Agenda and minutes

The Chairman welcomed everyone to the meeting.

Apologies were received from Councillors Jo Monk, Chris Rogers and Sue Baxter.

The Chairman pointed out that the Committee was smaller in number at this particular meeting, since District Council elections the previous week meant there would be some new representatives appointed to the Committee.

Regarding Agenda Item 7 (Integrated Care Strategy), Cllr Lynn Denham declared an interest as a member on the ICS Partnership Board in her capacity as a Worcester City Councillor.

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 9 May 2023). Enquiries can be made through the telephone number/email listed in this agenda and on the website.

None.

To follow

The Minutes of the Meeting held on 18 April 2023 were agreed as a correct record and signed by the Chairman.  A HOSC member pointed about that it would be beneficial for Committee Members to have names and roles of the representatives attending in advance of each meeting.

Present for this Item:

Herefordshire and Worcestershire Integrated Care Board

Katie Hartwright, Director of People and Workforce

Karen Paynton, Head of Primary Care

Worcestershire Acute Hospitals NHS Trust:

Tina Ricketts, Director of People and Culture

Herefordshire and Worcestershire Health and Care NHS Trust

Elaine Clough, Director of People and Organisational Development

Worcestershire County Council:

Mark Fitton, Strategic Director for People

Rebecca Wassell, Assistant Director for Commissioning

Voluntary, Community or Social Enterprise Sector:

Carole Cumino

The update on workforce pressures was introduced by Herefordshire and Worcestershire Integrated Care Board’s (ICB) Director of People and Workforce Pressures, who reminded the Health Overview and Scrutiny Committee (HOSC) that workforce was being looked at collectively as a system.  Workforce remained a challenge nationally as well as locally, with some specialist and social care roles being especially hard to fill.  The situation was not helped by factors such as media coverage and industrial action, however staff turnover had decreased slightly, which was testament to the huge effort involved.

The Primary Care workforce was in a good position, and the Herefordshire and Worcestershire (H&W) GP to patient ratio was one of the best in the country. However social care workforce pressures remained a challenge.

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

·         A Member questioned the number of staff that the increase in workforce numbers of 1200 equated to since the previous HOSC discussion.

·         Several members expressed concern about the amount of spend on agency staff and felt that measures should be introduced to limit this. The ICB Director agreed that agency use remained an issue for the system as a whole, and advised that currently, just under 10% of substantive pay was on agency staff (including Wye Valley Trust in Herefordshire). Every area had a programme in place to reduce use of agency staff, and the national target was 3.7%, although an outcome of 6% was more likely for H&W. Reasons for agency staff use were complex and many, involving decisions about wards, cover and strike action.

·         The Worcestershire Acute Hospitals NHS Trust (the Acute Trust) representative referred to the Trust’s quite high reliance on agency staff, although this had reduced the previous month to 12%. Successful recruitment levels this year was very positive and would make a difference to reliance on a temporary workforce. Measures to increase recruitment included international recruitment and welcoming CVs to aid the application process, as well as wider recruitment and retention work. Career progression paths and apprenticeships were also being developed for hard to recruit roles. The Herefordshire and Worcestershire Health and Care NHS Trust (the Health and Care Trust) representative referred to other work including getting teams to think critically about use of agency staff and to focus on fostering a robust staff base.

·         A member sought clarification about the actual difference in cost for an agency member of staff as opposed to a permanent employee, taking into account factors such as holiday pay, sick pay, and was  ...  view the full minutes text for item 1137.

Present for this Item:

Worcestershire Acute Hospitals NHS Trust: Jackie Edwards, Interim Chief Nursing Officer and Justine Jeffery, Divisional Director of Midwifery

Worcestershire County Council: Lisa McNally, Director of Public Health

The Interim Chief Nursing Officer referred to the Agenda report which gave an update on how Worcestershire Acute Hospitals NHS Trust (the Trust) was improving Maternity Services. As a Worcestershire resident herself, she had family members who had used the service and recommended it, which was important. There were some aspects which could be better and listening to user feedback was important.

The Divisional Director of Midwifery reminded HOSC members of the context for the successive updates to the HOSC, following a negative Care Quality Commission inspection in 2020 which reduced the overall rating for Maternity Services from ‘Good’ to ‘Requires Improvement’.

Improvement against the resulting Improvement Plan had continued and since the last update good progress had been made in filling staff vacancies. Importantly, new roles had been added to the Team including advanced practitioners which was very exciting and an incentive to the existing workforce. 24 Midwives had just been appointed to start in September, which was very pleasing as they had undergone their training with the Trust. Feedback from a recent visit by the Local Maternity and Neonatal System (LMS) was very good and although this needed to be validated, the representatives were confident the Service was now in a very good place.

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

·         HOSC members were very pleased to see improvements being made, which were particularly evident in the latest update.

·         A member sought assurances that the situation could not lapse, and the representatives acknowledged that a previous lack of leadership consistency at the Trust had likely had an impact but that the maternity leadership team was now much stronger. The role of the LMS provided further scrutiny - there was no way the Service could drift back.

·         Some of the new measures introduced had been enabled by additional NHSE funding arising from the national Ockenden Review.

·         The absence of current data for elective caesarean rates and emergency caesarean rates was because these indicators were no longer considered indicators of safety and were therefore no longer reporting measures, which was an outcome of the Ockenden Review.

·         In response to a query, it was explained that caesareans classed as emergency were monitored using the Robson classification to see trends of mothers having caesareans for the first time or repeated caesareans, to keep an eye on any changes, and this was monitored monthly by the LMS.

·         A member who had heard negative feedback from same sex couples about communication asked how this was dealt with and was advised that the Service had received considerable good feedback from same sex couples, although all feedback was actively invited as a listening approach was important. The Service had recently sought input from a Brighton hospital team and a number of changes around language were being introduced.

·         A HOSC  ...  view the full minutes text for item 1138.

Present for this Item:

Herefordshire and Worcestershire Integrated Care Board

David Mehaffey, Executive Director of Strategy and Integration

Alison Roberts, Associate Director, System Development and Strategy

Worcestershire County Council:

Lisa McNally, Director of Public Health

Mark Fitton, Strategic Director for People

Rebecca Wassell, Assistant Director for Commissioning

Karen May, Cabinet Member with Responsibility for Health and Wellbeing

The Executive Director of Strategy and Integration at Herefordshire and Worcestershire Integrated Care Board (ICB) referred to the Agenda report and reminded the HOSC of the context for the Integrated Care Strategy (the Strategy). Integrated Care Systems had been legally established by the Health and Care Act 2022, although in practice integrated working had been ongoing since 2015.

The Strategy for Herefordshire and Worcestershire had just been published and would be circulated to HOSC members. There was a close relationship between the Strategy and the Health and Wellbeing Strategy, since both were focused on improving health outcomes. The overriding principle was to work as close to the ground as possible and only at system level where necessary.

The ICB Associate Director for System Development and Strategy outlined the engagement approach during development of the Strategy, which had taken six months engagement with partners and involved three phases to gather information, consider how best to work together and to share the draft Strategy for feedback.

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

·         The Cabinet Member with Responsibility (CMR) for Health and Wellbeing pointed out that that factors affecting health were 20% economy and 80% wider determinants such as having a good home.

·         The Council’s Director of Public Health highlighted examples of how the Integrated Care Strategy could impact residents’ health. The number of women smoking during pregnancy had reduced down to the national average through integrated working between Public Health and Worcestershire Acute Hospitals Trust, and integrated working with the District Councils to signpost young people to opportunities for physical activity, had greatly increased those reaching the recommended level of activity. Future plans included a Public Health funded junior parkrun, being worked on with the District Councils and the NHS.

·         It was clarified that the majority of District Councils had provided input to the Strategy.

·         A member queried the absence of podiatry on the list of groups which had provided input to the Strategy, and pointed out its importance in heading off any issues experienced by children, yet GPs may not always refer them on to Podiatry. It was clarified that the group was not exclusive, therefore further appropriate sectors were welcomed, including podiatry. It was also confirmed that optometry was represented on the group.

·         The ICB Directors explained that the Strategy set out the priorities and it was now important to get people out there and working on the priorities. There was a collective desire for implementation and the ICB would make use of existing structures to ask the organisations involved how work would be taken forward.

·         A member sought acknowledgment that providing timely cancer diagnosis and treatment  ...  view the full minutes text for item 1139.

The Committee agreed to add the following to the work programme:

·         Out of Hours GP Services

·         Haematology

·         Neurology