Agenda and minutes

Apologies had been received from Councillors Salman Akbar, Chris Rogers, Frances Smith and Richard Udall.

None.

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 10 March 2023). Enquiries can be made through the telephone number/email listed in this agenda and on the website.

None.

Previously circulated

The Minutes of the Meeting held on 10 February 2023 were agreed as a correct record and signed by the Chairman.

Attending for this Item were:

Herefordshire and Worcestershire Health and Care NHS Trust (HWHCT)

Sue Harris, Director of Strategy and Partnerships

Natalie Willetts, Director of Nursing

Gemma Diss, Associate Director of Specialist Mental Health and Learning Disabilities

Herefordshire and Worcestershire Integrated Care Board (HWICB)

Jack Lyons-Wainwright, Senior Programme Lead – Mental Health

Members were reminded that the Care Quality Commission (CQC) had carried out an inspection of Hillcrest Mental Health Ward in July 2022 which had resulted in a notice of possible urgent enforcement action under Section 31 of the Health and Social Care Act 2008. In response to the concerns raised, an improvement plan had been developed and a multi professional task force established.

Hillcrest Ward, one of 3 Acute Mental Health Wards in the County, was originally designed to have 25 beds, however in August 2021, this was reduced to 18 to be more manageable. The improvement plan focus resulted in the number of beds reduced to 10 and that number continued to be in place.

Improvements included a new leadership structure, changes to staffing, including regular agency staff, increased therapy, greater patient voice and advocacy and enhancements to the structure of the building.

The CQC had recently revisited Hillcrest and although the full report had not yet been published, it was suggested that Inspectors had recognised that improvements were being made and there were no immediate concerns.

Members were invited to ask questions and in the subsequent discussion, the following points were raised:

·       As appropriate staffing levels was of concern, a Member asked about the pool of locally qualified staff. In response, it was reported that there was a shortage of nurses nationally, however HWHCT actively recruited from local schools, colleges and universities and promoted training opportunities, including apprenticeships. In addition, HWHCT had proactively worked with some agency staff to ensure regular shifts were covered which would provide better continuity at Hillcrest. The other Mental Health Wards were almost fully staffed

·       Staffing requirements at Hillcrest was outlined as a total of 35 professionals required, with 17.5 currently recruited. Figures related to the 18 bed model

·       HWHCT had worked with HWICB to determine that 10 beds was appropriate for Hillcrest. This had resulted in 5 patients being moved out of area. Patient Flow continued and all usual safeguards were in place with care co-ordination and discharge planning as appropriate

·       If staffing levels were fulfilled, Hillcrest could increase its bed base, however HWHCT was committed to first making and embedding the improvements set out. A decision to return to 18 beds would be multifactorial, including whether recruitment was fulfilled, listening to patients and carers and whether staff felt it was safe to do so

·       Nationally, length of stay for inpatient care averaged 28 days, with Worcestershire often better than average with the goal of the patient returning to their usual place of residence or looking at funding for appropriate longer term placements when needed

·       When asked whether Hillcrest was split into Male and Female areas, it was reported that  ...  view the full minutes text for item 1122.

Attending for this Item were:

Herefordshire and Worcestershire Health and Care NHS Trust (HWHCT)

Sue Harris, Director of Strategy and Partnerships

Hannah Wilson, Deputy Director of Allied Health Professionals / Therapies

Kate Pike, Associate Director for Integrated Community Services

Worcestershire Acute Hospitals NHS Trust (WAHT)

Kate Harris, Head of Therapies

Benjamin Thomas, Physiotherapy Lead

Members were briefly reminded of the key points within the Agenda Report, mainly that Physiotherapy was one of the 14 Allied Health Professions (AHPs) and physiotherapists worked at all stages of the patient pathway from prevention to acute care and rehabilitation and play a vital role in reducing dependence on long-term care services by enabling people to live well for longer. Services in Worcestershire were provided by HWHCT, WAHT, Primary Care and private providers working across a number of settings. The Agenda Report provided an overview of all services available.

In the ensuing discussion, main points included:

·       Physiotherapy Services for children would be provided via paediatric teams, however, self-management and self-care for children were mainly through primary care

·       Full time equivalent (FTE) staffing numbers, split across HWHCT (119), WAHT (122.32) and Primary Care (23.6) were documented, however, it was unclear on the numbers working privately in other settings. Nationally, it was predicted that around 70% of physiotherapists worked within the NHS

·       In relation to recruitment and retention, the HWHCT People Plan had clear policies that supported flexible working. Historically, there was less flexibility as clinics may have operated only in traditional office hours, however, there had been a shift towards extended hours and 7 day working, all of which supported flexible employment. WAHT also had a flexible working policy and support for staff was robust. Opportunities to return to practice were welcomed and apprenticeships were available

·       It was agreed that future reports should include data on workforce and patient profiles to provide the HOSC with a clearer picture of services offered

·       In relation to waiting times, HWHCT reported that the routine musculoskeletal physiotherapy target was 18 weeks and urgent cases was 2 weeks

·       Community physiotherapy was delivered successfully through Neighbourhood Teams and supported Pathway 1 discharge from hospitals and Reablement services. Bromsgrove Neighbourhood Team delivery was more of a challenge

·       No further detail on waiting times was available due to issues with Carenotes (electronic patient record software).  It was reported that since August 2022, a national issue had affected 1,000 organisations and recovery had been staggered in the subsequent months. An interim solution was in place and as the national situation had been resolved, it was anticipated that the system would be live very soon. Challenges would remain, especially in supplying performance data. It was agreed to provide HOSC with further information on this issue

·       A Member queried why the demand for physiotherapy services was increasing, to be informed that it was recognised that an ageing population, who was encouraged to keep well for longer at home, would need support

·       Staff did not require a degree to undertake physiotherapy, with some staff progressing through a career  ...  view the full minutes text for item 1123.

The Chief Executive of Worcestershire Acute Hospitals NHS Trust (WAHT) provided a summary of the elective recovery programme as outlined in the Agenda Report.

Elective Recovery was the process of working to eliminate long wait times for elective care, including hospital appointments, investigations and treatments. Prior to the COVID-19 pandemic, the target from GP referral to definitive treatment was 18 weeks. The current situation was a consequence of decisions taken nationally during the pandemic and lockdowns when all activity ceased, other than cancer and a very limited number of planned surgery. The Report was a good news story and showed the progress made in Worcestershire.

NHS England (NHSE) had developed a plan to eliminate waits of over 2 years by July 2022, waits over 18 months by April 2023, waits over 12 months by March 2025 and have 30% more elective activity by 2024/25 than before the COVID-19 pandemic.

Due to lengthy waiting times, the NHS was now seeing unmet health needs, alongside other physical and mental health requirements.

In Worcestershire, the delivery of elective recovery had been in place for 12 months, with a number of initiatives to increase capacity. One example was increased theatre capacity across WAHT which was now around 85%, compared to around 75% last year.

On the day of the HOSC meeting, Junior Doctors nationally were starting industrial action across a 72 hour continuous period. The Chief Executive reported that one third of WAHT Junior Doctors had reported for duty and as a result of the action, nearly all 4,500 outpatient appointments had been cancelled across 3 days. All operations were going ahead at the Alexandra Hospital in Redditch and 39 out of 46 operations were going ahead at the Kidderminster Hospital and Treatment Centre. With other health professions also involved in industrial action in recent months, including doctors, nurses and ambulance staff, a resolution was sought as it was starting to significantly impact on the people of the County.

The Herefordshire and Worcestershire Integrated Care System (HWICS) was working with WAHT to plan to reduce waits to 65 weeks by April 2024 in line with government expectations, however, this target had not taken into consideration any industrial action. Availability of workforce was the main risk for the HWICS.

To ease the backlog and plan for the future, from May 2023, all planned surgery would take place at either the Alexandra Hospital in Redditch or Kidderminster Hospital and Treatment Centre. Worcestershire Royal Hospital theatres would only undertake emergency operations. The plan did have risks; however, it was seen as a positive step in reducing waiting times.

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

·       19% of patients received treatment out of County, either due to patient choice, such as geography or shorter waiting times, or due to the specialist nature of the procedure required, such as neurosurgery and specialist cardiac surgery. HWICS was responsible for monitoring waiting times for patients on out of County lists. Worcestershire traditionally had longer waiting times than  ...  view the full minutes text for item 1124.

A Member asked whether the HOSC Chairman would write, on behalf of the Committee, to the Secretary of State for Health and Social Care expressing the HOSC’s concerns.  Some Members suggested that this was not within scope, advising that individual Members could correspond directly.  The HOSC Chairman agreed to seek advice outside of the meeting and report back.

The Cabinet Member with Responsibility for Health and Well being introduced the newly appointed Director of Public Health, Lisa McNally. 

The HOSC agreed to add the following its Work Programme:

·       Long Term Plan for WAHT Theatres

·       Carenotes Electronic Patient Records outage

·       Update on HWHCT CQC Inspection

·       Progress against targets for the elective recovery programme and future plans