Agenda and minutes

Apologies were received from Prof J W Raine and Mrs J. Till.

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 7 October 2019). Enquiries can be made through the telephone number/email address below.

None.

The Chairman welcomed Matthew Hopkins, Chief Executive and Richard Haynes, Director of Communications and Engagement, representatives from Worcestershire Acute Hospitals NHS Trust (the Trust).

The Committee received the Trust’s latest Care Quality Commission (CQC) report, following inspections in May and June 2019. The Chief Executive explained that the report contained details of a range of quality and safety improvements which had led the CQC to lift the Trust’s overall rating to ‘requires improvement’ from its previous rating of ‘inadequate’. He also highlighted that the Chief Inspector of Hospitals had recommended that the Trust should be removed from special measures, but he stressed that with some of the ongoing challenges identified, this would only take place when a system-wide support package involving local and regional partners had been agreed. The Committee was advised that a meeting of partners was due to take place the following week to agree a support package, to then put forward to NHS England on 12 November.

The Chief Executive explained the details of the inspection process which had commenced in February and had involved 408 data requests being responded to; 40 inspectors carrying out core service inspections, and re-inspections in May/June; 35 well-led review interviews followed later in June with a wide range of personnel and then the draft report being received in August for a detailed accuracy check. In terms of the Core service inspections, the Committee was informed that Maternity, End of life and Critical Care had not been included in this inspection, as the ratings for these areas were not of concern.

Turning to the details of the report, the Chief Executive gave a presentation of the key findings incorporating the following:

·         Improvements had been made across 41 of the 79 domains rated across 6 core services, with 9 of these going up 2 ratings. Previous ratings had been maintained in 35 other domains.

·         Surgery and outpatients had been lifted up two ratings in ‘well-led’.

·         Every single service across all hospitals received at least a ‘good’ rating for ‘caring’.

·         Key findings showed that there had been some significant improvements in:

- outpatient services and diagnostic imaging at the Alexandra hospital, with the latter now rated as ‘outstanding’;

- services for children and young people at Worcestershire Royal Hospital 

- the overall hospital rating for Kidderminster.

·         Other areas for further improvement were highlighted including medicines management, infection control and staff engagement. The Chief Executive was pleased that the CQC had noticed a significant improvement in terms of a culture of openness with staff who now felt much more engaged and able to speak out and be listened to.

·         The CQC had recognised the improvements that were taking place with regards to leadership. The development programme had resulted in Managers feeling well supported, and with a renewed sense of purpose.

·         A site by site comparison between 2017 and 2019 was shown to the Committee and Members were pleased to see that there was an overall improving picture. It was agreed that the colour versions of  ...  view the full minutes text for item 941.

The Committee received an update on the development of the Trust’s Clinical Services Strategy. The Trust was developing this strategy in line with its strategic purpose of ‘Putting Patients first’ and to support its overall strategic objectives. The aim of the strategy was to help secure the safest, highest quality, sustainable hospital services for patients from across Worcestershire and neighbouring counties.

The Chief Executive of the Trust gave a presentation of the key aspects of the development process:

·         Referring to the pyramid diagram of ‘Putting Patients First’ he explained that this demonstrated the way in which services would become financially and clinically sustainable in the future.

·         Whilst the overall focus of the Strategy was based on a 5-year plan, it was also underpinned by 3 year and 12-month plans.

·         In response to a query, the Chief Executive explained that the usual annual planning process would still be continued and would be the process by which a refresh of these plans was carried out. The Trust would continue to be scrutinised through various means, including through the Non-Executive Directors on the Board, the Kings Fund and through confirm and challenge conversations between the services.

·         The Chief Executive wanted to make it clear that this process was not about closing sites or services, but instead was about recognising the need to be responsive to the changing needs of the population. This would mean that there would be some changes particularly around ensuring more integrated care taking place outside of the main hospitals. The ambition was to reduce outpatient appointments by a third. The changes could also involve highly specialised care being managed as part of a network/partnership arrangement where appropriate. It would be crucial to make the most of the hospitals and the 42 service areas that the Trust currently had, but also to future proof the service. Details of any proposals in this regard would be brought to HOSC.

·         In terms of the out of county specialist care, referred to above, which was an area that had grown over the years, the Chief Executive advised that the current arrangements were currently being reviewed to establish what worked best for patient outcomes and ease of access. Once this had been completed a view would be taken as to future arrangements.

·         Staff had responded very positively to the development of the Clinical Services Strategy and had been proactive in drawing up plans for their areas and taking back control.

·         The stakeholder and public engagement events in August and September had proved to be very well attended and the Board received useful feedback to help them shape future services. The next key stage was consideration of the strategy at a private Trust Board meeting in October, to be followed by a public Trust Board meeting in November, where detailed plans would become available.

·         The Chief Executive set out the 3 key drivers to this process, and 4 imperatives, based on Frailty, Access, Cancer care and End of Life care. The Chief Executive explained that  ...  view the full minutes text for item 942.

No updates were received.

The Committee received details of its current Work programme to review and the following issues were discussed:

·         Mental Health/CAMHS. The Democratic Governance and Scrutiny Manager (DGSM) advised that the issue of emergency mental health care provision had been raised at Children and Families Panel. Meanwhile following an overview in September 2018, CAMHS was on the HOSC work programme to be reviewed in the near future. The Overview and Scrutiny Performance Board was supportive of the proposal that both these issues could be usefully considered jointly by HOSC and the Children and Families Panel. A Member suggested that the provision of emergency mental health services between Friday evening and Monday morning urgently needed reviewing. The Chairman asked that the link to the Committee’s previous consideration of this topic be circulated to members, so that they could be reminded of previous discussions.

·         Ambulance Trust.  The Chairman commented on the recent very good performance of the Ambulance Trust. He asked that a letter be sent to congratulate them on remaining the leading Ambulance Trust and also for their successful bid for the 111 contract. This was supported by the whole Committee.

·         Trust’s Action Plan in response to the CQC report.  In response to a query, it was clarified that the November Acute Board meeting would be the point at which the Action Plan would be made available to the public.

·         New housing developments factored in to planning for acute health services. This issue was being raised as District Councils were currently considering local development plans or revisions to them. An explanatory note prepared by a Planning Officer at the County Council on this issue was asked to be circulated to the Committee.  The DGSM commented that after reading the explanatory note, Members might feel that there was a role for HOSC to review the process and establish how health service provision was taken into account.  It was suggested that the Planning Officer could be asked to attend the next HOSC meeting, if required.

·         Sustainability and Transformation Partnership (STP). An update on the work and structure of the partnership was requested.