Agenda and minutes

Apologies had been received from Councillors Salman Akbar, Lynn Denham, Antony Hartley, Adrian Kriss, Emma Marshall, Kit Taylor 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 8 September 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 15 June 2023 were agreed as a correct record and signed by the Chairman.

The Managing Director of Herefordshire and Worcestershire Integrated Care Board (HWICB) introduced the Item by highlighting key points from the Agenda Report.

Out-of-Hours (OOH) Urgent Care Services in Worcestershire included NHS 111, GP Out-of-Hours, 5 Minor Injury Units (MIUs) and Urgent Community Response Services.  There had been a lot of investment to ensure services in Worcestershire were sustainable and to make it as simple as possible for the public to access.  OOH activity had grown, especially as NHS 111 was increasingly recognised as a first contact point for advice and appropriate response.  As a result A&E attendance in the County had stabilised and there were fewer ambulance attendances.

NHS 111, which was available 24 hours a day, all year round, was managed on an interim basis by DHU Healthcare due to a decision by West Midlands Ambulance Service University NHS Foundation Trust (WMAS) to hand back the contract.  Commissioners had been pleased with performance, in part attributed to the call handling process which was pathway driven to try to keep people out of hospital.

GP Out-of-Hours was provided by Practice Plus Group (PPG) and available between 6:30pm and 8am Monday to Friday and 24 hours a day during weekends and bank holidays.  Access was only available by patients contacting NHS 111.  The Service was performing well and although activity levels had risen to pre COVID-19 pandemic levels there was no increase in A&E attendance.  The GP OOH contract would have to be re-procured in the next 12-18 months.

The Urgent Community Response was a 2 hour response, managed by Herefordshire and Worcestershire Health and Care NHS Trust (HWHCT), which provided wrap around health and social care services to manage admission avoidance.  The Service was working very well, in particular with frail elderly patients and further investment in resources was likely.

It was hoped that increased OOH activity would continue to divert A&E attendance.

In the ensuing discussion, the following points were raised:

·       Some Members raised concerns from residents about difficulty accessing GP services, especially the different methods of communicating with their Surgery.  When asked whether this had any impact on NHS 111 or MIUs, no concerns had been raised with HWICB.  It was clarified that under the national GP contract, urgent cases had to be considered the same day and non urgent cases within 7 days.  Furthermore, more GP services were often available until 6:30pm

·       Clarity was given that residents should contact their GP during opening hours and only contact NHS 111 when the GP was closed.  OOH providers would hand back patients to their GPs and NHS 111 was commissioned to drive back to appropriate services, such as GPs

·       The demand for GP services was rising, in part due to the additional housing developments in the County.  Recruitment and retention of GPs was a national issue, although at present, there was less concern in Worcestershire than in other areas of the country

·       When asked whether there was any explanation for increased demand, it was reported that  ...  view the full minutes text for item 1151.

The Managing Director of NHS Herefordshire and Worcestershire Integrated Care Board (HWICB) advised that senior representation from Worcestershire Acute Hospitals NHS Trust (WAHT) had been planned for the meeting, however, they were needed on site to support clinical services.

Members were reminded that during the COVID-19 pandemic all routine elective care ceased as a result of a national mandate, resulting in a significant number of patients waiting for elective care.  Worcestershire’s backlog was of national concern resulting in regional and national support and scrutiny.

HWICB held weekly meetings with WAHT and Wye Valley NHS Trust (WVT) to make use of any extra capacity within the system.

It was noted that patient choice and personalised care on occasions impacted on performance, for example when patients did not wish to travel to an alternative hospital.

There had been a significant improvement in performance and there were currently no waits over 70 weeks, with the trajectory of eliminating waits over 65 weeks by March 2024 likely to be met in vast majority of areas.

The national team were pleased with the progress made and how good use had been made of the independent sector, with consultants working weekends to help. The current industrial action was likely to cause some problems and increase risks but overall the situation was improving.

The Chairman invited questions and the following main points were raised:

·       When asked which services were taken out of County, it was reported that WVT and Dudley Group NHS Foundation Trust was assisting with Dermatology and University Hospitals of Northamptonshire NHS Group was supporting Urology

·       Private providers, such as Spire and Nuffield, had provided much support for surgery and diagnostics

·       When asked when national support was expected to cease, it was suggested that as Worcestershire was now benchmarking well against similar areas, HWICB was hopeful that it would be soon move out of Tier 1 support into Tier 2

·       A Member asked about Dermatology and the Cancer Pathway, to be informed that the 2 week target of referral to appointment still applied, however, demand for Dermatology was of national concern.  A number of Consultants had left Worcestershire, but to ease pressure, it was now possible for clinicians to take photographs for Consultant review which helped prioritise cases.  The conversion rate for cancer was around 5%

·       It was reported that the backlog should ease in around 3 months and at that point, WVT would take on the function for both Herefordshire and Worcestershire

·       A Member asked what more could be done to reduce anxiety of patients waiting for diagnostics or surgery and them not knowing where they were on the list.  It was suggested that there was a lack of communication.  In response, it was reported that patients would receive an initial letter which outlined that although there was a long waiting list, if their condition deteriorated they should contact their GP.  Furthermore, text messages were sent to patients to provide updates

·       Increasing the capacity for surgery would be important for years to come.  Recent  ...  view the full minutes text for item 1152.

Members considered the Work Programme and agreed to schedule an update from West Midlands Ambulance Service.