Agenda and minutes

The Chairman welcomed everyone and confirmed the arrangements for the online meeting.

Apologies had been received from Mrs J Till.

Mr G R Brookes declared an Interest in Item 5 as his daughter was a GP and Mrs F Smith declared an Interest in Item 7 as her husband was the Cabinet Member with Responsibility for Health and Wellbeing.

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 17 July 2020). Enquiries can be made through the telephone number/email address below.

None.

To follow

The Minutes of the Meeting held on 18 June 2020 were agreed as a correct record and would be signed by the Chairman.

Attending for this Item were:

Herefordshire and Worcestershire Clinical Commissioning Group (CCG)

Lynda Dando, Director of Primary Care

GP Representative

Dr Gemma Moore, Clinical Director of Droitwich and Ombersley Primary Care Network

The Committee was led through the Agenda and attached presentation, entitled ‘General Practice in Worcestershire during COVID-19’.

Members were reminded of the origin of Primary Care Networks (PCNs) locally and the nationally mandated creation of PCNs as part of the NHS Long Term Plan.  Since 1 May 2019, Worcestershire GP practices had a contractual requirement to work together in groups covering a minimum population of 20,000 to enable improved quality of care and resilient and sustainable groups of practices. 

In Worcestershire there were 11 PCNs, led by 13 Clinical Directors, based around natural local communities, working together with a range of local providers to offer more co-ordinated health and social care support.  Members were directed to the map within the presentation for the PCN locations.  The new PCN model would also help to address recruitment and retention difficulties in parts of the County.

The Primary Care response to the COVID-19 pandemic had seen nationally mandated changes from 27 March to free up capacity in general practice and keep staff safe.  In addition, a national standard operating procedure (SOP) was introduced.  From 11 July 2020, some GP services could be restored, however, current access arrangements were likely for the foreseeable future.

Worcestershire residents saw GP access triaged remotely, with online video and telephone consultations available as appropriate.  Practices were grouped to ensure separate spaces for different patient cohorts if face to face assessment was required, i.e. shielding patients, those showing symptoms of COVID-19, wider population etc.  Those patients with COVID-19 symptoms were directed to NHS 111 in the first instance.

CCG support for GP Practices included digital enhancements, workforce, physical adaptations (such as screens and hard flooring) and stocks of personal protective equipment (PPE).  A process for the reimbursement of additional costs has been agreed by the CCG, including staffing costs related to staff absence, costs incurred by bank holiday working, adaptations to premises and expenditure relating to PPE and infection control.

Nationally, General Practice was now in the restoration stage of COVID-19, however, remote triage would continue and, when appropriate, the use of technology for consultations would remain.  It was vital that patient contact continued to be minimised and PPE used appropriately.

Moving forward, key priorities for General Practice included Immunisation, essential screening, unmet demand and backlog, the management of long term conditions, shielded patients and patients in Care Homes.  However, the impact of delivering these key priorities were around fewer available appointments due to longer consultation times, the threat of practices being overwhelmed especially in relation to the onset of flu and of general winter pressures.

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

·         General Practice had always been open and no Worcestershire Surgery had to be closed due to the pandemic.  Ways of accessing a GP service had changed as a result of COVID-19  ...  view the full minutes text for item 979.

Attending for this Item were:

Herefordshire and Worcestershire Clinical Commissioning Group (CCG)

Mari Gay, Managing Director (Worcestershire)

Worcestershire Acute Hospitals NHS Trust (WAHT)

Paul Brennan, Chief Operating Officer

Worcestershire Health and Care NHS Trust (WHCT)

Sue Harris, Director of Strategy and Partnerships

A report and presentation had been circulated with the Agenda and was discussed, with the following points being highlighted:

·         The NHS continued to be in the incident management phase of the pandemic, ensuring that urgent services were being carried out yet the spread of COVID-19 was being minimised.  The approach taken across the Herefordshire and Worcestershire Sustainability and Transformation Partnership (STP) continued to ensure good quality provision for residents in the constraints imposed nationally as a result of the pandemic

·         There had been a system wide approach to communications and service delivery and demand had been managed well

·         The temporary service changes discussed at the 18 June HOSC across Worcestershire Acute Hospitals NHS Trust, Worcestershire Health and Care NHS Trust and Primary Care, were broadly still in place, with some, such as digital solutions, likely to become more usual as restoration of services improved and was in line with the objectives of the NHS Long Term Plan 

·         Safety of patients, public, staff and service users would always be a priority and all services were reviewing waiting lists to ensure priority was given to those at highest risk

·         Limiting the risk of transmission was vital, whilst considering how best to restore services, especially for patients who were most vulnerable and giving confidence to patients that settings were safe places to receive care

·         A continuous engagement approach had been adopted throughout the pandemic and Healthwatch Worcestershire had undertaken a number of surveys, results of which provided themes to support the restoration phase

·         The impact of the temporary service changes was monitored constantly and any decisions involving long-term service changes would not take place without following due process in regard of consultation and engagement.

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

·         The use of private hospitals for NHS elective surgery would continue as per the national contract, which could perhaps be until the end of the financial year.  If so, the increased capacity throughout the winter months was welcomed

·         To date, 737 operations and 445 endoscopies had been undertaken privately, mainly diagnostics or surgery for cancer.  Bowel and breast screening had also been restarted

·         Non face to face consultations had increased from around 1,500 per month pre pandemic, to 15,000 in June.  This shift was expected to continue and become usual practice where appropriate, in line with the aims of the NHS Long Term Plan

·         Kidderminster Treatment Centre continued to operate as a ‘green’ site undertaking limited services.  With spare capacity, some patients waiting over 30 weeks for surgery were also being treated and the Minor Injury Unit based there had increased its opening to 8am to 10pm 7 days a week

·         Worcestershire Royal and the Alexandra Hospital would remain open for emergency activity only, however, some complex  ...  view the full minutes text for item 980.

Members were guided through the performance update and Year End 2019/20 financial update which were attached to the Agenda.

Public Health Performance

Members were reminded that the Public Health Ring Fenced Grant (PHRFG) was used to deliver a number of mandated services and a proportion of the PHRFG was used for discretionary services.

In relation to the national child measurement programme, one third of children were carrying excess weight at Y6 (age 10-11) in 2018/19.  The Director of Public Health reported that it was important to intervene as early as possible by promoting healthy lifestyles, diet and activity levels.  Excess weight in children would also widen the gap in health inequalities with some metrics suggesting areas of concern.  When questioned how accurate the data was, the Public Health Consultant would investigate and report back to the Committee.  Furthermore, clarification was sought on reporting mechanisms when pupils who reside in County are schooled out of County.  The most recent dataset was 2018/19 and it was acknowledged that there would be a gap in data collection as schools had been closed since 20 March.

A new contract to deliver the drugs and alcohol service had been agreed before COVID-19, alongside the new 0-19 service.  Working with District Councils to prevent rough sleeping and working with those most vulnerable in society was vital to improve outcomes.

Some of the sexual health information was recorded in 2018, however, in broad terms, there was less testing in Worcestershire in comparison to other similar Local Authorities and some further interpretation of the data was required.  The Committee noted that sexually transmitted infections (STI) data was showing an improving trend.

In relation to the NHS Healthchecks performance, a national programme of care, the Public Health Consultant suggested that further understanding was required as it could be one method of driving down health inequalities.  First introduced in 2013/14 and delivered through GPs in Worcestershire, it was reported that further publicity would be helpful and that comparisons were difficult as it was commissioned differently in other areas, such as delivered by private companies.

In response to a question as to how HOSC Members could help drive health improvements, it was explained that Member backing for initiatives was key.  Areas of concern for the County were residents maintaining a healthy weight, smoking in pregnancy and manual workers, especially in more deprived communities, and more generally widening health inequalities.  There was a duty in law to reduce health inequalities.  Plans were being prepared for budget setting, which the Committee hoped would target the areas of concern, however, there continued to be uncertainties around the PHRFG beyond 2020/21.

Public Health Finance  

The PHRFG for 2019/20 was £28,360,000, with the PHRFG for 2020/21 confirmed as £30,000,078 (6% increase).  Underspend had been reported in mainly strategic functions and adult prevention services, such as reduced spend in domestic abuse and reduced demand from GPs for NHS Healthchecks. In addition, the Healthwatch Worcestershire contract had reduced.

Overspend had been reported mainly in children’s prevention services,  ...  view the full minutes text for item 981.

HOSC Members had nothing to add at this time.

The HOSC had been asked to refresh its Work Programme in advance of it being agreed by Council on 10 September 2020.

In addition to those Items already scheduled, it was agreed to prioritise the following:

·         Mental Health Services (all ages) including Post Traumatic Stress Disorder resulting from COVID-19

·         Learning and new ways of working from COVID-19

·         Equalities in relation to COVID-19 – including how the HWB strategy tackles health inequalities identified in the Joint Strategic Needs Assessment.

The Chairman thanked everyone, especially Members, who had participated in the extended meeting.