Agendas, Meetings and Minutes - Agenda and minutes

Agenda and minutes

Venue: County Hall

Contact: Emma James / Jo Weston  Overview and Scrutiny Officers

Items
No. Item

1049.

Apologies and Welcome

Minutes:

Apologies had been received from Councillors Calne Edginton-White, Adrian Kriss and Jo Monk.

1050.

Declarations of Interest and of any Party Whip

Minutes:

None.

1051.

Public Participation

Minutes:

None.

1052.

Confirmation of the Minutes of the Previous Meeting

(previously circulated)

Minutes:

The Minutes of the Meeting held on 12 January 2022 were agreed as a correct record and signed by the Chairman.

1053.

Scrutiny Task Group Report on Ambulance Hospital Handover Delays pdf icon PDF 137 KB

(indicative timing: 10:05am – 11am)

Additional documents:

Minutes:

Attending for this Item were:

 

West Midlands Ambulance Service University NHS Foundation Trust (WMAS)

Vivek Khashu, Strategy and Engagement Director

 

Worcestershire Acute Hospitals NHS Trust (WAHT)

Robin Snead, Deputy Chief Operating Officer

 

NHS Herefordshire and Worcestershire Clinical Commissioning Group (HWCCG)

Mari Gay, Managing Director and Lead Executive for Quality and Performance

 

Herefordshire and Worcestershire Health and Care NHS Trust (HWHCT)

Rob Cunningham, Associate Director Integrated Community Services

 

Worcestershire County Council (the Council)

Paula Furnival, Strategic Director of People

Rebecca Wassell, Assistant Director of Commissioning

Adrian Hardman, Cabinet Member with Responsibility for Adult Social Care

 

The HOSC Chairman introduced the Item by reminding Members that in October 2021, the HOSC was alerted by WMAS to significant ambulance hospital handover delays at both WAHT sites.  The HOSC agreed to investigate and evidence was gathered at a single session in November 2021 from all the system partners present.

 

The resulting Scrutiny Task Group Report had been checked by contributors for factual accuracy and the feedback received indicated that the Report was a true reflection of the discussion.

 

The Chairman outlined that the purpose of the meeting was not to re-open the scrutiny, rather consider the recommendations and discuss any progress made.

 

Representatives were invited to make any opening remarks, which included:

 

·         Organisations had welcomed the focussed Scrutiny Task Group discussion and Report

·         Benefits were being seen from enhanced Discharge planning across both acute hospital sites, with the Alexandra Hospital (the Alexandra) now achieving 30% of discharges before 12 noon.  Worcestershire Royal Hospital (the Royal) was below 30%

·         The Alexandra had best practice in relation to patient flow and good performance in 7 day and 21 day length of stay

·         System partners had put extra physical capacity into the Royal with the aim to improve performance 

·         WMAS reported that significant issues remained, despite conveying fewer patients to the acute hospitals.  Exceptional delays were too regular and every month over 800 handovers were in excess of one hour across both sites.  It was noted however, that the Alexandra handover time was strong, being one of the best in the region.  Issues remained at the Royal with ambulances largely waiting outside with patients on board.

 

Members were invited to ask questions on progress made against the Scrutiny Report recommendations.  During the discussion, the following points were made:

 

·         When asked whether the target of 30% of discharges before 12 noon was good enough, it was clarified that the figure was a national target and the Alexandra was achieving it

·         Same day emergency care was performing fairly well, especially at the Alexandra, although both emergency departments (EDs) were congested

·         Conversion rate from ED to admittance was broadly in line with national figures, around 29%

·         WMAS performance in the number of patients conveyed to hospital was the best in the Country with less than half the calls received requiring an ED attendance.  This was attributed to all ambulances having a Paramedic on board, something which other Trusts may not offer

·         A Patient Tracker system had been introduced, which  ...  view the full minutes text for item 1053.

1054.

Update on the Public Health Ring Fenced Grant 2022/23 pdf icon PDF 330 KB

(indicative timing: 11am – 11:20am)

Minutes:

The Head of Finance reported that the Public Health Ring Fenced Grant (PHRFG) allocation for Worcestershire for 2022/23 had been confirmed at £31,217,923, which was an increase of £853,016 from the previous year.  Nationally, the PHRFG to local authorities was £3.417 billion, an increase of c2.8% from the previous year and was ringfenced for use on public health functions, which could include public health challenges arising from the COVID-19 pandemic.  In Worcestershire, it was proposed to use £3.2m of Reserves during 2022/23.  A breakdown of the funding, detailed in the Agenda Report, covered strategic functions, universal and prevention services for both adults and children.  The HOSC noted that the PHRFG was able to be carried forward to the following financial year.

 

During discussion and in response to Member questions, the Head of Finance and the Director of Public Health made the following key points:

 

·         It was clarified that the PHRFG was only available to be used for specific prescribed and non-prescribed functions as detailed in the Agenda Report

·         Through the Joint Strategic Needs Assessment process, the Public Health Team held a lot of detailed information and had an investment in well being

·         The budget for the Substance Misuse Contract was around the same as the previous year however additional funding would be received to maintain current provision

·         Public Health Reserves were approximately £8m and it was proposed to use £3.2m in 2022/23 to undertake the scheduled activity, including COVID-19 recovery, which was a key factor for the upcoming year

·         A Member referred to a recent national report stating the value of the PHRFG had decreased in value by 24%.  The Head of Finance reported that this was not the case and Worcestershire’s allocation had increased year on year, however, it was noted that increases were not in line with inflation

·         For clarity, the Sexual Health Contract was awarded to Herefordshire and Worcestershire Health and Care NHS Trust under a Section 75 agreement

·         When asked about support for Domestic Abuse victims, it was hoped that partners would work together to find a sustainable model for the future, as it was not a statutory duty

·         Funding for Warmer Worcestershire was being monitored given increasing energy prices and concern over fuel poverty

·         The HOSC noted that NHS inflation was about 5% with all goods and services costing more than previously.

1055.

Dental Services Access and Oral Health Promotion pdf icon PDF 1 MB

(indicative timing: 11:20am – 12:20pm)

Minutes:

Attending for this Item were:

 

NHS England and NHS Improvement – Midlands Region (NHSE&I)

 

Terry Chikurunhe, Senior Commissioning Manager

Anna Lee Hunt, Consultant in Dental Public Health

 

Worcestershire County Council (the Council)

 

Kathryn Cobain, Director of Public Health

Elizabeth Griffiths, Public Health Consultant

Karen May, Cabinet Member with Responsibility for Health and Well Being

 

The Chairman introduced the Item by thanking those present for the very comprehensive Agenda Report.  The NHSE&I Senior Commissioning Manager highlighted some of the key points within, including:

 

·         Unlike a GP Practice, there was no system of registration with a Dental Practice.  Patients with open courses of treatment were Practice patients for the duration of their treatment, however, once complete, apart from repairs, the Practice had no ongoing responsibility.  However, it was not uncommon for Practices to recall patients for a regular check-up

·         Dentistry had been severely impacted by the COVID-19 pandemic due to infection control measures and priority was given to urgent care, children and vulnerable patients

·         It continued to operate at a reduced capacity, although levels of activity were slowly increasing.  In 2021, Dental Practices had been operating at 65% of normal capacity and as of January 2022, that had risen to 85%

·         As a consequence of the pandemic, Dentists were reporting that patients were presenting with more complex cases which in turn meant less time for routine check-ups  

·         There were 63 general Dental Practices in Worcestershire with a NHS Contract

·         Historically, Worcestershire had particular challenges around workforce, across Dentists, Dental Nurses and Receptionists, especially in the rural parts of the County

·         NHSE&I was aware of access issues and was working collaboratively with the Council to strengthen oral health promotion and prevention activities.  In addition, there was a campaign to ensure patients at risk of oral cancer were referred in a timely manner.

 

During the opportunity for discussion, the following points were raised:

 

·         A Member noted that although the Report provided a lot of detail, it would have been useful to have some data

·         A request was made for further information on Urgent Dental Care triage categories.  In response, NHSE&I was to undertake an Out of Hours needs assessment, which would incorporate NHS111 data and could be shared with the HOSC when available

·         A number of HOSC Members were concerned about Dental Practices ceasing to provide NHS dentistry and the way in which ‘going private’ was communicated to residents.  A Member highlighted a case whereby a resident was unable to schedule an NHS appointment but was informed they could be seen privately 

·         NHSE&I accepted that there was a significant problem and was currently mapping dental need across the region.  It was clarified that NHS Dental Practices had an obligation to adhere to NHS standards and residents should not be funnelled into becoming a private patient, unless the NHS contract was ending or had ended

·         In response to a Member suggestion that private patients were subsidising NHS dentistry, the HOSC learned that when NHS contracts began in 2006, the rates  ...  view the full minutes text for item 1055.

1056.

Work Programme pdf icon PDF 134 KB

(indicative timing: 12:20pm – 12:30pm)

Additional documents:

Minutes:

Members considered the latest Work Programme and agreed the following:

 

·         A Report on the progress made against the recommendations from the Ambulance Hospital Handover Delays Scrutiny Task Group Report would be added to the 9 May 2022 agenda and a separate report on Patient Flow would also be provided

·         A further Update on Dental Services Access would be added at an appropriate time

·         Under Workforce Pressures (scheduled November 2022) the scope would be expanded to include Occupational Therapists

·         Under Health Inequalities resulting from the COVID-19 Pandemic (scheduled July 2022), the scope would be expanded to include Long Covid

·         Under Public Health Outcomes (date of report TBC) the scope would be expanded to include alcohol services and sexual health services

·         The Chairman agreed to discuss the scope of Primary Care Access outside of the meeting before determining whether to add it to the Work Programme.