Agenda and minutes

The Chairman welcomed everyone to the meeting and introduced Cllr Sue Baxter as the new Bromsgrove District Council Member.  Thanks were given to Cllr Jo Till for her contribution to HOSC over recent years.

Apologies had been received from Cllrs Calne Edginton-White, Mike Johnson, Jo Monk and Kit Taylor.

None.

The Scrutiny Co-ordinator advised the Committee that District Council Members had agreed to nominate Cllr Frances Smith (Wychavon District Council) as Vice Chairman.  The nomination would be put to the next meeting of Worcestershire County Council for agreement.

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 20 September 2021). Enquiries can be made through the telephone number/email address below.

None.

Previously circulated

The Minutes of the Meeting held on 10 March 2021 were agreed as a correct record and signed by the Chairman.

Attending for this Item were:

Herefordshire and Worcestershire Clinical Commissioning Group (HWCCG)

Jenny Dalloway, Lead for Mental Health, Learning Disabilities and Children

Dr Tim Lee, Mental Health GP Lead

Herefordshire and Worcestershire Health and Care NHS Trust (HWHCT)

Sue Harris, Director of Strategy and Partnerships

Emma Webber, Associate Director of Specialist Mental Health Services

Jayne Westwood, Service Manager – Older Adult Mental Health

Worcestershire County Council (the Council)

Dr Kathryn Cobain, Director of Public Health

Kerry McCrossan, Assistant Director of Adult Social Care

Cllr Karen May, Cabinet Member with Responsibility for Health and Wellbeing

The Health Overview and Scrutiny Committee (HOSC) had received a Report and Presentation Slides as part of the Agenda.  Members were guided through the detail by those present, with the following key points being made:

·         Mental Health services was a broad provision, covering all ages and a range of providers, including GPs, specialist services and the voluntary and community sector

·         Throughout the COVID-19 pandemic, mental health services continued to be provided, albeit with changes to provision to manage infection control

·         Services had been generally place based, however, with the inception of Primary Care Networks, there had been a shift in delivery options available and work with schools and the Police was increasing

·         Health economy partners were working to develop a new Mental Health Strategy, which was to be discussed at the Health and Wellbeing Board in late September and would be shared with the Committee in due course

·         The voluntary sector had a key role to play in localities, especially with the increase in social prescribing

·         Members learned of the range of services available for Child and Adolescent Mental Health Services (CAMHS), Adult Mental Health Services and Older Adult Mental Health Services

·         During the pandemic there had been pressure nationally on CAMHS Tier 4 beds, however, crisis support had been expanded to try and avoid admissions

·         The NHS Long Term Plan focussed on providing crisis support 24 hours a day, 7 days a week for patients experiencing an acute mental health crisis.  This had been achieved and additional funding had also been secured to expand A&E liaison

·         Within Worcestershire, there were 41 Adult inpatient beds, including an Intensive Care Unit, however, some patients required out of County placements

·         For Older Adults, there were 30 inpatient beds.  Capacity was managed well to avoid any out of County placements

·         The Mental Health Social Work Team had been run by the Council since April 2021 and continued to support the same number of people as previously.  Recruitment of front line professionals had been successful and investment in this area would continue

·         The Council promoted the 3 Conversation approach to social care

·         In relation to Public Health, the full impact of the COVID-19 pandemic on mental health was unknown, however, early indications suggested that although there had been a decline in average mental health it was an improving picture.  The impact of Long Covid was currently unknown.  The Mental Health Needs Assessment, when available, would be shared with the  ...  view the full minutes text for item 1025.

Attending for this Item were:

Herefordshire and Worcestershire Health and Care NHS Trust (HWHCT)

Sue Harris, Director of Strategy and Partnerships

Jayne Westwood, Service Manager – Older Adult Mental Health

Emma Webber, Associate Director of Specialist Mental Health Services

Herefordshire and Worcestershire Clinical Commissioning Group (HWCCG)

Jenny Dalloway, Lead for Mental Health, Learning Disabilities and Children

Dr Tim Lee, Mental Health GP Lead

Members were reminded that during the COVID-19 pandemic, a number of temporary service changes were made across the NHS to enable health services to be restored.  One such change related to a ward for older adult mental health.  The Athelon Ward at Newtown Hospital, Worcester was temporarily closed when efforts were made to keep older people out of hospital as much as possible and the ward budget was used to introduce a Hospital at Home service as a pilot scheme.

The HWHCT now wished to consult on the proposal to retain the Hospital at Home service provision and permanently close the 14 bed Athelon Ward.  Ward provision for older adult mental health would continue at the established New Haven Unit at the Princess of Wales Community Hospital, Bromsgrove.

During the introduction, main points included:

·         Recruitment to the Hospital at Home service had been very successful and it was fully staffed within 3 months of starting

·         Although the 14 bed Athelon Ward had closed, all Staff were reassigned

·         As a result of the changes made, weekend crisis support was now available and there were dedicated carers workers

·         Continuous feedback had been sought since the introduction of the Hospital at Home service, with patients and relatives appreciating the provision

·         HWHCT was pleased with the very positive results, with more patients being seen and length of stay reduced

·         The reduction of 14 beds from the system had not resulted in any patient being in need of an out of County placement and at the time of the HOSC, 5 beds were empty

·         Members heard that the proposal enhanced patient choice

·         HWHCT had engaged with patients and carers throughout the initiative and had continuously evaluated the feedback.  It was noted that the Equality Impact Assessment would be reviewed

·         Due to the ongoing COVID-19 pandemic, the Trust had no plan to hold a large scale engagement event during the consultation, something which they would have done in the past

·         A Report would be taken to the HWHCT Board and HWCCG in January 2022 for approval

·         The HWCCG was supportive of the proposal which had been considered some years previously, however, it was keen to see further formal consultation before any decision was made

·         Dr Tim Lee reported that the model of care proposed was in place across the world.

Members were invited to ask questions and the main points made included:

·         It was clarified that the loss of 14 beds was for functional mental health in older adults and that no Dementia beds would be lost as a result of the proposal

·         As national COVID-19 rules were relaxed, Clinicians had concerns about  ...  view the full minutes text for item 1026.

Attending for this Item were:

Worcestershire Acute Hospitals NHS Trust (the Trust)

Paula Gardner, Chief Nursing Officer

Justine Jeffery, Divisional Director of Midwifery

Richard Haynes, Director of Communication and Engagement

Members were reminded that as a result of an inspection by the Care Quality Commission (CQC) on 9 December 2020, the overall rating for the Maternity Service was lowered to Requires Improvement.  An Action Plan was produced and Senior Representatives attended HOSC on 10 March 2021. 

The Chief Nursing Officer had joined the Trust in March 2021 and alongside senior leaders developed a Maternity Service Improvement Plan, which would be used to deliver the requirements of the national maternity transformation plan.  Alongside this, the Action Plan, first developed after the CQC inspection, had 138 actions.  At the time of the meeting, 102 actions were complete, 17 on track for completion and 19 had been delayed.

A non-executive Director had been appointed for safety and his presence and regular walkabouts were received positively.

Regular reporting to the Trust Board, the national programme team and the CQC was ongoing, with CQC meetings held monthly although currently remotely.

At its last meeting the HOSC was concerned that the CQC may not reinspect the service for some time.  It was reported that there was no indication when an inspection may take place but could be up to two years.

Staff Communication and Engagement had improved greatly.  Social Media groups had been set up, monthly briefings were taking place and senior leaders were visible at all times of day and night.  Staff appreciated the efforts made.

Recruitment had been successful, despite a national shortage of nurses, in part due to Worcestershire being an attractive place to live and work.  Students and experienced Staff had joined the Trust, with all new recruits due to be in place by the end of September.

Some Members were concerned about the lack of maternity service at the Alexandra Hospital in Redditch.  It was clarified that consultant led maternity provision was centralised at the Worcester site on safety grounds, however, antenatal and postnatal support was always available in the local community.

There were challenges in the national programme’s Continuity of Care model, especially as no additional funding was available and staff were being asked to work differently.  This was a national picture and guidance was awaited from the national team.  Currently, around 28% of mothers had a named Midwife 

In relation to the actions which had not been completed, it was reported that some deadlines had been extended and most were now back on track to being completed.

Home Birth numbers had risen slightly in early COVID-19, however had settled at around 2% of all births.

The Improvement Plan had been developed with the Maternity Voice Partnership, providing a patient voice and regular monthly meetings were held to review.

The HOSC thanked everyone for the update and given the ongoing improvement, agreed to schedule an update in six months.

The HOSC agreed to add the following to the Work Programme:

Mental Health

·         The impact of COVID-19 on Children and Young People

·         Dementia Services

·         Preventative measures, for example peri-natal mental health

·         Mental Health Needs Assessment

Maternity Services

·         Schedule an update on the Action Plan in six months.