To receive apologies for absence.

Apologies for absence were received from Councillor Mark Dykes.

Apologies were also noted from Christine Price, Healthwatch Herefordshire.

To receive details of any councillor nominated to attend the meeting in place of a member of the committee.

Councillor Louis Stark was present as the named substitute for Councillor Mark Dykes.

To receive declarations of interest in respect of items on the agenda.

No declarations of interest were made.

To receive the minutes of the meeting held on Monday 25 March 2024.

The minutes of the previous meeting were received.

Resolved:  That the minutes of the meeting held on 25 March 2024 be confirmed as a correct record and be signed by the Chairperson.

To receive any written questions from members of the public.

A document containing a question received from a member of the public and the response given, plus a supplementary question and the response given, is attached at Appendix 1 to the minutes: Link to Appendix 1.

To receive any written questions from members of the council.

No questions had been received from councillors.

This report provides the Health, Care and Wellbeing Scrutiny Committee with the background and findings of the Care Quality Commission’s (CQC) inspection of Wye Valley NHS Trust: The County Hospital.

The committee considered a report on the background and findings of the Care Quality Commission’s (CQC) inspection of Wye Valley NHS Trust (WVT), The County Hospital: Link to the inspection report.

The slide pack was published as part of agenda: Link to the presentation 'Care Quality Commission Inspection: Emergency Department'.  The slides presented by WVT representatives are outlined below (in italics), with summaries of the responses provided to the key lines of questioning by the committee.

A       The Managing Director (WVT) introduced the presentation and welcomed the opportunity to update the committee on progress since the publication of the inspection report.  The committee was advised that: emergency demand had increased nationally since the Covid pandemic; the principal issue for the County Hospital was congestion in the Emergency Department (ED), this being the result of increased demand, discharge delay, and prioritisation given to offloading ambulances; and recent data (29 July 2024) showed the ED as being in the top quartile of performance nationally on ‘time to treatment’, and mortality indices were below the national average.

B       The Chief Transformation and Delivery Officer (WVT) presented:

Emergency Department: Overview

b.1     Clarifications were provided about attendance types and conveyances.

Emergency Department: Care Groups

b.2     Questions were asked about the inconsistent use of colours in the graphs.

b.3     It was noted that the slide pack had been updated following the postponement of the 28 May 2024 meeting, Link to the original presentation.

Minors by Herefordshire PCN (Primary Care Network)

b.4     It was considered unlikely that the ambulance service would dispatch a crew to attend a minor injury or illness; a ‘hear and treat’ approach triaged and directed callers to self-care, pharmacy or other services.  Examples were provided of scenarios where crews would respond but which might not result in conveyances to hospital, by providing care on-scene or through the deployment of different health resources.

b.5     The committee was advised that people with complex needs were driving the pressures in the ED, rather than those with minor injuries and illnesses; over 90% of minors were treated and discharged within four hours.

Emergency Department: Acuity

Emergency Department: Performance

Discharge Delays

b.6     It was reported that: a dashboard was being developed to combine health and social care data; there were significant discharge problems relating to Powys; and the Community Wellbeing Directorate was working jointly with WVT to reduce pressures in Herefordshire.

Acute Bed Occupancy

C       Chief Nursing Officer (WVT) presented:

Care Quality Commission

c.1    An overview was provided of the roles and background of the inspection team and their advisors.

CQC findings requiring urgent attention

c.2     The Chairperson outlined a personal experience involving triage at reception.  The Chief Nursing Officer explained that, given congestion and the findings of the inspection, the ED had returned to nurse led triage and risk assessment.

CQC safety summit – Friday 8^th December

ED Dashboard

c.3     It was reported that the dashboard provided the nurse in charge with a ‘helicopter view’ of the whole department to help manage risks  ...  view the full minutes text for item 7.

This report provides the committee with details of the proposed relocation of the out of hours general practice service for Herefordshire. NHS Herefordshire and Worcestershire Integrated Care Board (ICB) have agreed to this relocation, subject to approval by Herefordshire Council’s Health, Care and Wellbeing Scrutiny Committee.

The committee considered a report on the proposed relocation of the general practice (GP) out of hours service for Herefordshire.

The slide pack was published as part of Supplement 1 to the agenda: Link to the presentation 'Consideration of the proposed move of GP Out of Hours Service'.  The Director of Planning and Delivery (Taurus Healthcare) identified the following principal points:

i.             Feedback was invited from the committee on the proposed relocation of the service from the Station Medical Centre, Station Approach, Hereford to the Nelson Building, Whitecross Road, Hereford.

ii.            The service operated 6.30 pm to 8.00 am on weekdays and 24 hours at weekends, and it was accessed through the NHS non-emergency line on 111.

iii.          The Nelson Building was considered a good, central location and dedicated patient parking would be provided.

iv.          The proposal would consolidate the estate and provided the opportunity to co-locate the Community Integrated Response Hub to support the urgent care system.

v.           The facility would also provide additional clinical space during the day.

vi.          A public consultation had been undertaken by Healthwatch Herefordshire, with the majority of respondents indicating that the proposal would make ‘no difference’ to accessibility and convenience, and the recommendations from the consultation would inform design considerations.

The Chairperson noted that the public consultation report was comprehensive and many of the concerns that had been raised had been mitigated: Link to Healthwatch Herefordshire's report 'Public Consultation on Urgent Out of Hours GP Service'.

In response to a question, the Managing Director (Taurus Healthcare) outlined the challenges at Station Medical Centre and, whilst acknowledging the need to control, considered that the proposed move would deliver operational and financial efficiency, especially given the limited space available to health services currently.

The following resolution was agreed by the committee.

Resolved:

a.           That the presentation be noted; and

b.           That the proposals be endorsed.

To consider the draft work programme for the Health, Care and Wellbeing Scrutiny Committee for the municipal year 2024/25.

The Statutory Scrutiny Officer presented the draft work programme for the remainder of the municipal year 2024/25, with attention drawn to the following matters:

·             Cabinet had invited engagement from the scrutiny committees on the action plan for the Herefordshire All Age Carers Strategy 2024-2029; Link to Cabinet minutes, 18 July 2024.  It was recommended that terms of reference for a working group be developed, in consultation with the Children and Young People Scrutiny Committee and the Scrutiny Management Board, to enable the Health, Care and Wellbeing Scrutiny Committee to lead on this piece of work.

·             Informal briefings would be arranged to enhance understanding of topics within the remit of the committee, including on the Joint Strategic Needs Assessment, community transport, and technology enabled living.

·             Work was ongoing with officers in the Community Wellbeing Directorate to facilitate informal discussions between committee members and care providers.

The committee discussed potential additions to the work programme, including:

§    The intention of the Scrutiny Management Board to examine options for budget scrutiny on elements which fell within the remit of each scrutiny committee.

§    A future item on West Midlands Ambulance Service.

§    The timing for the further report by the Wye Valley NHS Trust on the outcomes of its work to review service performance to ensure patient safety and outcomes.

§    The timing for a report on the results of the review of Talk Community.

Resolved:

That the work programme, as amended and subject to periodical reviews, be agreed as the basis of the primary focus for the committee for the remainder of the municipal year 2024/25.

Date of the next scheduled meeting: Thursday 3 October 2024, 2.00 pm

The date of the next scheduled meeting was noted, Thursday 3 October 2024, 2.00 pm.