Agenda and minutes

The Chairman welcomed everyone to the Meeting.

Apologies had been received from Councillors Salman Akbar, Lynn Denham, Antony Hartley, Adrian Kriss, Jo Monk, Kit Taylor and Richard Udall.

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 10 October 2023). 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 11 September 2023 were agreed as a correct record and signed by the Chairman.

(Indicative timing: 10:05 – 10:10am)

The Interim Democratic Governance and Scrutiny Manager advised that following the nomination process by District Council Members, Cllr Christine Wild (Malvern Hills District Council) had been nominated as the Vice Chairman of the Health Overview and Scrutiny Committee.  Approval of the appointment would be considered by Worcestershire County Council at its meeting on 9 November 2023.

(Indicative timing: 10:10 – 10:50am)

Attending for this Item were:

Herefordshire and Worcestershire Health and Care NHS Trust (HWHCT)

Chief Operating Officer

Director of Strategy and Partnerships

NHS Herefordshire and Worcestershire Integrated Care Board (HWICB)

Programme Director for Mental Health, Learning Disability and Autism

At its 15 March 2023 meeting, the Health Overview and Scrutiny Committee (HOSC) had received a Report on Hill Crest Mental Health Ward following concerns about safety and staffing raised by the Care Quality Commission (CQC).

Hill Crest was an 18 bed Mental Health Ward at the Alexandra Hospital site, Redditch for adults of working age (18-65) and was 1 of the 3 Acute Mental Health Wards which were part of the County provision operated by Herefordshire and Worcestershire Health and Care NHS Trust (HWHCT).  The other 2 Wards were located on Elgar Unit at Worcestershire Royal Hospital site and on Stonebow Unit at Herefordshire County Hospital.  In addition, 4 Older Adult Acute Mental Health Wards were in operation throughout the 2 counties.

The HWHCT used its county wide provision flexibly resulting in patients being admitted to any of the 3 Wards, dependent on availability and patient need.  Length of stay was generally around 30 days.

As a result of the CQC Inspections in July 2022, an Improvement Plan was developed.  Over 200 tasks were identified and actioned and the Improvement Plan was now substantively complete with no critical outstanding issues.

Recruitment to this service remained a challenge, however, a number of newly qualified staff had recently started.  Although promising, the registered vacancy rate at the end of September remained at over 50%.  There were 10.81 whole time equivalent permanent Health Care Support Workers in place from a baseline of 17.2.  Further success had been achieved with a block booking Agency contract where Registered Nurses and Health Care Support Workers worked almost exclusively at Hill Crest.  Agency rostered staff were supplied with HWHCT uniform and received training and supervision as if they were employees.  This had provided stability and continuity of care.

Since March 2023, Hill Crest had temporarily been reduced to a 10 bed Ward (from 18) and as a result 5 beds had been commissioned at an independent hospital in Wrexham.  To date, 13 patients had been admitted to Wrexham Hospital with their full consent.  HWHCT was confident that the offer was well utilised and no patient nor carer had raised any concerns about the placement.  HWHCT had considered increasing the Hill Crest bed base to 14, however, had agreed to remain at 10 beds.

The clinical environment and estate at Hill Crest were challenging and complicated.  Although safety concerns had been mitigated, such as installing CCTV to combat blind spots, the area was not suitable for current nursing practice.  During 2022/23, Government ‘eliminating dormitories’ funding had been used to rebuild Holt Ward (16 beds) and Athelon Ward (14 beds) – both on the Elgar Unit at the Worcestershire Royal Hospital site.

Members were reminded that Athelon Ward was intended as an Older Adult Acute Mental Health Ward, however,  ...  view the full minutes text for item 1159.

(Indicative timing: 10:50 – 11:20am)

The Deputy Chief Medical Officer of Worcestershire Acute Hospitals NHS Trust (the Trust) provided a summary of the Agenda Report, explaining that the Trust had identified issues around the accuracy of some children’s hearing tests, specifically auditory brainstem response (ABR) tests, which the Trust provided across the County.  ABRs were mainly carried out when a baby failed a newborn hearing screen and on average 4 ABRs were conducted each week. 

The Trust had reviewed 462 tests taken since 1 April 2018 and 115 children had been identified to have their hearing retested.  To date, 7 cases of moderate harm and 16 cases of greater harm had been identified, such as language and development delay or providing appropriate intervention such as a cochlear implant.

Every family had been given a full explanation and apology and those affected were directed to seek further advice if required.  Plans were also being developed to identify affected children born between 2015 and 2018.

Nationally, concerns had been raised with NHS England (NHSE) around the failings in the standard of hearing tests and a national paediatric hearing service review was underway as similar issues had been identified in other NHS Trusts.

Retest appointments were being conducted by, or under the supervision of, a clinician from a separate United Kingdom Accreditation Service (UKAS) approved audiology service.  The Trust was providing support and mentorship for its own Audiology Department and was working towards achieving UKAS accreditation.

The Chairman invited questions and the in the ensuing discussion, the following points were raised:

·       As the Trust had self-identified the issue, it was further forward in its action plan than other Trusts identified as part of the national review

·       It was clarified that the 23 cases of moderate or greater harm reported was from the 462 tests reviewed, rather than the 115 children identified to have their hearing retested

·       Families, alongside special schools and speech and language services, were engaged and there had been minimal uptake of advice and guidance available

·       NHSE had advised that the initial review period start from 1 April 2018.  Plans were being developed to review cases between 2015 and 2018 and when complete, it was anticipated that older tests would be reviewed.  It was recognised that older children may potentially be already known to other services

·       When asked how big the issue could grow, it was reported that nationally the Trust’s performance was not an outlier and statistically there was no reason for concern.  It was reiterated that the Trust had self-identified the issue and had swiftly acted on its findings

·       A Member asked whether these findings could affect the cognitive development of affected children, to be advised that it was possible that hearing loss may already be identified and services, such as speech and language, were already involved.  Some children may have difficulties which were not recognised as being as a result of a hearing deficit

·       Retests were being undertaken alongside the normal workload of the Audiology Department and ABRs were performed across 3 Trust  ...  view the full minutes text for item 1160.

(Indicative timing: 11:20 – 12:00pm)

Attending for this Item were:

NHS Herefordshire and Worcestershire Integrated Care Board (HWICB)

Managing Director

Herefordshire and Worcestershire Health and Care NHS Trust (HWHCT)

Director of Intermediate & Urgent Care

Worcestershire County Council (the Council)

Strategic Director for People

Assistant Director for People Commissioning

Members were advised that the Chief Operating Officer of Worcestershire Acute Hospitals NHS Trust (WAHT) was due to attend, however, was needed to support clinical areas.

The HOSC had received an Agenda Report which outlined progress on winter planning and winter preparedness.  NHS England (NHSE) had identified 10 areas which were considered to contribute to effective patient flow and these, alongside the local response, were aligned to the System Plan on improving flow which was presented to the HOSC on 15 June 2023.  The Local Winter Plan had been developed with stakeholders and submitted to NHSE.

The new Emergency Department at Worcestershire Royal Hospital was due to open on 16 October and work on hospital flow continued to be a priority for WAHT.

The ‘Home before Lunch’ campaign would launch in November 2023 emphasising the importance of early discharge of patients.  It was agreed that the plans for this campaign would be shared with the HOSC.  In addition, 20 additional beds would be open from October 2023 to March 2024 to support increased demand.  Same Day Emergency Care (SDEC) would be utilised to its full extent and a single point of access for clinicians would assist in patient flow.

The HWHCT and the Council were supporting the community and social care response by advocating the right care in the right location.  The Onward Care Team continued to support WAHT colleagues.  20 additional community hospital beds would be available during the winter period and the community response service would be enhanced by, for example, embedding palliative care nurses into the service.

To co-ordinate activity across the system, the System Control Hub was in operation 7 days a week.  It would manage urgent and emergency care escalation and oversee the impact of industrial action.  The Centre was co-ordinated by HWICB.

The 2 hour Urgent Community Response was well developed, with triage undertaken at the Hub.  Furthermore, the Hub had access to the ambulance call stack to identify any patients that would benefit from that particular course of action.

The frailty Virtual Ward was able to support 12 patients in their own homes, currently in Wyre Forest District Council area.  HWICB had agreed to fund a further 12 high acuity beds – likely to be in the south of the County possible for respiratory patients.

In the ensuing discussion, the following points were made:

·       It was clarified that the Consultant led SDEC was not available for public access, rather for patient referrals from GPs and other healthcare professionals

·       When asked whether the new Emergency Department at Worcestershire Royal Hospital was adequate, it was suggested that the patient experience would be vastly improved, however, for it succeed, it would rely on other parts of the system.  Generally, there was a need  ...  view the full minutes text for item 1161.

(Indicative timing: 12:00 – 12:10pm)

The Work Programme was considered and the following Items were added:

·       Hill Crest CQC Inspection

·       Access to Primary Care

The Overview and Scrutiny Performance Board (OSPB) had asked Scrutiny Chairmen to invite their Members to make suggestions for topics for a future Scrutiny Task Group.  It was agreed to propose the topic of Disabled Facilities Grants to the OSPB.