Agenda and draft minutes

The Chairman welcomed everyone to the meeting.  Apologies were received from Councillors Adrian Kriss and Bakul Kumar, and from the Cabinet Member with Responsibility for Health and Wellbeing, Karen May.

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 14 March 2024). Enquiries can be made through the telephone number/email listed in this agenda and on the website.

None.

Previously circulated

The Minutes of the Meetings held on 9 January and 19 February 2024 were agreed as correct records and signed by the Chairman.

At the Chairman’s suggestion, consideration of this item was covered in two parts; the update on outcomes of the Care Quality Commission Inspection, followed by the update on Hill Crest Mental Health Ward.

The Deputy Chief Executive Officer (DCEO) of Herefordshire and Worcestershire Health and care NHS Trust (the Trust), provided context to the CQC inspection update, and advised the Health Overview and Scrutiny Committee (HOSC) that from 14 April he would be taking over as Interim Chief Executive.

The Trust’s Director of Strategy and Partnerships thanked the HOSC for the opportunity to provide an update on progress made since Trust representatives had previously addressed the HOSC about Hill Crest Ward, which had been followed by a further report to set out specific plans to potentially relocate this service. The report also set out next steps to take forward the work planned.

Overall CQC Inspection

The DCEO referred to the background set out in the Agenda report and explained that the process had started in July 2022 with an unannounced CQC inspection and concerns about Hill Crest had featured in the press. An Action Plan and response to that had ensued.

From February to May 2023, 4 core service inspections took place alongside the Well Led inspection in July. The final CQC report had taken longer than the Trust would normally expect, and the final report had been published in January 2024.

The CQC inspection report was not the report the Trust would like, was uncomfortable reading for the Trust Board and had required difficult decisions but had nonetheless been embraced in moving forward. The resulting Plan aimed to tackle two aspects, the Trust Improvement Plan, along with some specific actions requiring swift action. Very importantly, development of the Plan had involved widespread engagement with staff, service users, patients and partners, which had helped to frame the feedback from the CQC. The Trust was grateful to the Integrated Care Board (ICB) for its support in the form of capacity, from the Improvement Director. Further progress updates would be shared with HOSC.

The Trust’s Director of Nursing outlined the main points from the Well Led Inspection Report which had taken place from February to June 2023. The Inspection started with core service inspections (adult mental health acute inpatient and psychiatric intensive care wards, adult mental health crisis and health-based place of safety suites, adult mental health community teams and physical health neighbourhood teams), which were chosen either because of their inadequate rating or to check evidence or data.

Whilst the full report was not available until the end of the inspection process, weekly feedback was provided on any immediate concerns, which the Trust started work on straight away along with development of an action plan. Well Led inspections were much more focused, involving directors, staff, patients, and focus groups.

As a result of the inspection, ratings for the Trust’s mental health adult inpatient wards and mental health community teams both rose from ‘inadequate’ to ‘requires improvement.’  Ratings for mental health  ...  view the full minutes text for item 1191.

In introducing the report on Dermatology, the Managing Director (MD) of Worcestershire Acute Hospitals NHS Trust (the Trust) acknowledged this was classed as a fragile service and concerns were set out in the report. He was keen to cover processes in place to keep patients safe.

Dermatology had become a fragile service following the departure over a period of time, of a number of consultants who had retired or moved elsewhere. Subsequently, the Trust had been unable to recruit due to the fact that it is a very challenged speciality nationally, plus it was recognised that there were cultural issues. There reached a point where there were no consultants and the Trust took action to work with external companies which brought in staff to keep the service going, and recently this had been streamlined to one company.  Options to restore the long-term stability of the service were being explored with a preferred option for the service being to be run by Wye Valley Trust, which was now part of the Foundation Group.

A very important point was that while clinicians would be employed by Wye Valley Trust, services would remain in Worcestershire and there was no expectation for patients to travel to Wye Valley Trust hospital.

It was explained that fragile services were those which may have a small number of cliniciansor where there were challenges nationally recruiting. The Trust looked into whether there may be issues coming through performance or staff surveys, and this work was being done across the Foundation Group, in order to identify solutions.

A learning point from Dermatology was that staff within a small specialist unit could feel more isolated, making it harder to recruit.

Some examples of data were provided, and more would be forwarded to the HOSC. For April 2023, referrals for skin cancer two week waits (urgent referrals) were around 500 which was normal, but for the previous two months, figures had risen to 780, which was high. Conversations with Primary Care suggested that this reflected the fact that as staff had left, there had been a slight drop in confidence of the service, but this was now returning.

The number of patients who had waited over 62 days for skin cancer against this (national) 62 day wait target, had risen to 78 in February but was currently 36 and on a trajectory to below 10, which was better than performance prior to the problems.

The waiting list for other procedures was 2358, which was similar to previous performance, although this was not to say that wait times in some of the time frames given were good. A lot of work was taking place on waiting times for all services from the Trust and collectively, the NHS. A key target was to have no patient waiting over 104 weeks, which was now being achieved.

The Acting Joint Chief Medical Officer (JCMO) added that in reflecting on the two year period leading up to the point where there were no Dermatology  ...  view the full minutes text for item 1192.

The Chairman explained that as part of refreshing the Committee’s Work Programme, he would like to take a more joined up approach to reports, so that discussions were around care pathways. This would mean that representatives would be present from all the relevant organisations, rather than scrutinising specific services in isolation.

A Committee member suggested that a way of making meetings more outcome focused may be to reflect on the salient points and agree key areas of enquiry to refer back to in subsequent discussions, which would help monitor what progress had been made.

Another Committee member suggested a longer timeframe for scheduling further updates, since it took time to change performance, and the Interim Democratic Governance and Scrutiny Manager advised that timeframes and prioritisation of reports were negotiated with health colleagues, in liaison with the Chairman.

The Chairman pointed out the importance of monitoring service changes and the Vice-Chairman was keen to know that the Committee was making a difference to services which were a concern to local residents.

Regarding future meetings, it was suggested that the report on Cancer Pathway may need to focus on one or two specific cancers, and this would be discussed at the next agenda planning session for the Chairman and Vice-Chairman. A concern about funding for breast cancer specialist nurses, would also be looked into.

Dentistry was suggested as an area of concern, and it was noted that this was already on the Work Programme.