Agenda and minutes

Cllr Frances Smith, Vice-Chairman welcomed everyone to the meeting and explained that she would be chairing the meeting as the Chairman was unable to attend. Cllr Smith further explained that her husband, Cllr John Smith, Cabinet Member with Responsibility for Public Health, had decided on advice given by Democratic Services Officers that due to a conflict of interest, he would not be attending the meeting as she was chairing.

Apologies had been received from the Chairman, Cllr Paul Tuthill. Cllr Kit Taylor had also sent apologies as he was having IT problems but would continue to try to join the online meeting. 

None.

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 9am on the working day before the meeting (in this case 9 March 2021). Enquiries can be made through the telephone number/email address below.

None.

Previously circulated

The Minutes of the Meeting held on 27 January 2021 were agreed as a correct record and would be signed by the Chairman.

In attendance for this item were:

NHS Herefordshire and Worcestershire Clinical Commissioning Group – Simon Trickett, Chief Executive

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

Worcestershire County Council – Dr Kathryn Cobain, Director of Public Health

Simon Trickett, Chief Executive of NHS Herefordshire and Worcestershire Clinical Commissioning Group (CCG) referred to the presentation slides included in the Agenda which provided a high-level overview of the Covid-19 vaccination programme and next steps in restoring services.

The vaccination programme in Worcestershire had been very successful, and consistently one of the best performing in the country, and he paid tribute to everyone involved especially the primary care networks and GPs. Everyone was aware that immunisation was key to emerging from the pandemic and the programme was therefore likely to be the most important task in colleagues’ careers. Vaccines were being provided at three large scale vaccination centres, 12 GP-led sites and community pharmacies, a network which had worked well and was therefore likely to continue for the foreseeable future.

Updated vaccination figures were provided, and as of the end of 7 March, 338,000 first doses had been administered across Herefordshire and Worcestershire, equating to 51% of the adult population, and more than 75% of those over 50, which were really important figures. Cohort six was now being vaccinated, which included any adult with a long-term health condition who was eligible for a flu vaccine. Vaccine supply could be adapted, for example, since vaccination figures were slightly lower for Redditch, more vaccines would be allocated. 

There had been some problems with vaccine supply in January/February, when weekly vaccinations administered totalled 25,000 to 35,000, but a significant increase in supply was now anticipated, therefore the schedule moving forward would be 55,000 to 65,000 doses per week across Herefordshire and Worcestershire, which was really positive. In general, vaccine take-up was very high, almost 100% in many cohorts, and the CCG would continue work with Public Health and district councils to address the hard to reach groups such as black and ethnic minorities and homeless people, where an adapted approach was being taken.

The new phase of administering second doses was progressing well and it was hoped that by the end of March all of those aged over 50 would have received their first dose, ahead of the national target, with all adults having access to a second dose by the Summer. Nationally, it was anticipated that Covid vaccines were here to stay and that further vaccines would be needed in the Autumn.

As the local situation continued to improve and the really challenging level of demand for intensive care started to reduce, there was increased focus on the NHS recovery programme and health partners were working together to align capacity. Priority areas included urgent and cancer care, clinical assessment and diagnostics for patients on waiting lists, addressing health inequalities in recovery and ensuring Long Covid symptom support.

The Chairman invited questions and the following main points were made:  ...  view the full minutes text for item 1014.

In attendance for this item were:

Worcestershire Acute Hospitals NHS Trust – Paul Brennan, Chief Operating Officer and Deputy Chief Executive and Richard Haynes, Director of Communications and Engagement

NHS Herefordshire and Worcestershire Clinical Commissioning Group – Simon Trickett, Chief Executive

Richard Haynes, Director of Communications and Engagement explained that the Committee had already been updated on the impact of Covid at Worcestershire Acute Hospitals NHS Trust (the Trust) as part of the previous Agenda item. The aim of this report was to start discussions with members before the forthcoming County Council elections, about work to restore services and how future services might be configurated and to discuss the issues involved. There were significant challenges ahead including the ongoing need to protect patients from Covid.

Since publication of the Agenda, the Trust had been able to publicise the proposed development of Worcestershire Royal Hospital’s (WRH) Urgent Care and Emergency Department (ED) following a national review of the size and attendance at emergency departments which identified WRH as one of three trusts with an ED of disproportionate size. The Trust had been allocated £15m to improve the size and flow of the ED, and following evaluation of the site, the preferred option was to use the two unoccupied floors of the Aconbury building, with an additional ground floor extension. Plans also included a separate children’s ED, new helipad funded by the Air Ambulance, and a same day emergency care assessment facility. This development would release the existing ED building, and options for its use were being considered.

The Chief Operating Officer (COO) set out the set out immediate next steps to restore and restart services as part of work to address increased waiting lists, through looking at ways to safely increase capacity of surgery and ambulatory care – proposals were being worked through and would start at different stages from 15 March and over the next few months, including:

·         use of Kidderminster for elective day case and short stay activity

·         increased elective capacity for confirmed non-Covid patients at the Alexandra Hospital (the Alex)

·         increased capacity for more complex elective care for confirmed non-Covid patients at the Alex with high care provision in designated Covid-secure wards – this would allow continued focus on elective orthopaedic and urology services as well as transfer of more planned elective and cancer surgery from WRH to the Alex

·         transfer of activity from WRH to the Alex which would be balanced by moving some urgent surgery back to WRH. For non-Covid patients requiring urgent or complex surgery which could only be provided at WRH, one ward had already been designated as a Covid-secure ward.

Longer term plans also included further expansion of elective capacity at the Alex through development of a business case to improve the operating theatre on that site.  It was emphasised that there was no debate about the ED at the Alex, which was a key asset and would definitely remain.  The operating theatre at the Alex would be important in increasing capacity, since  ...  view the full minutes text for item 1015.

In attendance for this item were:

Worcestershire Acute Hospitals NHS Trust – Vicky Morris, Chief Nursing Officer and Richard Haynes, Director of Communications and Engagement

The Chief Nursing Officer referred to the presentation slides included in the Agenda.  Addressing the Care Quality Commission (CQC) Report on Maternity following its unannounced inspection in December 2020, it was important to consider the context of Covid, which had been very challenging. The inspection came following whistle-blower concerns to the CQC over staff shortages. Maintaining staff levels was key and this had been particularly hard during September when staff had rightly been concerned. No safety concerns had been raised during the inspection and other positive feedback included excellent multi-professional team working, recognition of work already undertaken and staff being highly motivated to provide good care. Therefore, it was important to reassure Mums and families and also staff who were working really hard.

Concerns raised were staffing in particular reliance on bank staffing, documentation of escalation, incident reporting, mandatory training, poor completion of maternal early warning score and risk assessments and incomplete Birmingham Symptom Specific Obstetric Triage System.

The Chief Nursing Officer believed that there were established systems in place around staffing but they had not always been recorded. For example, routine ‘huddles’ took place to see whether staff needed to be moved around to fill any gaps, however actions taken to do this were not always documented, and this needed to improve. The concerns raised around accident reporting and mandatory training had sometimes been due to needing ‘all hands to the pump’.

However, the CQC had recognised the Trust as being well led for its leadership capacity, vision and strategy, culture, clear roles and responsibilities, managing risk issues and performance, use of data to support quality, public engagement, learning and training.

Actions which the Trust had put in place already included sustained focus on safety huddles and Chief Nursing Officer safety walkabouts, increased recruitment, training and governance to strengthen processes. 

Recruitment of 17 fulltime midwives and two team matrons was very positive. Staff engagement now also involved the Director of Midwifery and the leadership team was involved in six open meetings with all staff groups to formulate an action plan, discussion of the plan with staff at monthly briefings, and ongoing engagement events.

The collective response to the CQC report meant the Trust would continue to work closely with Maternity Voices Partnership (MVP) on co-production of a revised Induction of Labour pathway and MVP monthly Q&A sessions with the Director of Midwifery throughout the pandemic to support sharing of information and views. Another positive step was that partners were once again able to accompany mums to scans.

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

·       The Chairman acknowledged that pressures from Covid-19 must have made staffing particularly challenging.

·       It was encouraging to see the steps already taken by the Trust to address the concerns raised and HOSC members sought clarity on the timescale for this being reflected by the CQC  ...  view the full minutes text for item 1016.

In attendance for this item were:

NHS Herefordshire and Worcestershire Clinical Commissioning Group:

Simon Trickett, Chief Executive and David Mehaffey, Director of Integrated Care System Development

Worcestershire County Council:

Paula Furnival, Strategic Director for People, Dr Kathryn Cobain, Director of Public Health and Cllr Adrian Hardman, Cabinet Member with Responsibility for Adult Social Care

David Mehaffey, Director of Integrated Care System Development referred to the Agenda report and provided a brief summary of Integrated Care Systems (ICS) and progress in Herefordshire and Worcestershire. The NHS defined integrated care as being about giving people the support they needed, joined up across local councils, the NHS and other partners, and removing the traditional divisions between hospitals and family doctors, physical and mental health, the NHS and council services.

This was an early update, following publication of the White Paper ‘Integration and Innovation: working together to improve health and social care for all’ on 11 February; a lot of information was emerging, and further updates would be provided. The new legislation built on changes in 2012 which created clinical commissioning groups and moved public health function to councils.

The Paper proposed creation of two new bodies, an ICS Group which would be a new body of core NHS organisations and local councils that would subsume the Clinical Commissioning Group (CCG) and an ICS Health and Care Partnership which would bring together wider partners and stakeholders. Together these formed the ICS, which would replace the Sustainability and Transformation Partnership (STP).

The changes would not affect Health and Wellbeing Boards although it would be important to align the new Partnership’s responsibilities as closely as possible. The biggest impact would be for the CCG, which would be worked through over the next few months. A new Unitary Board, to govern the NHS ICS Body would be constituted by a full range of NHS providers, General Practice and Local Authority representatives.

Importantly, a change to competition legislation would reduce the amount of unnecessary procurement when there was an obvious choice of provider for services. Another key difference would be a single system financial target, meaning more collaboration

The new arrangements were due to be implemented from 1 April 2022 and national guidance was awaited, however Worcestershire had a strong base to build on, having already demonstrated its ability to work in partnership. The public may not notice a great deal of change but would see better integrated and digitalised health and social care and a single clinical record system.

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

·         The ICS changes could be viewed as yet another change, however the different approach was welcomed by the Committee

·         The CCGs representatives acknowledged debate over recent years about competition within the operating model giving potential for providers including those from abroad to pitch for services with greater potential profit, however ICS legislation was a shift away from this culture, whilst still maintaining flexibility for example to procure help from the independent sector

·         The legislation was  ...  view the full minutes text for item 1017.

No updates provided.

It was agreed that an update on Maternity Services would be added to the work programme, to monitor progress by the Acute Trust’s action plan for improvement.

In closing the meeting, Cllr Frances Smith pointed out that this was the last HOSC before the County Council elections, and she thanked the Scrutiny Team for their work. Cllr Paul Tuthill, Chairman was not seeking reselection and on behalf of the Committee, she wished him well for the future, as well as the Cabinet Member for Public Health, Cllr John Smith who would also not be standing for election.