Agenda and minutes

Apologies had been received from Prof J W Raine and Mr G J Vickery.

Following the local elections in May 2015, District Council Representation on HOSC had changed.  The Chairman expressed his thanks to former HOSC Members Jan Marriott, Pat Witherspoon and Mike Johnson and welcomed their newly appointed replacements, Mr Tony Baker from Malvern, Mrs Nina Wood-Ford from Redditch and Mr Andy Stafford from Worcester.

In addition, the Chairman welcomed Mrs Frances Smith as Vice Chair – an appointment which is taken from and decided by District Council Representatives.  The appointment will be forwarded to Council in September for final approval.

Mr Stafford declared an interest as a Partner in Actons Opticians Worcester with his wife who is an Optometrist. She is also Vice Chair of the Worcestershire Local Optical Committee and involved in the negotiation and the delivery of Community Optometry Services with South Worcestershire and Wyre Forest CCGs.

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 14 July 2015). Enquiries can be made through the telephone number/email address below.

None.

Previously circulated

The Minutes of the Meeting held on 22 April 2015 were agreed as a correct record and signed by the Chairman.

Attending for this item were:

South Worcestershire Clinical Commissioning Group

Simon Trickett, Chief Operating Officer

Lynda Dando, Head of Primary Care

Redditch and Bromsgrove / Wyre Forest Clinical Commissioning Groups

Jan Butterworth, Director of Primary Care

NHS England

Donna MacArthur, Head of Primary Care for Midlands & East of England Region

A presentation had been prepared which outlined the background, changing commissioning arrangements, development of local plans and delivery of 7 day access to services.

In summary, from the creation of Clinical Commissioning Groups (CCGs) in April 2013 to now, NHS England (NHSE) had commissioned primary care (which included GP services, pharmacies, dentists and opticians). 

From January 2015, and starting from April 2015, CCGs were invited to apply for a level of involvement in commissioning of GP services.

In Worcestershire, South Worcestershire CCG agreed to "full delegated responsibility" (taking the budget and full responsibility from NHSE) and Wyre Forest and Redditch and Bromsgrove CCGs agreed to "joint commissioning with NHSE" whereby the budget would be retained by NHSE but commissioning would be undertaken jointly.

Early discussions had taken place to determine how conflicts of interest would be managed, recognising that GP practices could therefore be responsible for commissioning as well as providing services as there were 66 GP Practices in Worcestershire and all are members of a CCG.

NHSE would continue to contract with GPs under the General Medical Services contract and a national per patient fee for core GP services was expected to be standardised by 2020 at £78.77.  The new arrangements enabled CCGs to commission additional services which reflected their agreed local key priorities.

South Worcestershire CCG Arrangements

There are 32 GP practices, with £22.3m allocated for core General Medical Services. 

The CCG would also look to commission services which reflected their agreed key priorities, such as:

·         local 'enhanced' services (extra provision to keep people out of hospital) to the sum of £2.4m

·         local 'promoting clinical excellence' contract to the sum of £1.3m (to include proactively caring for frail elderly, medicines optimisation, focus on particular clinical interventions) with the desired outcome of reducing the need for patients to go into hospital

·         creating a commissioning committee to oversee strategy developments and making decisions

·         managing conflicts of interest.

It was intended that negotiations would take place with Practices to deliver these services on top of core requirements and the CCG would be responsible for monitoring delivery.  

Redditch and Bromsgrove CCG Arrangements

There are 22 GP Practices, with £21million allocated to core General Medical Services.  Although the CCG had agreed to work on a joint committee model from April 2015, it was hoped that full delegation be granted by April 2016.  Like SWCCG, a lay Chair had been appointed to avoid any conflict of interest.

£1.42m had been allocated for local 'enhanced' services, £391,000 for medicines optimisation, £258,000 for engagement schemes, and £128,000 for reinvestment.

Ensuring that GP Practices had extended hours and cover over bank holidays was a local priority and the Clinical Navigation Unit at the Alexandra Hospital in Redditch  ...  view the full minutes text for item 747.

Attending for this item were:

Worcestershire Acute Hospitals NHS Trust (WAHT)

Harry Turner, Chairman

Rab McEwan, Interim Chief Operating Officer

Following an unannounced Care Quality Commission (CQC) inspection in March 2015 of the Trust's two Emergency Departments (EDs) and subsequent publication of findings, an Action Plan had been drawn up.  By way of presentation, the Trust's Chairman and Chief Operating Officer explained what action had been taken since March.

Staffing levels had increased, procedures had been put in place to provide better patient care and work was being done to rebuild relationships, both with partners and between staff at hospital sites.

There was concern about patient flow through the EDs and although not yet perfect, improvements had been made, including clarifying the criteria for discharges and transfers in order to reduce delays.  One example was cited whereby 14 patients on a particular day were not in need of acute care, but had no sub acute setting to move to, suggesting that a needs assessment for stroke rehabilitation was not wholly accurate.

An urgent care transformation team had been established and early successes included the expansion of the ED discharge lounge, in the hope of freeing up beds earlier in the day.  Along with ambulances being offloaded quicker and corridors being kept clear, improvements had taken place but the system had a long way to go to be perfect.

In addition, capital funding had been secured to create around 150 new car parking spaces at Worcestershire Royal Hospital and subject to planning, should be completed by the end of the year.

When looking at data in relation to the number of patients dying in hospital and within 30 days of discharge, there was an increase in December 2014/January 2015 over and above what would be deemed as normal during winter months.  With 35% of deaths occurring post discharge during these months, a process had been agreed with CCGs and GP Practices to analyse this data further.  One consideration was the increased positivity of end of life care.  The Committee noted that the figures had improved for February 2015.

Adult Safeguarding was being supported by closer working relationships between the Trust and Lead Social Workers.

A follow up Risk Summit had taken place with stakeholders and progress had been noted with further actions agreed, including the reduction in mortality rates and the need to plan for the fragility of maternity and emergency care services.

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

·         One Member asked whether patients were being sent home too early, contributing to high mortality rates after discharge.  It was difficult to comment, but the piece of work to look at individual cases was to be available by the end of the financial year

·         In relation to patient flow, a change in mindset was required and this would take time.  The concept of discharging earlier in the day was possible, but would need new ways of working to be embedded

·         With national difficulties with recruitment, particularly in the  ...  view the full minutes text for item 748.

The Chairman invited updates from around the County.

From Wychavon, it was reported that there were rumours that restaurant services may be reduced in the community hospitals, having a detrimental effect on both patients and visitors.

In Bromsgrove, there was nothing to report other than the Alvechurch GP Practice issue discussed earlier.  Healthwatch confirmed that they had contacted South Birmingham CCG and a meeting involving the Parish Council was due shortly.

Wyre Forest Local Strategic Partnership was undertaking some work on childhood obesity, statistics were available at ward and school level that may be useful to all Councillors.

There was nothing to report from those present from attendance at any NHS Board Meetings.