Agenda and minutes

The Chairman welcomed everyone to the meeting and advised that this meeting was not being webcast. 

Apologies were received from HOSC members Peter Griffiths, Adrian Kriss, Antony Hartley and Tom Wells.

None.

Members of the public wishing to take part should notify the Democratic Governance and Scrutiny Manager 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 6 December 2023). Enquiries can be made through the telephone number/email listed in this agenda and on the website.

None.

The Chairman invited initial comments from the organisational representatives present.

The new Managing Director (MD) of Worcestershire Acute Hospitals NHS Trust (WAHT) introduced himself to the Health Overview and Scrutiny Committee (HOSC). He reminded the HOSC that his role was MD of WAHT, since WAHT had joined the Foundation Group Partnership of NHS Trusts, of which Glen Burley was Chief Executive and Russell Hardy was Chairman. WAHT had retained its own Board and the MD saw the move as a real opportunity.

Nonetheless, the MD was under no illusions about the challenges for WAHT.  He apologised to residents that recent experiences at Worcestershire Royal Hospital (WRH) and the Alexandra Hospital (the Alex) were not acceptable, which needed to improve at pace.

The majority of those attending the hospitals were older people, and frailty was a big issue, therefore there were plans to rebalance the hospitals by increasing geriatric and frailty teams, and the bed base, with help from social care colleagues and inpatient beds within Herefordshire and Worcestershire Health and Care Trust (HWHCT).  ‘Home First’ was a big campaign.

WAHT was financially challenged, but £4.5m had been identified to address winter schemes, for example, from 18 December two wards would be used (one at each hospital) as general medicine wards, to give increased flexibility to enable the Same Day Emergency Care Ward to provide support.

The Executive Team’s focus was to try to simplify things, including governance, in order to have more pace and hopefully, deliver improvements.

The Divisional Director of Nursing, Urgent and Emergency Care explained that the whole scope of the new project was to co-locate the Emergency Department (ED) with acute medicine and Same Day Emergency Care (SDEC), which would cater for the biggest numbers of emergency patients coming into WRH. There was a separate paediatric emergency department, as well as a GP, diagnostics, CT scanning and X-ray facilities to hand. The new environment was much more seamless and efficient and benefitted staff as well as patients and overall feedback was fantastic.

The Director of Operations (Urgent Care) added that the improved environment had a much larger major area and there were future opportunities for frailty using the first floor and being able to move patients between the two floors was really flexible. There were other pockets which helped prevent people staying too long in the ED, for example co-location of mental health partners, and the team continued to review opportunities for the new area and there was massive potential to work on pathways, including work with partners within the Foundation Group.

The concept of frailty was explained, which resulted from more people living longer with comorbities. The critical key issue was to identify very quickly those people coming into the ED who did not have any particular acute needs, and with the help of HWHCT colleagues, to be able to turn them around within hours, rather than days, to avoid unnecessary time in a hospital bed which was not good for their health –  ...  view the full minutes text for item 1172.

The Director of Performance and Improvement of West Midlands Ambulance Service (WMAS), who was also still a paramedic, gave a brief summary of the slides included in the Agenda, which provided an overview of the Service.

He reminded the HOSC that WMAS had a paramedic on each ambulance, of which there were around 45-50 a day in Worcestershire. 15 Hubs received around 6000 calls a day with 3000 incidents.

WMAS was the only ambulance service rated as outstanding. The Service covered 6 different ICS areas and had an ICS lead.  WMAS had no financial deficit.

While WMAS really valued face to face contact with patients, the Service recognised that an ambulance response was not necessarily what was needed for all patients and a pressurised healthcare system required different ways of working, therefore more people were redirected.  The Director highlighted that WMAS rates for ‘Hear and Treat’ had risen from 4% (in 2019) to 20%. Rates for ‘See and Convey’ showed that only 50% were now transported to A&E. The Service was really pleased with performance on non-call answering which was exceptional compared to other services.

However, WMAS recognised that performance standards to patients at the current time were not acceptable, which led to some patients making their own way to Emergency Departments, and performance was lower compared to the previous year - this was due to a number of factors which had been discussed during the previous Agenda item on patient flow.

WMAS did not provide patient transport services from hospitals in Worcestershire, but this worked well in other very challenged areas. New use of technology was also referred to, including use of drones.

Importantly, sickness absence was being managed and mandatory training was being maintained; staff wellbeing was very important to WMAS as an organisation.

The Chairman invited discussion and the following main points were raised:

·         It was explained that the 6000 calls in relation to 3000 incidents included repeat calls from patients due to the current pressure on the Service.

·         Hear and Treat rates in Worcestershire were good which resulted in less patients being seen in person, and WMAS could also access GP appointments across the region where appropriate.

·         The Redditch Borough Council HOSC representative asked whether the reconfiguration of maternity and paediatric services had resulted in any increase in ambulance activity to Worcestershire Royal Hospital and was advised that activity had remained fairly static.

·         Common themes from complaints were delays in getting to patients due to current pressures, since the public perception was around a prompt response. Productivity in terms of calls responded to per shift had dropped dramatically.

·         When asked about resuscitation of patients on ambulances, the Director advised that paramedics had completed a 3 year degree level programme and were therefore trained in resuscitation. Staff at WRH were very good and would make room for any patient waiting on an ambulance with critical needs.

·         A HOSC member sought the Director’s strategic insight from other areas serviced by WMAS about pressures in Worcestershire  ...  view the full minutes text for item 1173.

The Chairman asked members to prepare questions for the 9 January meeting, the main focus of which was services to avoid people requiring acute hospital stays. In relation to this report, the Chairman reminded members that the Committee’s request for further information and data about access to GP care had been picked up by the ICB representative present at the meeting today.

In relation to the work programme, the following suggestions were made, which would be scheduled as part of agenda planning with the Chairman:

·       Dementia Care – new

·       Routine Immunisation

·       Screening (and whether prostrate screening could be included)

A member who was also on the Children and Families Overview and Scrutiny Panel referred to a request for Scrutiny to consider aspects of West Mercia Youth Justice Service, and the Scrutiny Officers would check arrangements.