Agenda and minutes

The Chairman welcomed everyone to the Meeting. 

Apologies had been received from Cllrs Salman Akbar, Mike Johnson, Natalie McVey and Jo Monk.

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 9.00am on the working day before the meeting (in this case 15 October 2021). Enquiries can be made through the telephone number/email address below.

None.

Previously circulated

The Minutes of the Meeting held on 21 September 2021 were agreed as a correct record and signed by the Chairman.

Attending for this Item from West Midlands Ambulance Service University NHS Foundation Trust (WMAS) were:

Mark Docherty, Executive Director of Nursing and Clinical Commissioning

Murray MacGregor, Communications Director.

By way of background, Members were referred to the Agenda Report and reminded of the salient points.

West Midlands Ambulance Service University NHS Foundation Trust (WMAS) response times were recognised as not being good enough and ambulance handover delays at hospitals was a contributing factor alongside the continuing impact of the COVID-19 pandemic.  Of the 10 Community Ambulance Stations (CAS) due to close across the region, 2 were in Worcestershire (Malvern and Evesham).  WMAS had planned to review the CAS sites in 2022, however, the review had been brought forward as a matter of urgency to try to improve the current situation.

When WMAS was formed in 2006, there were initially around 70 ambulance stations, however, in recent years, a new model of operation had seen 15 ‘Make Ready’ Hubs and a fleet of rapid response vehicles being utilised.  In Worcestershire, the Hubs were in Worcester and Bromsgrove.  The rapid response vehicles had now been replaced with additional ambulances. 

WMAS Staff were exhausted and had been on high alert since the winter of 2019/2020.  Initially, there was severe flooding throughout the region, then from late January 2020, WMAS was involved in transporting citizens returning from China in the UK, followed by over eighteen months of working with COVID-19 procedures and infection control measures.  Staff had often had no holiday,  no opportunity for furlough and had often been working with COVID-19 positive patients and were still working in situations requiring personal protective equipment (PPE).

Reassurance was given that the same number of ambulances and the same number of staff would continue to operate in the area and all ambulances would start and end at a Hub, meaning they would be fully stocked and fuelled for a full 12 hour shift.  Ambulance crews that operated from a CAS, lost around 2.5 and 3 hours of ambulance time over each 24 hour period mainly due to travelling back to the CAS for meal breaks and to swap vehicles.

Delays at hospitals were putting patients at risk of death, with over 15,000 ambulance crew hours lost in just one month.  Worcestershire hospitals often had more delays than the whole of the UK combined and it was not uncommon for 40% of the Worcestershire fleet to be waiting at a hospital. 

On behalf of the HOSC, the Chairman thanked WMAS and all NHS staff for the work everyone was doing every day.  Members were invited to ask questions and in the ensuing discussion, the following main points were made:

·       WMAS believed that it was important to look at the role of the ambulance service rather than the buildings they operated from.  Buildings were very rarely occupied given the role of the service and the buildings did not provide patient care

·       5,000 – 6,000 hours of crew time would be released across the 10 CAS sites

·       Saving money  ...  view the full minutes text for item 1033.

Attending for this Item from NHS Herefordshire and Worcestershire Clinical Commissioning Group (HWCCG) were:

Charmaine Hawker, Deputy Director of Primary Care

Dr Jonathan Leach, Primary Care GP Lead.

HOSC Members had received a Report as part of the Agenda.  A summary of key points was presented.

The way in which general practice (GP) operated had changed since the beginning of the COVID-19 pandemic.  The latest central Government directive, given in July 2021, included the Standard Operating Procedure to continue with infection control measures and the wearing of masks.  It was mandated that a blend of face to face and online appointments be given, increasing patient choice.  From October 2021, there would be a minimum number of online consultations permissible.  HWCCG believed that many patients liked the telephone/online offer.

The NHS acknowledged that there was a significant backlog of cases, huge workload and capacity constraints in primary care, however GPs had contributed hugely in the COVID-19 vaccination programme and the flu vaccination programme.  Furthermore, the County had an aging and growing population, which added to the challenge.

Recruitment and retention was a national issue and Worcestershire was no different.  Since 2015, the number of full time equivalent GPs had reduced by 15, with 7 GPs leaving in the last Quarter.  GPs were demoralised and practice staff were under strain, including reception and administrative staff who were often the first point of contact for patients. 

There were 80 GP practices across the 2 Counties.  Appointment data collected nationally suggested that Herefordshire and Worcestershire was performing well in most areas and activity had increased 7% since August.  54% of patients were seen face to face and more appointments were available per head of population than nationally.  Before the pandemic, 50% of patients were seen same day and currently this was 57% locally and 54% nationally.  Overall, Herefordshire and Worcestershire benchmarked well.

A recent audit reported that, on average, telephone calls were answered within 7 minutes.  If a practice was found to have calls unanswered within 45 minutes, a package of support was given by HWCCG, including the technology to move to a cloud based telephony system, which would result in more telephone lines being available.

Associated issues for GPs included the backlog in hospital procedures and practices, resulting in patients asking for progress in hospital matters, which were out of the GP’s control. 

HWCCG was clear that if concerns were raised, they would be addressed, however, the workforce had not grown and the pressure remained.

In the ensuing discussion, the following main points were made:

·         The NHS intent was that all GP practices would have a cloud based telephony system by the end of 2021, resulting in increased telephone lines and the ability to monitor inbound and outbound call volumes.  This would support each practice in managing capacity and staffing.  Furthermore, the ability to log in to the system could result in calls being answered securely from those working off site.  The disadvantage of such a system was the single point of failure,  ...  view the full minutes text for item 1034.