Agenda and minutes

Apologies had been received from Councillors Lynn Denham, Calne Edginton-White, Jo Monk, Frances Smith, Richard Udall and Cabinet Member with Responsibility for Adult Social Care, Adrian Hardman.

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 Thursday 7 July 2022). Enquiries can be made through the telephone number/email listed in this agenda and on the website.

None.

To follow

The Minutes of the Meeting held on 10 June 2022 were agreed as a correct record and signed by the Chairman.

Attending for this Item and representing the Herefordshire and Worcestershire Integrated Care System (HWICS) was:

NHS Herefordshire and Worcestershire Integrated Care Board (HWICB)

Mari Gay, Managing Director

Worcestershire Acute Hospitals NHS Trust (WAHT)

Dr Jules Walton, Deputy Chief Medical Officer

West Midlands Ambulance Service (WMAS)

Vivek Khashu, Director of Strategy and Engagement

Herefordshire and Worcestershire Health and Care NHS Trust (HWHCT)

Matthew Hall, Chief Operating Officer

Worcestershire County Council (the Council)

Mark Fitton, Strategic Director for People

Rebecca Wassell, Assistant Director for Commissioning

HOSC Members were reminded that on 1 July 2022, the Herefordshire and Worcestershire Integrated Care System (HWICS) was established, resulting in health, social care and voluntary organisations working together to integrate services for the benefit of residents within Herefordshire and Worcestershire.  An Integrated Care Board (ICB) had also been established, with a new Chairman appointed.  Further integration plans from central Government were expected in time.

Turning attention to the Agenda, it was explained that since the last Report on 9 May 2022, delays in ambulance hospital handovers had not improved and had deteriorated, with the month of June 2022 recording over 1,000 ambulances waiting over 60 minutes to be handed over to Acute Hospital staff.  The number of ambulances attending the hospital had not significantly increased, however, the number of walk-in patients had increased, with staff seeing more acute cases.  Admissions were stable, yet the number of in-patients with COVID-19 had increased and there was increased staff sickness.

Extra capacity was now available at Worcestershire Royal Hospital (the Royal), through a 29 bed Acute Medical Unit (AMU).  This allowed patients to be referred by their GP to be admitted directly to the AMU and had opened on 4 July.  Alongside this, the existing Medical Assessment Unit had been repurposed providing the Royal with over 35 extra spaces overall.  ‘Plan, Do, Study, Act’ continued to be in place and targets were being monitored as the system was aware of the quality risk.  A target of significant improvement in 5 weeks had been set, alongside the aspiration of 7 day working.  There continued to be a need to improve flow at the Royal and the Alexandra Hospital in Redditch (the Alex) had assisted with the Royal flow.

Members were invited to ask questions and in the discussion, key points included:

·         The Chairman expressed his disappointment about the lack of improvement made on the Worcestershire Royal site

·         Clarification was given that for the month of June 2022, across the 2 acute hospitals, 1,300 ambulances had waited over 60 minutes to handover patients - 975 at the Royal and 325 at the Alex.  To date in July, on average 30 ambulances each day had been waiting over 60 minutes, totalling 229 at the Royal to 8 July

·         WMAS reported that the service had escalated the risk of handover delays and delayed responses to the highest level (25/25).  A score of 25 was defined as ‘likelihood certain, risk catastrophic’.  The service was seeing examples of severe harm, including death, on a  ...  view the full minutes text for item 1078.

Attending for this Item was:

Scott Parker, Director of Partnerships and Health Inequalities, NHS Herefordshire and Worcestershire Integrated Care Board

Dr Ash Banerjee, Public Health Consultant, NHS England

Hayley Durnall, Public Health Consultant, Worcestershire County Council

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

By way of introduction, attention was drawn to key points from the Agenda Report, mainly that at the time of the meeting nearly 2 million vaccines had been delivered across Herefordshire and Worcestershire since December 2020 and performance at every level was in the upper quartile nationally.  The 2 Counties ranked highest nationally for vaccinations for those aged 17-18 years.  The success was attributed to solid partnership working.  In Worcestershire, 87.1% of residents aged 12+ had received their first dose.  Figures dropped slightly for second doses (83.9%) and 86.1% of the eligible cohort had received a booster dose.  Publicity campaigns remained a priority and residents continued to come forward for vaccination.

During the ensuing discussion, the following main points were raised:

·         The drop in uptake from the second dose could be attributed to ‘vaccine fatigue’ or lack of confidence in the effectiveness.  Some people had stated that they felt less threatened by COVID-19 after a single dose.  In relation to booster doses, it was believed that some people felt there was less urgency to have the booster when it was due

·         The HOSC was pleased to hear the positive statistics, however, was keen to learn how residents were being encouraged to come forward.  Examples were given, such as targeted sessions, quiet hours and different ways of working with communities to overcome concerns.  Worcestershire had been recognised nationally for its work on its targeted approach

·         It was known that there was a strong link between low uptake and deprivation.  In Worcestershire, there was a 12.5% gap between more and less affluent, compared with 19% regionally.  Although the County performed well, the gap was still too wide

·         District specific Incident Management Teams had been established during the programme and the Teams continued to work to contribute to the high uptake of vaccines, effectiveness of outbreak support and local engagement, including working with local elected Members

·         It was reported that vaccination data was available to Street level, which helped to target communities through pop up vaccination hubs

·         Partnership working had been key to the success to date and the enthusiasm of the Incident Management Teams, alongside a strong voluntary sector and clinicians on the ground

·         Clarification was given on the vaccine delivery schedule, that nationally, the Joint Committee on Vaccination and Immunisation (JCVI) advised the Government on the vaccination programme and associated updates

·         At the time of the meeting, national planning was underway for an Autumn booster programme for residents aged 65+ or people working in health and social care, eligible carers or those with specified underlying health conditions.  Across Herefordshire and Worcestershire, around 340,000 people would be eligible and the plan was to deliver the booster mainly through the GP/Pharmacy model or vaccination vehicles in  ...  view the full minutes text for item 1079.

The Cabinet Member with Responsibility (CMR) for Health and Well being and Senior Officers from the Public Health Team reported that the Worcestershire Health and Wellbeing Strategy consultation period had run from 7 February to 2 May 2022.  Overall, 1,627 responses had been received, 97% from residents and 3% from organisations.  The Team was pleased with the level of response and analysis of the feedback was ongoing. 

Throughout the consultation period a survey was used to test the vision of ‘working together for all to be well in Worcestershire’.  The survey also sought to understand what ‘being well’ meant to residents.  The breadth of the communication campaign and the wide ranging engagement activity undertaken was outlined.

Development of the draft 10 year Strategy would progress over the Summer, with a view that it would be discussed by the HOSC in September before being agreed by Cabinet in November 2022.

During Member questions, the following main points were raised:

·         The Strategy aimed to achieve several goals, including keeping residents out of hospital, ensuring communities were sustainable, upskilling adults to attain better life outcomes and for older people to be independent for longer

·         The Report stated that consultation responses were generally reflective of an older and white British population, with a suggestion that 77% of respondents were female.  A Member asked whether the CMR was confident that the developing Strategy would therefore meet the needs of the County.  In response, it was noted that men were generally known to be less interested in their health, however, a number of different engagement approaches had been undertaken during the consultation period to gather evidence

·         Alongside the Strategy, Action Plans would be developed and monitored through a performance monitoring framework

·         When asked how residents would know whether the Strategy was having an impact on their lives, the HOSC learned that there was a commitment to inform the public through regular communications, such as ‘you said, we did’

·         The overarching priority of mental health would address problems such as alcohol and drug misuse, which had seen an increase during the COVID-19 pandemic.  It was agreed that the priority of healthy living at all ages was huge as it linked in to all the other priorities and that poor mental health had an impact on any individual

·         The Health and Wellbeing Board was responsible for the Strategy, however partners, including those in the newly formed Integrated Care System (ICS), would be responsible for delivery.  Furthermore, the Health and Wellbeing Board would hold partners to account for their performance

·         The ICS would need to develop and publish a Strategy by the end of 2022 and the Health and Wellbeing Strategy would form part of the wider ICS Strategy, to ensure a consistent message for Worcestershire.

The Chairman thanked those present for a useful discussion and looked forward to receiving the draft Strategy at the September HOSC.   

Members were reminded that the Public Health Ring Fenced Grant (PHRFG) had limited scope and the HOSC had asked for twice yearly updates.  A summary of the 2021/22 Year End position was given.

The PHRFG allocation for 2021/22 had been £30.365m, with an in-year underspend of £3.3m mainly due to the unexpected availability of other grants.  The Reserve now totalled £9.7m and a 3 year plan was being developed for its utilisation.

Additional COVID Grants, amounting to £16.1m for Worcestershire, had been managed by Public Health, including the Contain Outbreak Management Fund (COMF) and Test and Trace.  Of this, £4.3m was carried forward to 2022/23.  These Grants were used, in partnership with District Councils, on elements such as support for residents self-isolating, supporting vulnerable people and additional testing.

Members were invited to ask questions, with the following points made:

·         The plan to allocate the £9.7m in Reserves was in development, however, £2.2m was currently unallocated

·         When asked how the discretionary element of the PHRFG was agreed, Officers would look at population need, consider the Joint Strategic Needs Assessment (JSNA), determine what would meet local need, look at what had worked elsewhere and deliver targeted activity to reduce Public Health concerns

·         A query was raised in relation to a nil outturn for several projects, such as the Here 2 Help Scheme and a Care Home Project.  Officers confirmed that in these instances funding had been provided by additional grants, not the PHRFG

·         A Member queried whether the night time economy was an area which was being considered by Public Health, to be informed that it was definitely an important area and was worth investigating further.

Members agreed to schedule a further report on Patient Flow and Progress Update Against Recommendations from the Scrutiny Task Group Report on Ambulance Hospital Handover Delays to the 19 September 2022 HOSC Agenda.