Agenda and minutes

The Chairman welcomed everyone to the meeting. Apologies were received from Councillors Salman Akbar, Sue Baxter and Kit Taylor.

Cllr Lynn Denham declared an interest in respect of Agenda item 4 (Integrated Care System Development and Development of the Draft Integrated Strategy) as a district council member of the Health and Well-Being Board.

During Agenda item 5 (The Role of Community Hospitals) Cllr Frances Smith declared an interest as the Chairman of Friends of Evesham Community Hospital.

During Agenda item 5, Simon Adams, Managing Director of Healthwatch Worcestershire declared an interest in that years ago in his previous role at the County Council he had chaired meetings which discussed the future of community hospitals.

Members of the public wishing to take part should notify the Democratic Governance and Scrutiny Manager 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 Tuesday 1 November 2022). Enquiries can be made through the telephone number/email listed in this agenda and on the website.

None.

(Indicative timing 10:05 – 10:45am)

A summary of the Agenda report was provided by the Associate Director for System Development and Strategy for Herefordshire and Worcestershire Integrated Care System (ICS) and the Executive Director of Strategy and Integration.

It was emphasised that the ICS was not one organisation, and included all of the representatives present, as well as the voluntary and community sector. The Agenda report focused predominantly on the ICS, the Integrated Care Partnership (ICP) and more specifically, the Integrated Care Strategy.

Since the last report to the HOSC in January, some significant legislative changes had taken place, including implementation of the Health and Care Act 2022, which put ICSs on a statutory footing. Essentially, the Act meant that all providers and partners involved in the ICP had responsibility to improve the health of the local population, including the wider determinants of health and wellbeing.

Other important factors were:

·       the ICP would be co-chaired by the two Health and Wellbeing Chairs, reflecting the joint working approach

·       the important role of public health

·       the timeline for production of the Strategy which included three phases of engagement including ICP representatives and wider engagement with people who lived and worked in the ICS area

·       the Strategy would be published in April 2023.

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

·       In terms of the membership of the ICB and how it would work in practice, it was explained that the aim had been to create an equal partnership between the three statutory organisations, which would encompass public health and the Health and Wellbeing Board (HWBB), and organisations had been asked to nominate representatives – however ICP meetings took place within a much wider forum.

·       No cap had been given for membership of the ICP which had more than 50 partners, as it was a platform for development and it was pointed out that Bristol and Somerset ICP had 200.

·       Regarding appointments to the ICB, Board members were all highly experienced, and recruitment had involved advertising in medical journals and the wider press, use of an agency to search nationally, and appointments panels involving Council Cabinet Members.

·       Regarding the key requirements to include in the IC Strategy, a HOSC member suggested that ‘population health and prevention’ should top the list and stressed that interventions such as NHS health checks were far too late to influence and promote the importance of healthy lifestyles, which should start at school age. The Director of Public Health completely agreed with the importance of this message, which would be included in plans for a whole prevention agenda and wider public health work set out in the Health and Wellbeing Strategy – she clarified that the health check programme for those aged 40-70 was to screen for specific markers.

·       The Cabinet Member with Responsibility (CMR) for Health and Wellbeing agreed that prevention was key.

·       In terms of monitoring expenditure of the considerable budgets involved, it was explained that this would be largely the responsibility of the relevant organisation’s Board and auditing  ...  view the full minutes text for item 1095.

(Indicative timing 10:45 – 11:30am)

The Director of Strategy and Partnerships at Herefordshire and Worcestershire Health and Care Trust (the Trust) welcomed the opportunity for a dedicated discussion about community hospitals following the briefing notes circulated to Committee members during the Covid pandemic. Community Hospitals were also clearly a very important part of integrated care, urgent care and therefore patient flow. 

The Trust’s Associate Director for Countywide Community Services and responsible for all community hospitals and other community services introduced the Report, which gave an overview of community hospitals and site by site services, with the caveat that these may change where changes to staff teams or pathways were necessary.

The seven community hospitals ranged from state of the art, to post war, prefabricated buildings and hosted three distinct clinical areas: inpatient services (across all seven sites), outpatient services (across four sites) and minor injury units (MIUs) across four sites. Ordinarily there were 233 inpatient beds available however on most days this figure was exceeded and that day there were 245 beds which incorporated additional ‘surge’ capacity for when the whole system was under pressure.

Additional points made included:

·         MIUs were technically a sub-contract of the A&E contract, so while the Trust was sub-contracted to run the MIUs, the activity belonged to Worcestershire Acute Hospitals Trust (the Acute Trust) and some aspects such as X-Ray services were provided by the Acute Trust.

·         Where historically there had been situations of multiple of contracts for clinics, this was being streamlined and Outpatient Services would be predominantly provided by staff from Worcestershire Acute Hospitals Trust, at community hospital sites.

·         Community Hospital sites were also the work base for a range of community health services such as neighbourhood teams at Tenbury, which benefitted patient flow as staff from one team could speak with another more easily.

·         Bromsgrove MIU hours had recently been increased to include Saturdays and Sunday mornings since while the Trust tried to offer a consistent timeframe across all MIUs, Bromsgrove had been an anomaly in not having weekend provision, and it was by far the busiest MIU.

·         Staffing shortages sometimes meant services had needed to close temporarily, since even the most expensive recruitment agencies could not provide the specialist staff – an example was Tenbury MIU which was by far the least used.

·         The number of people requiring stroke rehabilitation had increased significantly and at times, every bed allocated to this pathway was occupied and there were people waiting.

·         Over the past 18 months the Trust had demonstrated success with a newly commissioned 21 bed pathway at Worcester City Inpatient Unit for intensive assessment and reablement of people who previously would have moved from acute care to a residential care home.

·         A recent development programme looking at the role and remit of community hospitals had identified the clinical medical model as an area of focus, leading to a move away from a situation of multiple contracts with GP practices to provide care and intervention on an individual basis, to develop an advanced clinical practice model,  ...  view the full minutes text for item 1096.

(Indicative timing 11:30 – 11:40am)

The HOSC agreed the following in respect of the Work programme:

·       A development session for HOSC members to aid members understanding on the role of health scrutiny of the Integrated Care System would be arranged

·       The information from Centre for Public Scrutiny about scrutiny of the Integrated Care Systems would be circulated to the Committee

·       Screening (Cervical/antenatal/newborn/diabetic/Eye/abdominal aortic aneurysm/AAA/breast/bowel) would be scheduled in early 2023

·       A further update on the ICS would be scheduled for February/March 2023.