Agenda and minutes

Apologies were received from Mr T Baker, Mr G R Brookes, Mr C Hotham, Prof J W Raine and Mr R P Tomlinson.

Mrs F Smith declared an Interest as her husband was the Cabinet Member with Responsibility for Health and Well-being.

Ms P Agar declared an Interest as her husband worked at Worcestershire Royal Hospital.

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 January 2018). Enquiries can be made through the telephone number/email address below.

None.

Previously circulated

The Minutes of the Meeting held on 17 October 2017 were agreed as a correct record and signed by the Chairman.

Attending for this Item were:

Frances Howie, Director of Public Health, Worcestershire County Council

Sue Harris, STP Communications and Engagement Lead, Worcestershire Health and Care NHS Trust

Ruth Lemiech, Director of Strategy, Worcestershire Clinical Commissioning Groups

A presentation was given which outlined the national and local background to STPs, highlighting that the NHS Five Year Forward View set out plans to improve health and well-being, improve quality of services and narrow the funding gap.  After consultation and engagement during 2016/17, the Herefordshire and Worcestershire Sustainability and Transformation Plan was published in Summer 2017 and the 'P' for Plan was changed to Partnership to reflect the joint working required in the implementation phase.

Structurally, a Partnership Board had been formed, which had an Independent Chairman.  Its remit was to oversee the delivery of the Plan through various sub groups.  Membership was drawn from clinicians, managers and leaders from across all programme areas and both Counties.

Triple Aims were often referred to and for the STP, these were:

·         Health and Well Being (improving Health Outcomes)

·         Care and Quality (improving Care and Quality)

·         Finance and Efficiency (delivering Financial Sustainability).

The STP vision was described as 'local people will live well in a supportive community with joined up care underpinned by specialist expertise and delivered in the best place by the most appropriate people'.  Within Worcestershire, there were already good examples of health economy partners working together to achieve better outcomes for residents.

The Presentation also explored Accountable Care Systems (ACS), where the NHS England definition was 'An ACS is an evolved STP through which local organisations take collective responsibility for the performance of their system'.

Nationally, it was hoped that STPs would evolve to become Accountable Care Systems, where NHS organisations (both commissioners and providers), in partnership with local authorities, choose to take collective responsibility for system resources and the population's health, providing joined up, better co-ordinated care, acting and behaving as one single system even though in law there are a number of distinct entities with distinct duties.

Nationally, in time, as ACSs demonstrate their ability to act collectively as a system, greater control and freedoms may be given.

Further developments were cited in relation to the ways in which working across organisations was already occurring, such as winter planning, a system wide focus on frailty and diabetes and extended access to Primary Care.

Next Steps included strategic discussions at all partners' Boards, including the County Council, to agree a set of principles which would guide the work towards accountable care.

In the ensuing discussion, the following main points were raised:

·         Members noted the shift from Sustainability and Transformation 'Plan' to 'Partnership', but agreed that the language used was not clear and the concept continued to be confusing

·         The Committee noted that some partners had statutory duties to fulfil and these would have to be taken into account when looking at future services, unless there was a move to change legislation.  Despite the desire to work collaboratively, it was  ...  view the full minutes text for item 867.

Michelle McKay, Chief Executive for Worcestershire Acute Hospitals NHS Trust, attended for this Item and took Members through the Agenda Report.  In the general discussion, the following details and questions were addressed:

·         Since the Care Quality Commission (CQC) had served a section 29A notice on the Trust in January 2017, requiring significant improvement, a number of inspection visits had taken place, both expected and unannounced.  Most recently, service reviews of 4 services (out of 22 core services) and a focussed assessment on governance was undertaken in November 2017 and the report published on 17 January 2018

·         Positively, the report showed that all 4 core services inspected showed improvement since the last inspection, however, given the fact that not all core services were reviewed, the overall judgement for the Trust had not changed

·         The CQC had also advised that they would conduct a 'well led' review at the end of February 2018 and review further core services over the coming weeks

·         Members were very pleased to note the progress made, the positive effect that substantive leadership was having and it was clear that the Chief Executive was driving forward the agreed change programme.  When asked, it was clarified that all Board Member positions had been successfully filled

·         In response to a question, the Chief Executive commented that it was not a surprise that there had been no movement on 'well led' for Urgent Care as the Division was newly formed (following the split from the Medicine Division) with a new Leadership Team, a fact which CQC acknowledged

·         Training was a key focus in the improvement programme and the signature behaviours of 4ward was a part of this:

§  Do what we say we will do

§  No delays, every day

§  We listen, we learn, we lead

§  Work together, celebrate together

·         Winter Pressures had seen a massive increase in activity and for the period 22 December 2017 to 16 January 2018, an additional 418 patients presented to the two acute hospitals A&E departments and there was an additional 264 ambulances.  It was pleasing to note that there had only been 3 12hour trolley breaches in this time, compared to 135 for the same period last year and the amount of time patients spent in corridors was considerably less than last year

·         During this period, ambulance waiting times also deteriorated and handover delays were especially problematic when there was a surge in activity

·         Prior planning across all health economy partners had built on previous practice and an additional £2.6m of winter pressure funding had helped, however, patient flow continued to be an issue and therefore focus for the Trust and other partners

·         In response to a question, Members learned that only around 30 to 35% of patients presenting at A&E were admitted to hospital and the Committee discussed other options available to residents, including GP access, pharmacies and Minor Injury Units.  It was felt that clarity was needed across the health sector to inform residents of the options and  ...  view the full minutes text for item 868.

When asked whether any Member wished to report any activity from around the County, Cllr Smith raised concern about the future viability of hospital shops nationally if NHS England progressed with their plan to insist in a reduction in sales of sugary drinks and high calorie snacks.