Agenda and minutes

The Chair welcomed everyone to the meeting. Apologies had been received from Cllr Tony Baker.

None.

Members of the public wishing to take part should notify the Head of Legal and Democratic Services in writing or by email indicating the nature and content of their proposed participation no later than 9.00am on the working day before the meeting (in this case 26 April 2016). Enquiries can be made through the telephone number/email address below.

None.

Previously circulated

The Minutes of the meeting held on 10 March 2016 were agreed as a correct record and signed by the Chairman.

In attendance for this item were:

Future of Acute Hospital Services in Worcestershire - Lucy Noon, Programme Director

Clinical Commissioning Groups

Simon Trickett, Interim Chief Officer (Redditch and Bromsgrove CCG and Wyre Forest CCG) and Chief Executive Officer (South Worcestershire CCG)

Carl Ellson, Chief Clinical Officer (South Worcestershire CCG)

Worcestershire Acute Hospitals NHS Trust – Chris Tidman, Interim Chief Executive

Simon Trickett, Chief Executive Officer (SWCCG) and Interim Chief Officer (RBCCG and WFCCG) introduced the presentation, intended to provide an update on the Future of Acute Hospital Services in Worcestershire (FoAHSW) Programme.

The HOSC was shown a chart which captured a brief history of the programme, which had been initiated in 2012 by the Worcestershire Primary Care Trust, originally with the aim of completion before the introduction of clinical commissioning groups; over four years on, everyone agreed that the delay was regrettable, and in particular the impact on services.

Progress since the West Midlands Clinical Senate Report June 2015

Two particular areas of focus had been urgent care and associated paediatric elements of the model, which had been redesigned through an Emergency Care Redesign Group.

Engagement with clinicians and GPs was on-going, creating greater cohesion. Formal approval of the clinical model by all three CCGs was a significant step and reaffirmed the case for change.

Monitoring of patient safety, service quality and sustainability took place through a monthly multi-agency committee.

Emergency changes to gynaecology, maternity and neonatal services had taken place on the grounds of patient safety – services had been centralised at Worcestershire Royal Hospital.

Activity and the capacity model were to be finalised by May 2016. The Clinical Senate had returned the previous week to review progress and it was very much hoped to receive their report by the end of May, and be in a position to complete the NHS England assurance process and proceed to public consultation in September. The HOSC's input to consultation plans would be sought.

The case for change centred around neonatal, maternity and emergency care, where workforce sustainability issues had been flagged up previously, and had proved to be true – however everyone involved would have wanted changes to evolve in a planned way.

Summary of the Clinical Model - The proposed model included:

·         Delivering care locally for the majority of patients, with no change to the majority of existing services

·         Separation of emergency and planned care to improve outcomes and patient experience

·         Centralisation of inpatient care for children

·         Centralisation of consultant-led births

·         Centralisation of emergency surgery

·         Creation of centres of excellence for planned surgery

·         Adult-only emergency department at the Alexandria Hospital (the Alex) with robust arrangements for managing a seriously sick child if they arrive unexpectedly or their condition deteriorates whilst they are in the department

·         Urgent Care Centre for adults and children at the Alexandria and Worcestershire Royal Hospitals

·         The Alexandria Hospital will continue to care for undifferentiated adult medical patients - except heart attacks and strokes which are already centralised at Worcestershire Royal Hospital.

The West Midlands Clinical Senate  ...  view the full minutes text for item 782.

In attendance for this item from Worcestershire Acute Hospitals Trust were:

Chris Tidman, Interim Chief Executive

John Burbeck, Interim Chairman

Representatives from Worcestershire Acute Hospitals' Trust (WAHT) had been asked to provide an update on the quality of hospital services, and in particular with the Patient Care Improvement Plan.

Chris Tidman talked HOSC members through the Plan, which was also published on the Trust's website, and followed the standard approach required of any Trust where the Care Quality Commission (CQC) had asked for improvements to be made. It was important to note that alongside oversight by the HOSC, the Trust was held to account at various other levels.

Key issues from the CQC's inspection report centred on:

·         Outpatient Strategy

·         Women and Children's services

·         High Dependency Unit Review Emergency Surgery Reconfiguration

·         Governance and Safety (All Divisions)

A return visit by the CQC in November would determine whether the Trust could move out of special measures, and green ratings across the board were aspired to.

Key achievements

·         Within Women and Children's Services, huge strides had been made in terms of safety, governance and lessons learned, which was recognised by the CQC and the 'buddy' Trusts. Caesarean birth rates had reduced considerably.

·         Infection control was much better

·         Health Education England had greater assurance in the Trust's work with junior doctors

·         There was good progress with the reconfiguration of acute hospital service programme.

Emergency Departments had shown greater resilience over a very challenging winter, because of building blocks which had been put in place. As discussed under the previous agenda item, capacity issues for ambulance handover would be further improved by continuing to move away from the perspective of a patient needing to be admitted to a bed to receive treatment. More effective triage would help.

A 'big conversation' approach was changing the working culture, including more work with internal communications.

Work streams

The three big priorities were:

·         urgent care and patient flow

·         avoidable mortality

·         organisational development / staff engagement

The Chief Executive talked through workstreams for each priority area, and improvements to date, and a graph showing numbers of Primary Mortality Reviews completed between June 2015 and February 2016 was an example of how far the Trust had improved.

Staff training was hugely important to retain and attract staff. Work was continuing on recruitment and retention, including links with training colleges.

Culture and honesty were key, and the Trust had learned the importance of different levels and approaches of communication.

Next steps – included:

·         Improvement framework agreed, with a 'bottom up' approach

·         Support in place for full development of project plans and improvement trajectories in time for May 2016 QORG meeting

·         Mock inspections to prepare for the re-visit from the CQC in November

·         Stability of leadership Team – Chair, Director of Finance and Chief Nurse soon to be appointed and there were strong interim arrangements in place.

Main discussion points

The Trust was congratulated on its work to address the areas identified by the CQC, and set out the processes in place to  ...  view the full minutes text for item 783.

The Committee agreed the approach for providing comments on draft Quality Accounts of local organisations providing NHS services in 2015-16.

Once received, Quality Accounts would be circulated to HOSC members, and lead members (those nominated by HOSC to have oversight of an organisation) would be asked to draft an initial statement, which would be circulated to the Committee. Other members would then be invited to ad comments and after consultation, the Chairman would agree the statement for submission within the 30 day consultation period.

Cllr Smith, Vice-Chair reported that Worcestershire's community hospitals would now all have a matron.

From Wyre Forest, Cllr Rayner expressed concerns about the impact on staff of plans to close the GP-led unit in Kidderminster. The Chairman advised that the scrutiny team was liaising with commissioners and Cllr Oborski (as Wyre Forest District Council HOSC member, who had alerted the Committee to this issue), and an update would be provided.

Cllr Vickery expressed concern about performance of the NHS111 contract, which the scrutiny team would follow up for possible scrutiny.

Cllr Cooper asked about plans to scrutinise the Health and Wellbeing Board, and the Democratic Governance and Scrutiny Manager advised that this had been a popular suggestion from the recent work programme consultation exercise, and would be included in the overall scrutiny work programme which would be discussed by Council at its meeting in May.