Agendas, Meetings and Minutes - Agenda and minutes

Agenda and minutes

Contact: Emma James / Jo Weston  Overview and Scrutiny Officers

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1057.

Apologies and Welcome

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Minutes:

The Chairman welcomed everyone to the meeting and explained that the meeting would be webcast.

 

Apologies had been received from Councillors David Chambers, Lynn Denham and Adrian Kriss.

 

Members were informed that Councillor Mike Johnson, Worcester City Council HOSC Member, had stood down from Worcester City Council at the recent election. As a consequence there was a vacancy on the Committee for a Worcester City Councillor.  Thanks were given for Mike’s commitment to HOSC over recent years.

1058.

Declarations of Interest and of any Party Whip

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Minutes:

None.

1059.

Public Participation

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Minutes:

None.

1060.

Confirmation of the Minutes of the Previous Meeting

Previously circulated

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Minutes:

The Minutes of the Meeting held on 9 March 2022 were agreed as a correct record and signed by the Chairman.

1061.

Refresh of the Scrutiny Work Programme 2022/23 pdf icon PDF 135 KB

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Minutes:

Members had been asked to consider suggestions for the 2022/23 HOSC Work Programme prior to it being submitted to Council for approval.  It was agreed that the latest Work Programme was still valid, with one additional Item – Out of County elective surgery.

1062.

Progress Update against Recommendations from the Scrutiny Task Group Report on Ambulance Hospital Handover Delays pdf icon PDF 283 KB

To follow

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Minutes:

Attending for this Item were:

 

NHS Herefordshire and Worcestershire Clinical Commissioning Group (HWCCG)

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

 

Worcestershire Acute Hospitals NHS Trust (WAHT)

Paula Gardner, Chief Nursing Officer

 

Herefordshire and Worcestershire Health and Care NHS Trust (HWHCT)

Rob Cunningham, Associate Director Integrated Community Services

 

Worcestershire County Council (the Council)

Mark Fitton, Interim Strategic Director of People

Rebecca Wassell, Assistant Director of Commissioning

Adrian Hardman, Cabinet Member with Responsibility for Adult Social Care

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

 

The Chairman explained that the Strategy and Engagement Director from West Midlands Ambulance Service University NHS Foundation Trust (WMAS) was unexpectedly unable to attend the meeting, however, had provided a summary for the attention of HOSC Members.  WMAS was taking fewer patients to the two acute hospitals in Worcestershire, however, delays in hospital handovers remained a significant concern.

 

The summary discussion of the progress made against the recommendations from the Scrutiny Task Group Report included the following key points:

 

·       The Health and Care System continued to be extremely challenged.  WAHT Emergency Departments (EDs) were seeing many more walk in patients with more complex clinical needs, COVID-19 continued to be prevalent although there were signs that cases were beginning to fall.  Workforce continued to be of national concern, with high rates of vacancies across the health and social care sector

·       The System had recognised that ED capacity at the Worcestershire Royal Hospital site (the Royal) was not right.  The new ED was anticipated to be open in December 2022, however, the enhanced Medical Assessment Unit (MAU), which would provide an additional 21/22 beds, had been delayed due to water sampling issues

·       Since 25 April 2022, the System had adopted a different approach to patient flow, working through a Rapid Improvement Cell, which had Executive Leadership.  The focus was on earlier discharges and identifying patients who could be discharged before 10am, known as ‘golden’ discharges.  It was reported that on Friday 6 May, 50% of patients were discharged before midday and 90% before 6pm.  This pace was commended but needed to be embedded and become usual practice

·       Same Day Emergency Care was being delivered in key services and signposting to appropriate services, such as Minor Injury Units, was being undertaken

·       Patients waiting in ambulances were checked on a regular basis, however, it was acknowledged that it often caused patient distress

·       Performance in discharge to Home was very good and discharge to Community Hospital had increased, with the HWHCT opening an additional 20 beds.  As a consequence, Staffing levels had been stretched

·       Workforce across the health and social care sector continued to be of concern, both locally and nationally

·       The situation continued to be run as an Incident and would run as such throughout the Summer until sustainable patient flow could be achieved.

 

Members were invited to ask questions and in the ensuing discussion, the following key points were made:

 

·       A Member asked why workforce issues had not been resolved given it had  ...  view the full minutes text for item 1062.

1063.

Patient Flow pdf icon PDF 136 KB

To follow

Additional documents:

Minutes:

Attending for this Item were:

 

NHS Herefordshire and Worcestershire Clinical Commissioning Group (HWCCG)

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

 

Worcestershire Acute Hospitals NHS Trust (WAHT)

Paula Gardner, Chief Nursing Officer

 

The previous Item and discussion had covered much of this Agenda Report; however, it was reiterated that rapid improvement had been seen as a result of focussed work to discharge patients early in the day. 

 

Simple discharges, those patients without any ongoing health or social care need, may be medically fit, however, they were often still poorly.  A project to provide wrap around care for 24 hours was underway.  Capacity at the Royal would be increased to support the ED and was expected to open in the coming months.

 

Member questions were invited and key points included:

 

·       The Chairman highlighted that there was no mention of delays to discharge due to Pharmacy and it was previously reported that provision was not an issue.  In response the Managing Director HWCCG explained that there were few delays resulting from Pharmacy provision and as part of the rapid improvement cell,  where possible pharmacy was dispensing medicines the day before discharge

·       The bigger challenge was related to transport.  Hospital transport needed to be booked earlier and where possible families encouraged to collect relatives, rather than relying on hospital transport

·       There was no delay to occupational therapist support and if there was such a delay, steps were in place for it to be escalated immediately

·       It was agreed to provide HOSC Members with further information on patient flow Key Performance Indicators, which were nationally mandated, alongside performance information over time to show trends.  The target for Pathway 1 discharges was 80% within 24 hours

·       A Member asked whether patients would stay in hospital if adaptations were needed in their own home, to be informed that patients did not remain in hospital if adaptations were required at home except in a few instances eg if a patient lived outside of Worcestershire. A risk based approach was taken and if needed Community Hospital beds would be used

·       There were currently 253 Community Hospital beds open and the Council had commissioned further transition beds to ease patient flow.  It was reported that the financial investment in Pathway 1 had been huge both in and out of County.

 

It was agreed that a further Report would be scheduled for the 8 July HOSC.

1064.

Maternity Services pdf icon PDF 142 KB

To follow

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Minutes:

The Chairman had agreed to change the Agenda order.  Attending for this Item from Worcestershire Acute Hospitals NHS Trust (the Trust) were:

 

Paula Gardner, Chief Nursing Officer

Justine Jeffery, Divisional Director of Midwifery

 

Members had received a comprehensive Agenda Report, highlighting the progress made on Maternity Services since the Trust’s last HOSC Report in September 2021. 

 

As a result of the Care Quality Commission (CQC) inspection in December 2020, the Trust had developed an Improvement Action Plan to meet all of the CQC recommendations.  At the time of the meeting, only 5 actions were outstanding with an expectation that these would be completed by September 2022.

 

Workforce issues remained, however, there had been excellent progress in recruitment.  Nationally, there was a shortfall of 5,000 midwifes, yet in Worcestershire, there would be no vacancies by February 2023, if the same level of recruitment was undertaken.

 

Good progress was being made against Key Performance Indicators in clinical outcomes and Staff had been responding to the recommendations in the Ockenden Reports.  These Reports followed the independent review of Maternity Services at Shrewsbury and Telford NHS Trust and Worcestershire had 92% compliance against the Reports immediate actions.

 

In the ensuing discussion the following key points were made:

 

·       The Trust did not have any timeframe on a full CQC re-inspection of Maternity Services, however CQC monitoring visits had taken place and progress reports were taken regularly to the Trust Board for scrutiny

·       In response to a member question about whether the use of beds were designated and dedicated for use in particular area eg antenatal or postnatal, the Committee was advised that as physical space was limited, if a patient needed care, it would be provided in the bed that was most appropriate and available at the time.  It was more important that a patient received the most appropriate care

·       Midwifery students graduated twice a year and it was hoped that students would stay local, however, neighbouring Trusts were also attractive propositions.  The Trust was active in engaging with the University early

·       A Member asked for data to be included in future reports.  It was agreed that the Key Performance Indicators from the Improvement Action Plan could be shared with the HOSC now

·       The Trust acknowledged that Staff morale continued to be very low.  This was a national picture with challenges in recruitment, the concern from the review in Telford and Shrewsbury, capacity and demand and the ongoing implications of absence due to COVID-19.  The Trust had recognised International Day of the Midwife, was due to recognise International Nurses Day and was committed to building morale across the Trust

·       The number of midwifes retiring was low, however, from exit interviews it was suggested that midwifes were leaving the profession or moving to national organisations, rather than moving to another Trust

·       In response to a question as to why people were not joining the midwifery profession, Members learned that overall there were fewer training places available but no shortage of people wanting to join the profession.  ...  view the full minutes text for item 1064.

1065.

Dementia Services in Worcestershire pdf icon PDF 172 KB

To follow

Additional documents:

Minutes:

Attending for this Item were:

 

Herefordshire and Worcestershire Clinical Commissioning Group (HWCCG)

Carol Rowley, Dementia Services Lead

 

Herefordshire and Worcestershire Heath and Care NHS Trust (the Trust)

Dr Dhan Marrie, Consultant in Older Adult Mental Health

 

Worcestershire County Council (the Council)

Matt Fung, Public Health Consultant

 

By way of introduction, a summary of the Agenda Report was provided.  Members learned that prevention was an important work area and a number of lifestyle interventions, such as limiting alcohol use, reducing obesity and controlling blood pressure, may prevent or delay dementia onset.

 

During the COVID-19 pandemic, funding had been received to enhance the memory assessment service. Clinical Staff had been redeployed and there was a backlog of cases, however the additional funding had been used to manage the service which was now operating at pre-pandemic levels.

 

Nationally, there was a recommendation to diagnose dementia within 12 weeks and statistically, Worcestershire was measured as having a diagnosis rate of 67%.  This was explained as a prediction that around 8,000 residents were aged 65 or over and two thirds would expect to have dementia.  There were currently around 4,600 diagnosed residents, meaning that an additional 1,350 patients would need to be found.  Worcestershire was currently performing at around 50%.  A recent NHS England study suggested that diagnosis rates were higher in urban areas.

 

Work on the County Dementia Strategy had paused during the COVID-19 pandemic; however, activity was restarting and professionals from various sectors were actively engaged.  Activity and awareness raising was encouraged and a mapping exercise had taken place to establish what services were available across the County to identify any gaps in provision.

 

Care Home diagnosis rates would be expected to be around 80%, however, some Worcestershire Care Homes had figures as low as 40%.  This was currently a piece of focussed work.

 

Members were invited to ask questions and the following points were made:

 

·       When asked to what extent GPs were trained, it was reported that across Herefordshire and Worcestershire the level of understanding was high, with very experienced GP Leads.  Lunchtime education sessions for GPs were being developed and some GPs were able to diagnose

·       Low Care Home diagnosis rates was of concern; however it was suggested that the focus was on early detection and residents in Care Homes may have more advanced dementia

·       The Council and HWCCG were working together to better understand the national modelling to determine whether the 67% estimate was a true reflection of the situation in Worcestershire.  Members learned that only age and sex were used in the modelling and no account was taken on other factors such as social isolation, levels of deprivation or any hearing loss.  There was a known link between hearing loss and dementia.  People with hearing loss generally became withdrawn resulting in the brain becoming less stimulated

·       NHS England reported that urban areas usually achieved, or exceeded, the target of 67% diagnosis.  When asked whether the working life of a resident could be of relevance, it was reported that  ...  view the full minutes text for item 1065.