed new Joint Health Overview and Scrutiny Committee (JHOSC). The JHOSC has been set up because the footprint of the new hospital will cross local authority boundaries, and there is a requirement in law for a joint committee to scrutinise substantial changes to health services when this is the case.

The proposed JHOSC will include four members from Hampshire County Council, four from Surrey County Council, and two from Bracknell Forest Council. Other local authorities whose residents use Frimley Park Hospital, will be allowed to send observers to meetings. The terms of reference were agreed and referred to full council for approval.

Recommendations Tracker and Forward Work Programme

The committee noted the recommendations tracker and the forward work programme. The Chair explained that the forward work programme would need to be reviewed, given that an impossible amount of work was scheduled for May.