Agenda and minutes

The Chairman welcomed everyone to the meeting. Apologies had been received from Mr P Grove and Prof J W Raine.

Suzanne O'leary (Democratic Governance and Scrutiny Manager) was thanked for her contribution, as this would be her last meeting before she moved to a new role.

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 8 December 2015). Enquiries can be made through the telephone number/email address below.

None.

To follow

The Minutes of the meeting held on 4 November 2015 were agreed as a correct record and signed by the Chairman.

Attending for this item were:

Worcestershire Health and Care NHS Trust

Sue Harris – Director of Strategy and Business Operations

Mark Dickens – Deputy Director of Operations and Adult Mental Health and Learning Disability Service Delivery Unit Lead

Pete Jordan – Service Lead for Mental Health Employment and Reablement

Jane Thomas – Head of Community and Patient Involvement

Carol Rowley – Mental Health Commissioning Manager

Worcestershire County Council

Jenny Dalloway – Lead Commissioner for Mental Health and Dementia

The Director of Strategy and Business Operations introduced a presentation which set out redesign plans for Employment and Reablement services and specifically the vocational centres.

This formed part of the overall redesign of Primary and Secondary Mental Health Services which the Committee had been briefed on, the intention being to provide further detail about each specific aspect.  In early 2016 the Committee was due to look at redesign plans for Primary and Secondary Mental Health Services and Inpatient Services.

Worcestershire Health and Care NHS Trust was the main provider of Adult Mental Health Services, and the 2016/17 budget was £23.5 million (health) and £8 million (social care). As with any redesign project in the current economic climate, there was an opportunity for savings, in this case of £2.37 million (7.5%), with real ambition to move across £500,000 to the voluntary and community sector.

Other challenges included the transformation agenda, parity of esteem (between mental and physical health care) and financial pressures. There were a range of developments taking place to modernise services and manage challenges in the system; reducing resources, growing demand and changing care needs.

The case for change in vocational services was to develop a more modern service that would build on the significant developments of the previous 5 years, which had seen a shift away from traditional day centres. Helping people in their recovery from mental health through engagement in meaningful activities, particularly towards employment was key and service user feedback indicated a desire to access more 'normative' settings, with support. The Service Lead believed passionately in his service and stressed that employment and reablement was often a central part of recovery, rather than the 'end product'.

The Trust was constantly considering how best to ensure equitable access across the county and the plan was to extend and develop more outreach activities in the community with other partners and groups.

The £250,000 funding reduction, equating to a third of the budget, meant that change was inevitable for vocational centres, and realistically, meant fewer staff and less costs tied up in buildings. However there was a genuine desire to protect elements of facilitated recovery and integrate reablement and employment into the wider redesign of Mental Health Services.

The current service model focused on three vocational centres - Link Nurseries in Powick, Orchard Place in Redditch and Shrub Hill Workshop in Worcester. The centres provided a more supported environment to build confidence and skills before service users progressed to other community activities. There had already been success in starting linked community  ...  view the full minutes text for item 768.

The Chairman had requested an additional urgent item – Item 7 (Quality of Acute Hospital Services), which would be considered ahead of Item 6 (Health Overview and Scrutiny Round-up).

Subsequently, the Chairman deferred item 6 until the next meeting.

Attending for this item from Worcestershire Acute Hospitals NHS Trust (the Trust) were:

Chris Tidman – Chief Executive (Interim)

Lisa Thomson – Director of Communications

Marie-Noelle Orzel – Improvement Director

John Burbeck – Deputy Chairman

The Chairman had added this item to the Agenda as a matter of urgency, for HOSC to be updated on the quality of services at the Trust following the Care Quality Commission's (CQC) decision to place the Trust into special measures, as a result of the planned inspection in July 2015.

The outcomes of the inspection had been published on 2 December shortly after publication of the Agenda; press releases from the CQC, the Trust and the Trust Development Authority (TDA) were attached as appendices.

Chris Tidman, the Trust's Interim Chief Executive gave a presentation which included the CQC inspection findings and an update on progress since the previous HOSC discussion in September.

The CQC report on what they find at that moment in time, and it was important to consider the report in a balanced way, and to look at the context of the organisation, which was challenging: sustaining services during the on-going review of future acute hospital service in Worcestershire, pressures on urgent care, finances and the impact on the organisation's reputation.

Attention was drawn to the many positive outcomes from the report, which it was important to recognise and share with staff, without wanting to gloss over the overall report findings. Staff were found to be caring, there was an open culture, and the organisation was clinically led. The need for stability at Board level was being addressed and whilst Accident and Emergency (A&E) remained busy, it was unrecognisable compared to the CQC's unannounced visit in March 2015.

Of the 115 domains rated, the Trust received ratings of outstanding in 2, good in 54, with 13 inadequate and the rest requiring improvement – for the latter this meant that consistency needed to improve, and not that all areas were poor.

The HOSC was shown a grid where services were rated against the key criteria, and shaded as green (good), amber (requires improvement) or red (inadequate). Two overall inadequate ratings (safety and leadership) resulted in an overall inadequate rating for the Trust.

At Worcestershire Royal Hospital (WRH), both Emergency Services and Maternity and Gynaecology Services were operating in very difficult circumstances and yet were judged to be good or outstanding for being caring. The services needed to be managed in a more planned way and taking into account lessons learned. A midwifery expert was assisting with this work.

The recent temporary change to relocate emergency gynaecology services from Redditch's Alexandra Hospital to WRH had been controversial, but had improved staffing resilience. Much of the progress needed within urgent and emergency care was in the gift of the Trust and currently there were still too many times when corridor space had to be used.

There was a similar situation at The Alexandra, with the main areas of concern being women and children's  ...  view the full minutes text for item 770.