Agenda and minutes

Apologies had been received from Mr A C Roberts (Chairman), Mr P Grove and Prof J W Raine.

Ms J Marriott (Vice Chairman) would take the Chair.

Mr M Johnson was welcomed to the Health Overview and Scrutiny Committee as the new Worcester City representative.

None.

Members of the public wishing to take part should notify the Director of Resources 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 14 July 2014). Enquiries can be made through the telephone number/email address below.

Mr N Stote, Chair of the Save the Alex Campaign, addressed the Committee to raise concerns in relation to the recommendation that the consultant led Delivery Unit at the Alexandra Hospital close.  He believed there was a reluctance by Worcestershire Acute Hospitals NHS Trust to work with other providers and understood that additional capacity to be provided through Birmingham Women's Hospital would not be visible for 2 to 3 years, resulting in pregnant women being forced to travel to Worcester.  He asked what information had been shared with the Committee and whether Members shared his concerns.

(to follow)

The minutes of the meeting held on 17 June 2014 were confirmed as a correct record and signed by the Chairman.

Attending for this item and representing the 3 Worcestershire Clinical Commissioning Groups were:

South Worcestershire Clinical Commissioning Group

Mari Gay, Director of Quality and Patient Safety, Executive Nurse

Ruth Davoll, Urgent Care Strategy Lead

Background

The Health Overview and Scrutiny Committee (HOSC) was reminded of the increasingly integrated approach to health services and winter pressures was a good example of this with various partners working together to plan accordingly.  In addition, the HOSC had discussed the work undertaken on the county wide urgent care strategy earlier in the year.

An evaluation of the winter schemes in 2013/14 was carried out by the Emergency Care Intensive Support Team (ECIST), concluding that:

·         data suggested that the 2013/14 winter schemes did not lead to a significant reduction in emergency admissions or A&E attendance

·         the reduction in type 1 A&E attendances seemed to be part of a longer term trend and nationally attendances were also lower than in the previous winter

·         the A&E conversion rate had been steadily increasing, partly driven by the fall in A&E attendances

·         there was little evidence overall to suggest the schemes collectively reduced admissions or A&E attendances and some schemes were relatively small scale and therefore unlikely to have a measurable impact

·         several of the hospital based schemes were late starting and relied on recruitment.

The evaluation made some recommendations, mainly:

·         patient flow through the Acute Trust needed to be improved

·         new processes, including ambulatory emergency care, assertive management of frailty pathways and a relentless focus on eliminating internal delays, needed to be developed to improve flow

·         the local reliance on community hospitals as a preferred discharge destination needed to be questioned

·         discharge to assess must replace assess then discharge

·         processes to lessen the number of frail older people being admitted to hospital needed to be developed at scale with the ambition of reducing admissions by at least 25%

·         the length of stay in community hospitals should be halved

·         the need for whole system action and collaboration and the avoidance of the temptation to blame others for system failures.

Resilience and Capacity Planning 2014/15

New national guidance on resilience and capacity planning had been jointly produced by NHS England, the NHS Trust Development Authority, Monitor and the Association of Directors of Adult Social Services (ADASS).  Published on 13 June 2014, each Clinical Commissioning Group (CCG) received a one-time funding allocation to support delivery during 2014/15.  In Worcestershire, the allocation was just over £3million across the three CCGs and, to promote maximum benefit, it had been agreed locally to pool this resource.  This was in addition to a proportion of the Better Care Fund already devolved to the CCGs.  Furthermore, additional funding was expected from NHS England to contribute to the delivery of Referral to Treatment waiting time targets.

The guidance made it clear that urgent care working groups needed to evolve into system resilience groups, covering both urgent care and elective activity.  Locally, the Group would need to develop a local operational resilience and  ...  view the full minutes text for item 692.

Attending for this item were:

South Worcestershire Clinical Commissioning Group

Carl Ellson, Chief Clinical Officer

Simon Trickett, Chief Operating Officer

Redditch and Bromsgrove Clinical Commissioning Group

Paul Sheldon, Chief Financial Officer

Future of Acute Hospital Services in Worcestershire

Simon Angelides, Programme Director

Claire Austin, Communications Lead

The Committee was reminded that the last update was on 22 January 2014, at which point, the outcome of the Independent Clinical Review was known and the 'case for change' was developing.

In the subsequent months, NHS England had completed strategic checks and its Assurance Panel was due to meet on 6 August 2014 to decide whether to authorise a consultation process for the Future of Acute Hospital Services in Worcestershire (FoAHSW).

Members were reminded that the Independent Clinical Review Panel had recommended a modified Option 1 (delivering care across all three sites in Worcester, Redditch and Kidderminster, to refine and update the proposals) and this had received a warm response from both the public and politicians.

In summary, the Independent Clinical Review Panel found:

• move inpatient services for sick children to Worcestershire Royal Hospital (WRH) and establish a new paediatric assessment unit at the Alexandra Hospital (AH)
• move consultant led maternity services to WRH
• enhance local access and birthing choice and consider a midwifery led unit in North Worcestershire
• led by consultants, network hospital based emergency services across the County.  Introduce an Emergency Centre at the AH, which would be co-located with a GP led integrated urgent care centre.  At WRH a major emergency centre would be developed
• there was a need for clear communication with the public about the proposed changes
• issues such as transport and ambulance requirements would need to be addressed.

An engagement timetable had been drafted in anticipation of consultation being agreed to start in September.  The three Clinical Commissioning Groups were committed to a widespread and inclusive 12 week consultation and considered it vital to encourage all residents to have a say.  There would be roadshows and public meetings and it was hoped that every household would be delivered a postcard for feedback.  There were also ideas for a Community Bus to travel the County and work to engage with hard to reach groups was developing.  Officers were also committed to utilising existing networks and encouraged all Councillors to spread the word.  NHS colleagues also welcomed requests to attend any stakeholder group if practicable. 

In the ensuing discussion the following main points were made:

• HOSC Members were encouraged with the wide reaching proposals in relation to consultation and engagement, however, expressed caution with a postcard drop, which could get confused with general junk mail by the householder
• When concern was raised about the timing of the consultation, especially the end being near to Christmas, it was noted that there would be ongoing independent analysis of the consultation responses, allowing continuous feedback throughout the 12 week period
• It was noted that the General Election in May 2015 constrained the consultation timescales
• Discussions were ongoing in  ...  view the full minutes text for item 693.

Attending for this item were:

Redditch and Bromsgrove Clinical Commissioning Group

Marion Radcliffe, Urgent Care Lead

Paul Sheldon, Chief Financial Officer

Worcestershire Acute Hospitals NHS Trust

Chris Hetherington, Consultant in Emergency Medicine

Care UK

Rebecca Chislett, General Manager

Zahida Adam

Dr Marion Radcliffe, Urgent Care Lead for Redditch and Bromsgrove Clinical Commissioning Group outlined the proposal for a 'clinical navigation' pilot at the Alexandra Hospital in Redditch, as part of the strategic priority to improve and enhance current systems within the Emergency Department.

In summary, the project would allow a patient to present at the entrance to the Emergency Department and be triaged by a multi-disciplinary team to be navigated to the most appropriate healthcare, whether primary care, social care, general practice, home or the emergency department.  A GP service at the Hospital would be available up to midnight every day of the week, re-opening in the early hours.  It was hoped that in future this provision could be 24 hours a day.

Dr Radcliffe explained that the pilot dovetailed with national initiatives in developing new types of emergency care (type 2 emergency centres) and would provide vital experience to the ongoing reorganisation of hospitals in Worcestershire. 

The overarching benefits included:

• Patients being seen by the right clinician at the right time
• Enhanced patient experience would be achieved with a key focus on self-care and patient education
• Significant reductions in unnecessary acute admissions and attendances
• Improvements in the national 4 hour A&E performance target.

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

• The Pilot would be for a period of one year, introduced from September 2014
• As Care UK provided the out of hours service at the Alexandra Hospital, the transition would not be anticipated to be great and the organisation had experience of clinical navigation elsewhere
• Members were encouraged to hear that small changes to the local environment would take place to show patients clear signage
• If patients were navigated towards making an appointment with their own GP, this could be done immediately through a booking system.  Members felt this was a useful tool as staff would be equipped to undertake this task
• Dr Hetherington suggested that the project would enable patients to be re-directed to primary care more efficiently and would more clearly support patients to navigate the healthcare system.  He also added that data gathered would be extremely useful to the Clinical Commissioning Groups.  There was a risk of creating an increase in demand for the out of hours GP service, but the aim was to redirect appropriate patients to primary care in order to increase capacity in the emergency department to look after sicker patients 
• The Committee supported the Pilot and looked forward to receiving an evaluation report at a future meeting.

This item was deferred until the next meeting.