Agenda and minutes

The Chairman welcomed everyone to the meeting and explained the arrangements for meetings taking place online.

Apologies had been received from Committee member Bob Brookes.

Cllr Frances Smith declared a interest in Item 9 (Performance and In-Year Budget Monitoring) as her husband was the Cabinet Member with Responsibility for Health and Wellbeing.

Members of the public wishing to take part should notify the Assistant Director for Legal and Governance 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 29 September 2020). Enquiries can be made through the telephone number/email address below.

None.

Previously circulated

The Minutes of the Meeting held on 20 July 2020 were agreed as a correct record and would be signed by the Chairman.

The Chairman advised that Cllr Frances Smith had been put forward by the Committee’s District Council members to continue in the role of Vice-Chairman, and this nomination would now be put forward to Council on 12 November for approval.  The Chairman congratulated Cllr Frances Smith.

In attendance for this item were:

NHS Herefordshire and Worcestershire Clinical Commissioning Group (CCG):

Dr Clare Marley, Medical Director

Julia Neal, Programme Lead for End of Life Care

Worcestershire Health and Care NHS Trust:

Claire Curtis,Clinical Director for Specialist Palliative Care Services

Dr Marley, Medical Director at Herefordshire and Worcestershire CCG summarised the Agenda report and explained that she had worked as a GP in Wyre Forest for over 9 years with particular interest in end of life (EOL) care.

In April 2019 an End of Life Care workstream was set up across the Herefordshire and Worcestershire Sustainable and Transformation Partnership (STP) to ensure a focus on care across the two counties. It was fortunate that Worcestershire already had in place a very good network.

The need for collaborative working had been recognised and a workshop attended by representatives from the health, care and voluntary sector had reviewed good practice and identified areas for improvement including:

• increased and early identification of people who wold benefit from EOL support and care planning
• high quality care for people at EOL, their families and carers in every setting
• accessible, coordinated and digitally-enabled palliative and EOL services for all patient groups
• an appropriately skilled workforce
• high quality bereavement support and information
• an embedded ReSPECT process.

Examples of specific actions taken to address the priorities identified included:

• promoting identification of those living with severe frailty, recognising their vulnerability to acute deterioration in health, and potentially higher risk of hospital admission and death – work took place to utilise GP practices’ registers of patients with severe frailty, which gave an opportunity to proactively identify such patients and offer personalised care planning
• work with Neighbourhood Teams to ensure proactive review of patients at risk of acute deterioration
• a quality improvement workshop for GPs, which allowed practices to review how patients were identified and personalised care planning discussions.

Monitoring patient and carer experiences was fundamental to improving EOL Care, and a number of approaches had been taken – one example was the enhancement of local GP contracts with an EOL component which meant practices could take additional actions such as reviewing every death, expected and unexpected. Other examples included mortality reviews of patients dying within 48 hours of attending an Emergency Department and a workshop to identify learning to support patients out of hours.

The COVID-19 pandemic had necessitated a shift in focus to ensure increased demand could be met. An End of life COVID response group had been set up, which had proved invaluable in the rapid development of guidance to support patients. Hospitals had been given additional funding to increase capacity for bereavement support and St Richards Hospice had played an important role in providing education to care home staff.

Summing up, the Medial Director explained that a refocus on the Personalised End of Life Care Strategy was now taking place, to include some additional priorities to reflect on learning identified, including from experiences during COVID, which had revealed some very positive elements  ...  view the full minutes text for item 989.

In attendance for this item were:

NHS Herefordshire and Worcestershire Clinical Commissioning Group:

Mari Gay, Managing Director

Worcestershire Acute Hospitals NHS Trust:

Matthew Hopkins, Chief Executive

Becky Bourne, Head of Communications

Worcestershire Health and Care NHS Trust:

Matthew Hall, Chief Operating Officer

Sue Harris, Director of Strategy and Partnerships

Healthwatch Worcestershire

Peter Pinfield, Chairman and Simon Adams, Managing Director

The Chairman welcomed everyone and congratulated Worcestershire Acute Hospitals Trust (the Acute Trust) on emerging from special measures and invited comment from the Chief Executive.  The Chief Executive explained that the Care Quality Commission had recommended the organisation come out of special measures the previous September following its inspection in May/June, but only once a system-wide package had been put in place to ensure continued improvement. The NHS Improvement Senior Committee had signed off this recommendation, which was very good news for staff and patients and he also thanked all the Trust’s stakeholders for the part they had played, although there was more work to do.

Mari Gay, Managing Director of Herefordshire and Worcestershire Clinical Commissioning Group (CCG) referred to the presentation included in the Agenda which set out the temporary service changes made to allow services to be managed against COVID predictions and provided an update since the previous two updates to the HOSC on the guiding principles for future planning and services provided by the Acute Trust, the Health and Care Trust) and Primary Care.

Guiding Principles

The health system was now preparing for the future and in the case of a second surge of COVID, was in the better position of having early warning triggers and pre-agreed actions to take if required. However, this time it was planned to maintain more services than previously and the guiding principles were to:

·             Limit the risk of transmission of the virus to patients and staff, routinely using alternatives to face to face consultations where this was clinically possible and acceptable to service users

·             Enable clinicians to restore many of the services paused in response to phase 1 so that the amount of cancer surgery, planned care and specialist diagnostic activity was increased

·             Give confidence to the local population that healthcare settings were safe.

It would be important to maintain core essential services, cancer services, some diagnostic services and high category elective care such as urgent surgery, whilst restoring patient confidence to come forwards.

Worcestershire Acute Hospital Trust

Most face to face outpatient appointments had been suspended and independent sector hospitals (Spire, BMI, Dolan Park) were being used for elective surgery. It was pointed out that screening for breast, bowel and aortic aneurysms previously suspended nationally, had now resumed.

There had been some challenges in achieving 100% restoration of services because of COVID restrictions and extra measures needed to prevent infection which therefore reduced capacity.

Whereas urgent surgery had been maintained, elective care (planned surgery) had been suspended over 3-4 months, therefore nationally there would be long waits. Public confidence was another obstacle resulting in some members of the  ...  view the full minutes text for item 990.

The following were in attendance:

Herefordshire and Worcestershire Clinical Commissioning Group (CCG)

Mari Gay, Managing Director

Worcestershire Health and Care Trust (Health and Care Trust)

Matthew Hall, Chief Operating Officer

Sue Harris, Director of Strategy and Partnerships

Mari Gay, the CCG Managing Director summarised the new ‘NHS 111 First’ national programme which was designed to help the NHS manage urgent care and COVID pressures, and inappropriate use of walk-in Emergency Departments. Worcestershire was one of the earliest adopters of this programme, which was designed to encourage people to contact their GP in the first instance or to contact 111. NHS 111 was now able to book directly with GPs, Minor Injuries Units (MIUs) as well as Emergency Departments (EDs).  A Care Navigator would also now be present at the front door of EDs, not to turn people away but to educate them in more appropriate ways to access care in future.

The direct booking process was currently being trialled, with positive feedback and it was emphasised that no one being turned away. The programme was due to be rolled out across the country in November.

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

·       The Chairman referred to the second stakeholder briefing (appendix 2) and sought clarification that the new programme was not suggesting that calls to 999 may go via 111 and that the main message was to encourage people to ring 111 first if this was the sensible route. The CCG representative emphasised that the programme was not to discourage people from using 999 when needed and that the 999 function for emergencies would continue as normal.

·       The Chairman asked whether the NHS 111 service may be affected by the impact of losing students and was advised that this was a key risk to the programme because the service had also had to support COVID advice to patients –concerns about what would happen once the rest of the region was using the new 111 programme had been highlighted, and was being reviewed urgently by regional commissioners.

·       A member pointed out that he had heard of a resident being directed to Sandwell Hospital, which the CCG representative would follow up as this should not be the case.

·       A member asked whether waiting lists for children’s autism had increased due to COVID as she was aware they had previously been 10 months which was unacceptable, and the Health and Care Trust representatives advised that waiting times for umbrella appointments had generally remained the same, but that two more paediatricians were being brought in to help reduce waiting times. An update on this would go to the Council’s Children and Families Overview and Scrutiny Panel in November.

·       The Chairman queried the advice contained in the second stakeholder briefing (appendix 2) about people arriving at Emergency Departments without an allocated time slot possibly experiencing longer waits, and the CCG representative clarified that the programme was to tackle people who did not need A&E care, for example it was common  ...  view the full minutes text for item 991.

In attendance for this item were:

Dr Kathryn Cobain, Director for Public Health

Maria Idoine, Senior Finance Business Partner

Cllr John Smith, Cabinet Member with Responsibility for Health and Wellbeing

The Chairman queried whether a quarterly update was needed, the Director of Public Health was aware that all of the scrutiny bodies had a performance and budget monitoring role, but agreed that reporting patterns for public health needed to be reconsidered since the relevant performance data was not updated quarterly and use of the public health ring-fenced grant was subject to specific conditions. It was agreed that the scrutiny officers would liaise with the Director regarding performance information reporting patterns.

Performance Monitoring – Quarter 1 (April to June 2020) – there was no update at this time.

Budget Monitoring – Quarter 1 (April to June 2020/21)

Maria Idoine, Senior Finance Business Partner referred to the presentation included in the Agenda.

From this year’s public health allocation of £30 million, spend was forecast to break even, with a small underspend on staffing. Due to funding uplift this year, there was currently an unallocated grant of £1.1m and plans for its use were likely to include additional support to the alcohol care team, smoking cessation, substance misuse, quality assurance, as well as the Agenda for Change staffing inflation.

The forecast position excluded the impact of COVID-19 as the following specific costs were assumed to be funded from the following external sources:

·       COVID-19 grant £29m         

·       Test and Trace - £2.75m

·       Infection Control - £7.45m

·       Transport - £1.3m

·       Community Hardship - £0.6m

·       Support for loss in sales, fees and charges

·       Use of PHRFG reserve- £0.4m

·       CCG grant relating to hospital discharges and avoiding admission to hospital.

Areas where COVID-related spend had occurred relevant to the Committee included additional costs of personal protective equipment, test and trace activity, support for the community and additional payments to providers.

·       The Chairman asked whether public health reserves were being spent to address COVID-19, since during previous updates, the Committee had noted that reserves were relatively high and were being saved for appropriate future need, which COVID-19 surely must be, and it was confirmed that this was the case.

·       Several members highlighted the growing critical problem of obesity in Worcestershire, including child obesity, and the risk factor of obesity for COVID, and would welcome use of public health funds to tackle this area. The Director reassured the Committee that the problem of obesity was absolutely relevant, although it was a very complex area which linked to various public health issues and social factors, therefore funds would be directed to work with communities on the wider perspective.

·       Regarding numbers of mothers smoking during pregnancy, the Chairman sought reassurance that people in maternity wards were not allowed to smoke, which the Director confirmed, although the overall hospital site was not completely smoke free. Public Health commissioned a service from the Acute Trust to address smoking during pregnancy, which was important as it affected the whole household, however it would take  ...  view the full minutes text for item 992.

There were no updates for this item.

The following updates had been requested during the meeting:

·       Update on performance from Worcestershire Acute Hospitals NHS Trust (next meeting)

·       Public Health – the new Health and Wellbeing Board Strategy and the areas being given extra focus from the use of reserves and how Public Health was responding in comparison with other councils (early 2021)

·       Update on End of Life Care in six months’ time

Several Committee members said how pleased they were that the Acute Trust had been taken out of special measures and what good news this was for staff and patients. On behalf of the Committee, the Chairman would contact the Acute Trust to offer congratulations to the Trust and its staff on this achievement.

The Overview and Scrutiny Co-ordinator reminded HOSC members that due to IT problems, the first part of the livestream of the meeting had not been available, and she therefore provided a brief summary of actions agreed under items 1 to 5.