Agendas, Meetings and Minutes - Agenda and minutes

Agenda and minutes

Venue: County Hall

Contact: Emma James / Jo Weston  Overview and Scrutiny Officers

No. Item


Apologies and Welcome


The Committee Vice-Chairman, Cllr Frances Smith explained that she would be chairing the meeting as the Chairman was unable to attend.  As Chairman, she welcomed everyone in particular three new members (Cllr Jo-anne Till from Bromsgrove District Council, Cllr Calne Edginton-White from Wyre Forest District Council and Cllr John Gallagher from Malvern Hills District Council).


Apologies had been received from Cllrs Mike Johnson, Chris Rogers and Peter Tomlinson.


Declarations of Interest and of any Party Whip




Public Participation

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 26 June 2019). Enquiries can be made through the telephone number/email address below.




Confirmation of the Minutes of the Previous Meeting

Previously circulated


The Minutes of the meeting on 9 April 2019 were agreed as a correct record and signed by the Chairman.


Vice Chairman pdf icon PDF 64 KB


The Democratic Governance and Scrutiny Manager explained that the HOSC Vice-Chairman is a role allocated to one of the Committee’s district council members, to reflect partnership working. The district council members had nominated Frances Smith to continue as Vice-Chairman, and this nomination would now be put to Council for approval.


West Midlands Ambulance Service Update pdf icon PDF 74 KB

Additional documents:


In attendance for this item were:


West Midlands Ambulance Service University NHS Foundation Trust: Mark Docherty, Director of Clinical Commissioning and Strategic Development / Executive Nurse

Worcestershire NHS Clinical Commissioning Groups: Mari Gay, Chief Operating Officer and Lead Executive for Quality and Performance

Worcestershire Acute Hospitals NHS Trust: Paul Brennan, Chief Operating Officer and Deputy Chief Executive


West Midlands Ambulance Service University NHS Foundation Trust (WMAS) had been asked to provide an update and the Director of Clinical Commissioning and Strategic Development/Clinical Nurse outlined the following key points from an information pack which had been circulated to HOSC members (available on the website).


·         The organisation centred on strong values.

·         This year’s Quality Account had been published and summarised WMAS achievements during the year and priorities for 2019/20, for example improving the performance for the National Ambulance Clinical Quality Indicator for Sepsis, a life-threatening condition.

·         WMAS served a population of 5.6 million, and a large geographical area which was 80% rural and which generated more than 4000 999 calls a day.

·         The fleet of over 1000 vehicles was the newest in the country.

·         WMAS had no vacancies and had the lowest sickness rate in the country, whereas nationally there were 2500 paramedic vacancies. This was attributed to having its own academy to train and develop staff.

·         WMAS had been working towards having a paramedic on every ambulance, which this year had been achieved.

·         WMAS was rated outstanding by the Care Quality Commission (CQC).

·         Many other initiatives were in progress, such as supporting anti-knife crime, aspiring to be paperless through use of electronic records and partnership work with universities to help establish the Ambulance Service as a graduate entry profession.

·         Efficiency and effectiveness were very important and WMAS was the highest performer in almost all metrics in two recent national reports (Lord Carter’s Report and the National Audit Report) including cost and productivity.

·         The Service was keen to regain the NHS111 service, so that it could be integrated with 999 calls and ideally reach a level where 20% of calls were emergency and 80% responded to at a slightly slower rate.

·         The Patient Transport Service had been focused on this year and was performing well although Worcestershire’s rural nature presented problems.

·         Ambulance handover delays at hospitals in Worcestershire were not a good news story however and WMAS was working with colleagues at Worcestershire Acute Hospitals Trust and the CCGs; this was an area where patients were being let down.

·         WMAS’s digital journey continued using electronic patient records to integrate with other organisations, and the Emergency Department could see all electronic records of patients likely to be taken there, allowing pre-assessment and liaison.

·         A Directory of Services supported clinicians, call handlers, commissioners and patients and included every service and was integrated with NHS pathways and electronic records.

·         Work was also taking place on a plan for patient flow through additional clinical input, which aimed to ensure patients were routed to the right place.


The Chairman invited questions and the following  ...  view the full minutes text for item 926.


Acute Stroke Services pdf icon PDF 78 KB

Additional documents:


In attendance for this item were:


Worcestershire NHS Clinical Commissioning Groups: Mari Gay, Chief Operating Officer and Lead Executive for Quality and Performance

Worcestershire Acute Hospitals NHS Trust: Paul Brennan, Chief Operating Officer and Deputy Chief Executive

Stroke Association – Sarah Adderley, Head of Support for Central England and Lorraine Wright, Support Manager for Worcestershire


The HOSC had requested an update on stroke services provided within acute hospital settings when a patient first requires diagnosis and hospital treatment.


The Worcestershire NHS Clinical Commissioning Groups (CCG) Chief Operating Officer (COO) referred to the report included in the agenda and advised that stroke services for Worcestershire were centralised at Worcestershire Royal Hospital (WRH), and rehabilitation was centralised at Evesham Community Hospital. This meant a much better patient flow however currently, acute stroke services across Herefordshire and Worcestershire Sustainability and Transformation Partnership (STP) were challenged by workforce shortages, and therefore unable to meet the clinical standards for 7-day services. This situation reflected the national picture.


As part of an STP programme, a number of potential models had been looked at with partners, with focus on alternative workforce models with less consultant focus whilst remaining safe. The preferred option was a centralised acute stroke service for Worcestershire and Herefordshire at WRH site, however this was no longer feasible due to capital constraints at a national level. Therefore, the STP Programme Board had been tasked with developing an alternative service model that would deliver outcomes of 7-day working. Two options were being worked through and commissioners would be happy to return to HOSC for further discussion.


Following recruitment campaigns, the workforce situation was at its strongest point yet for a number of years but it remained a struggle to ensure a 7-day service. A lot of stroke prevention work was also taking place however a significant increase in strokes was predicted in the 75 plus age group in the next ten years.


The Worcestershire Acute Hospitals NHS Trust (WAHT) Chief Operating Officer (COO) advised that within Worcestershire, performance against the Stroke Sentinel National Audit Programme (SSNAP) had improved from level D to C, A being the aspiration. Currently there were 5 consultants employed and 6 were needed to be able to aspire to the 7-day service model. In summary it was a picture of improvement but with issues around staffing and 7-day services.


The aim was to have a single service across Herefordshire and Worcestershire, with acute stroke services on one site and rehabilitation on another. Recruitment was being targeted at joint appointments across the two Trusts, which could reduce the travel to work distance for consultants and bring variety to their work through delivering a service at two sites. The current stroke ward was too big for need meant that it was used by other patients.  During the Autumn wards were due to be moved around so that the stroke ward would be adjacent to A&E and radiology, improving flow and service score.


Comment was invited from the representatives present from  ...  view the full minutes text for item 927.


Proposed Merger of Worcestershire and Herefordshire NHS Clinical Commissioning Groups pdf icon PDF 75 KB

Additional documents:


In attendance for this item were:


Worcestershire NHS Clinical Commissioning Groups:

Mari Gay, Chief Operating Officer and Lead Executive for Quality and Performance and Tom Grove, Head of Communications, Engagement and Organisational Development


The Chief Operating Officer (COO) and Lead Executive for Quality and Performance summarised the journey of the three clinical commissioning groups in Worcestershire.  Over time this had become more co-ordinated, with a shared management team which designed pathways and made decisions for the whole of Worcestershire, taking into account the differences of the three areas. The NHS Long-term Plan and more integrated systems had brought on this way of working and a proposal was being put through the NHS governance system for one CCG to span the Herefordshire and Worcestershire STP area.  There was already one Accountable Officer for the 4 CCG’s. Maintaining a place-based structure, with joint commissioning, would be important.


Engagement with the public was taking place although the proposal was not about service change. Participation had been low, but regarding the options of whether to proceed with the merger now or take more time, the preference was to ‘get on with it’. The CCG representatives said that questions from the public had included querying whether local engagement would continue, which it would, and whether services would change, which they would not.  


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


·         A member queried the low number of responses (119) and the Head of Communications, Engagement and Organisational Development explained that consultation was still taking place using a combination of drop in meetings, online channels and posters – while more responses would be good the low numbers may reflect the lack of proposed service change where greater response would be expected. Derbyshire had only received 101 responses.

·         It was confirmed that the legal status of the proposed CCG model would be one statutory body from the current four.

·         A HOSC member asked whether this was another step to Integrated Care Organisations and the CCG COO advised that this would depend on central government but was debateable and would be challenging in her view. For now there were still individual organisations but they were all trying to integrate pathways and work as a network to use NHS services better and more efficiently.

·         A HOSC member asked how the local aspect would be retained under the proposed merger and whilst acknowledging this concern the CCG COO advised that staff could be assigned to work on specific areas and specific issues and local forums and networks would remain unchanged. She also referred to frustrations from service providers about working with different CCGs.

·         A HOSC member asked how the merger would affect lower levels of staff and was advised that director level was clear, while the next tier down was being looked at and the structure would be based on delivering the strategic function but also the operational one.

·         When asked about drug purchasing the CCG COO advised that procurement would be more cost effective across  ...  view the full minutes text for item 928.


Health Overview and Scrutiny Round-up pdf icon PDF 77 KB


The Chairman invited any updates or news about NHS organisations or local news and the following main points were made:


Cllr Chalk reported that Redditch was doing work to improve walking groups and a task group had started on suicide, which he would report back on.


Cllr Raine planned to attend the July Board meeting of Worcestershire Acute Hospitals NHS Trust (as lead HOSC member for this organisation) and would report back.



Work Programme 2018/19 pdf icon PDF 74 KB

Additional documents:


HOSC members were content with the current work programme and suggestions for the new work programme would be sought following the meeting.


Cllr Edginton-White’s asked for information about Kidderminster Hospital and the presence of a doctor there on a more permanent basis.  The scrutiny officers would gather initial information to enable HOSC to determine if more work was needed.