Agendas, Meetings and Minutes - Agenda and minutes

Agenda and minutes

Venue: Council Chamber

Contact: Emma James / Jo Weston  Overview and Scrutiny Officers

Media

Items
No. Item

1083.

Apologies and Welcome

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Minutes:

Apologies had been received from Cllrs Salman Akbar, Calne Edginton-White and Jo Monk.

1084.

Declarations of Interest and of any Party Whip

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None.

1085.

Public Participation

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None.

1086.

Confirmation of the Minutes of the Previous Meeting

Previously circulated

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The Minutes of the Meeting held on 8 July 2022 were agreed as a correct record and signed by the Chairman.

1087.

Update on Improving Patient Flow and Winter Planning pdf icon PDF 100 KB

To follow

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Minutes:

Attending for this Item were:

 

NHS Herefordshire and Worcestershire Integrated Care Board (HWICB)

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

 

Worcestershire Acute Hospitals NHS Trust (WAHT)

Paul Brennan, Deputy Chief Executive

 

West Midlands Ambulance Service University Foundation NHS Trust (WMAS)

Vivek Khashu, Strategy and Engagement Director

 

Herefordshire and Worcestershire Health and Care NHS Trust (HWHCT)

Rob Cunningham, Associate Director for Integrated Community Services

 

Worcestershire County Council (the Council)

Mark Fitton, Strategic Director for People

 

At the 8 July 2022 HOSC, Members had received information on plans to improve patient flow and improve performance on ambulance hospital handover delays.  By way of update, the HOSC learned that the Worcestershire System continued to be in a very challenged position and ambulance delays were of greatest concern nationally.  All partners were committed to the agreed  Improvement Plan, however, delivery of the Plan had stalled, in part due to a spike in COVID-19 cases and workforce issues. 

 

The Winter Plan, covering Herefordshire and Worcestershire, referred to specific geographical issues when required.  It focused on national core objectives and actions and gave clearer responsibility for the HWICB.

 

Demand and capacity analysis had shown that before any of the winter schemes or urgent care improvements were implemented, there was a shortfall of 45 acute beds to effectively manage urgent care pressures.  This figure was an improvement on previous years when a shortfall of 80 to 100 beds had been reported.

 

Several immediate winter schemes were referred to, including additional pharmacy capacity, extra transfer teams to move patients out of the Emergency Department (ED), more discharge co-ordinators and a Matron to oversee long length of stay.  In addition, hours had been extended at Minor Injury Units (MIU) and the 2 hour community response had been well utilised to respond to patients in their own home.  Furthermore, a pilot scheme for virtual wards with a dedicated team and technology was to begin for frail elderly patients.

 

To improve handover delays, the adoption of the ‘North Bristol Push Model’ had been implemented in September, initially on the Worcestershire Royal site.  The North Bristol Model required a minimum number of transfers of patients in each 24 hour period from the ED to assessment units and from those units to wards.  The transfers required at least the equivalent number of safe and timely discharges.  The Model had delivered some improvements, however further work was required to fully embed the Model before consideration would be given on possible introduction at the Alexandra Hospital.

 

The HOSC Chairman invited questions and in the ensuing discussion, the following main points were made:

 

·         WMAS had previously stated the risk level for Worcestershire was 25/25, which had now remained the same for 12 months.  Some areas within the region were in a slightly better position than Worcestershire, but most areas were incredibly challenged

·         At the 8 July HOSC, it was reported that a target for significant improvement had been set for 1 September.  When asked whether this had been achieved, it was stated  ...  view the full minutes text for item 1087.

1088.

Maternity Services pdf icon PDF 98 KB

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The Chairman agreed to take the Agenda out of order.

 

Attending for this Item from Worcestershire Acute Hospitals NHS Trust (WAHT) were:

 

Paula Gardner, Chief Nursing Officer

Justine Jeffery, Divisional Director of Midwifery

 

Since the last report to HOSC, in May 2022, a number of improvements had been made, most significantly in workforce.  Staff turnover had reduced, new recruits had been retained and there had been an increase in the number of student placements available.  It was hoped that by February 2023, when the next cohort of students would qualify, the Service would have no vacancies.

 

Progress had slowed on the agreed actions from the Maternity Service Improvement Plan, although several engagement events had taken place over the summer and a number of actions had been completed.  Following the publication of the Care Quality Commission (CQC) report in March 2021, of the 20 actions, 4 remained partially completed with work in progress.  This was an improvement since the last HOSC update.

 

The Final Ockenden Report (the independent review of maternity services at Shrewsbury and Telford Hospital Trust) was published 30 March 2022.  The Report highlighted 105 actions which Health Trusts were required to review and make improvements on, if actions were not already in place.  This was a similar amount to the actions in the first Ockenden Report.  WAHT had undertaken a risk assessment and gap analysis and was developing a single overarching service improvement plan to consolidate all actions in one document.  It was acknowledged that nationally the spotlight on maternity services remained.

 

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

 

·         When asked whether 1 Consultant Midwife was sufficient, it was clarified that at present it was a 0.5 full time equivalent post, which needed to be increased.  The Ockenden Report recommended that consideration be given to maternity leadership requirements and funding had been secured to recruit a Deputy Director of Midwifery and other specialised midwifes.  It was hoped that further funding would be secured for additional staff

·         Members were concerned about the threat of national strike action over a fair pay deal and the possible impact on services locally.  It was explained that WAHT would not know in advance how many employees may be involved in any strike, however, safety would be monitored around the clock.  If at any point, staff were required they could be called for duty through an official process

·         A successful international recruitment campaign for nursing staff had also introduced to midwifery and staff were being offered incentives to take additional ‘bank’ shifts, to reduce agency spend.  Furthermore, WAHT was working with Wye Valley NHS Trust to explore career development opportunities for Health Care Assistants, which could result in enhanced pay for additional responsibility after 2 years of experience

·         It was reported that 50% of midwifes leaving were completely retiring from the profession, which was a change from previous behaviour which saw midwifes return on an occasional basis.  Other staff were leaving to return to previous careers

·         When asked how  ...  view the full minutes text for item 1088.

1089.

Update on Stroke Services pdf icon PDF 124 KB

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Minutes:

Attending for this Item from Herefordshire and Worcestershire Integrated Care Board (HWICB) were:

 

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

Anita Roberts, Stroke Programme Manager

Tom Grove, Director of Communications and Engagement

 

HOSC Members had been provided with the Agenda Report, which had also been considered by the Health Scrutiny Committees in Herefordshire and Powys. 

 

Stroke was a serious, life-threatening condition which required immediate urgent action.  The Herefordshire and Worcestershire Integrated Care System (HWICS) wanted to ensure that high quality stroke and TIA (transient ischaemic attack or mini stroke) services were delivered across the 2 Counties and had prepared an Issues Paper highlighting the challenges currently faced and outlining potential solutions.

 

At present, across Herefordshire and Worcestershire, services were provided by Worcestershire Acute Hospitals NHS Trust (WAHT), Wye Valley NHS Trust (WVT) and Herefordshire and Worcestershire Health and Care NHS Trust (HWHCT).  In addition, the Stroke Association was commissioned to offer stroke rehabilitation and support.

 

The population of the 2 Counties was growing, getting older and living with more long-term health conditions, meaning more people were at risk of having a stroke, most significantly after the age of 60.

 

Several service challenges were highlighted, including the ability to recruit staff with specialist stroke skills to provide 24 hours a day, 7 days a week services across the 2 Counties.  At present, the service at WVT was reliant on 2 locum consultants and there had been times when the unit at WAHT was at risk.

 

The Herefordshire and Worcestershire Stroke Programme Board had outlined 4 potential solutions for Acute Stroke Unit (ASU) and Hyper-Acute Stroke Unit (HASU) services:

 

Option 1 – No change to the current service across Herefordshire and Worcestershire

Option 2 – 7 day HASU at 1 site and 7 day ASU at 2 sites

Option 3 – No HASU nor ASU in either County (HASU and ASU out of area) 

Option 4 – 24 hour/7 day HASU and ASU on 1 site with stroke specialist consultant cover (potentially Worcestershire Royal Hospital)

 

The preferred clinical model was Option 4 as residents would access services locally, however a business case was required.  An engagement exercise was in progress to gather early views of patients and stakeholders.  Transport and population modelling were still required before further discussions at the Stroke Programme Board.  Any potential solution would require various stages of governance, including a full public consultation on any proposed changes ahead of a final decision being made.

 

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

 

·         When asked the extent of the impact of ambulance handover delays on stroke patients, it was clarified that patients conveyed with a potential stroke would be taken from the ambulance quickly for diagnostic testing, however a delay may occur if no HASU bed was available.  Time waiting for an ambulance was unknown, therefore it was vital that patients with any symptoms immediately called 999

·         Service centralisation was not unusual.  It was an attractive model for the  ...  view the full minutes text for item 1089.

1090.

Worcestershire Joint Local Health and Wellbeing Strategy pdf icon PDF 154 KB

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Attending for this Item were:

 

Cllr Karen May, Cabinet Member with Responsibility (CMR) for Health and Wellbeing

Dr Tanya Richardson, Public Health Consultant

Lucy Chick, Senior Public Health Practitioner

 

The CMR introduced the Item by reminding Members of the development of the Worcestershire Joint Local Health and Wellbeing Strategy (the Strategy).  The overarching priority of good mental health and wellbeing was supported by the 1,627 consultation responses.  The Strategy supported collaborative working and although it covered 10 years, it was a moving document to keep it relevant for the time.  HOSC Members were thanked for their support with the consultation process and there was a commitment for ongoing engagement. 

 

The Strategy was agreed and adopted by the Health and Wellbeing Board (HWB) on 27 September 2022 before being considered by Cabinet on 27 October 2002.  Its ambitions were:

-          Good Mental Health and Wellbeing

-          Healthy Living at all ages

-          Safe, thriving and healthy homes, communities and places

-          Quality Local Jobs and Opportunities.

 

The Managing Director of Healthwatch was a Member of the HWB and commented that the approach to tackling health inequalities was vital.

 

The HOSC Chairman was pleased with the engagement undertaken and agreed the response was positive.  In opening the discussion to questions, the following key points were made:

 

·         A Member asked how, in 10 years, the CMR would know the Strategy had been successful, to be informed that there would be less people in hospital and more independent living. 10 years was short in health terms, yet there was an urgent need to tackle health inequalities and that prevention was an important factor

·         When asked what the role of HOSC was in relation to the Strategy, it was suggested that HOSC could look and challenge the Plans and data that sat below the Strategy.  It was further suggested that HOSC could request an annual update to hold the CMR and partners to account

·         A Member was concerned about the mental health of young people and students, especially in relation to social media and was assured that plans would be developed around these issues.  In addition, domestic abuse was raised as a possible gap, however, Members were assured that many interlinking plans were vital to the overarching Strategy and the HWB would discharge its duty to the next level of partnership for appropriate action

·         In response to a suggestion that some people would fall outside of the remit of the Strategy, the CMR clarified that the Strategy was an enabler for creating opportunities to address need and that prevention was better than cure

·         A Member advocated the need to encourage residents to move around, especially if their work was based sitting, to reduce long term health needs.  Furthermore, promoting active travel was an area the CMR supported.

 

The HOSC Chairman wished the CMR good luck in delivering the Strategy over the coming years.

1091.

Work Programme pdf icon PDF 85 KB

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It was agreed that Glaucoma services would be added to the Work Programme.