To receive apologies for absence.

Apologies for Absence were received from Councillor CA Gandy.

To receive details of any Members nominated to attend the meeting in place of a Member of the Committee.

Councillor EL Holton for Councillor CA Gandy.

To receive any declarations of interest by Members in respect of items on the Agenda.

None.

To approve and sign the Minutes of the meeting held on 7 June 2015.

The Minutes of the meeting held on 9 June 2015 were approved and signed as a correct record.

To consider suggestions from members of the public on issues the Committee could scrutinise in the future.

(There will be no discussion of the issue at the time when the matter is raised.  Consideration will be given to whether it should form part of the Committee’s work programme when compared with other competing priorities.)

Several members of the public requested that the Committee undertake a review of the proposed closure of 1 Ledbury Road Centre for children with complex health needs.

Members debated the suggestion and, after a prolonged discussion, it was agreed that a Task & Finish Group be held to consider the provision of short breaks and respite care in the County, the proposed closure of the facility at 1 Ledbury Road and the issues surrounding the consultation process that had been undertaken with parents of service users and stakeholders.

An initial date of 30^th September for the meeting was suggested, but this was subsequently moved to the 10^th September in order to help address the concerns of parents and service users.

Resolved: that the Terms of Reference for a one day Task and Finish Group review be formulated and that the Group should meet as soon as possible.

To note questions received from the public and the items to which they relate.

(Questions are welcomed for consideration at a Scrutiny Committee meeting so long as the question is directly related to an item listed on the agenda.  If you have a question you would like to ask then please submit it no later than two working days before the meeting to the Committee Officer.  This will help to ensure that an answer can be provided at the meeting). 

To receive an updated report on progress at the County Hospital following the intervention by the Care Quality Commission.

The Committee received a presentation from The Chief Executive, Wye Valley NHS Trust, on progress at the County Hospital following the intervention from the Care Quality Commission (CQC).  As part of his presentation, the Chief Executive highlighted the following areas:

·           That the CQC had highlighted good practice in both the Acute and the Community Services in the Hospital and had emphasised the caring and empathy shown by staff to families that was exemplary.

·           The Emergency Care Intensive Support Team (ECIST) had shown a volatile performance, but there that there was a planned expansion of the medical team in acute care, in line with an agreed recovery plan.  Recruitment in Herefordshire was an issues, and it was proving difficult to recruit to parts of the organisation. 

·           Stroke Services were subject to recruitment problems, but the transient ischaemic attack (TIA) service was improving and the hospital had exceeded national targets in this area and did not want to lose this impetuous. 

·           Patient safety had improved, as there had been a 38% increase in reported incidents with no concomitant increase in patient harm.  The hospital had also been free of MRSA for over 850 days. 

·           Bed occupancy and demand remained challenging as it was the smallest district hospital in the country and the highest bed occupancy rate. 

·           Diagnostic targets would be met with the addition of a second CT scanner by the end of the calendar year and a mobile unit by the end of the summer.

·           That there was a deficit plan in place for 2015/16 to address the deficit of £19.1m.  This was against the deficit from the previous year of £12.7m.  Changes to services would be considered in order to improve the position but reduction in costs would not be straightforward, as the largest cost centre was that of staff.

·           That exacting national standards and a reducing financial envelope were issues for the hospital.  There was a strong case for the future of the hospital, but work would need to be done to invest in and change the community provision of healthcare.

In reply to a series of questions from a Member the following points were made:

That staff turnover was currently at 13%, with a target of 10%.  Recruitment and retention was benchmarked against other organisations, and that 40 additional nursing staff had been recruited from residents within the County. 

That attendance in June and July had been around 160 a day.  The Chief Executive’s personal view was that this situation arose as a result of the inability of a poorly understood and fragmented health service to admit acutely unwell patients in a timely fashion.  The urgent care system needed to be simplified, and work was in hand with the HCCG to address this.

That there was a good working relationship with the Powys Teaching Health Board.

In reply to a comment regarding delay at patient discharge, he said that the main issues were not associated with the pharmacy, but with the limited time available to junior doctors,  ...  view the full minutes text for item 17.

To receive a presentation on the joint project to develop an integrated pathway for mental health services.

The Committee received a presentation on a project to develop a joint, integrated, all age pathway for mental health services based around the needs of the population and the outcomes they required.  During the presentation, the following issues were highlighted:

·                Target contract completion date of 30^th September 2016 and target contract commencement date of 1^st April 2017.

·                There would be an extension to the current contract with 2Gether NHS FT to allow the time to develop the joint mental health services specification with Herefordshire Council.

·                That the Joint Commissioning Board would be the appropriate governance route for a joint procurement project and would oversee a project specific Project Board.

During the ensuing discussion, the following points were raised:

A Member pointed out that partnership working could be fraught with problems, and asked whether there would be a system in place to ensure that all partners delivered against the obligations within the contract.  The Director of Operations, HCCG, said that whilst that level of detail had yet to be laid out, it was important to ensure that there was a structure in place to scrutinise and support the providers.  Best practice ideas were being utilised from other areas within the country.

The Director of Adults Wellbeing added that the key to the initiative was the public health aspect that meant that the Local Authority, the CCG and the Wye Valley NHS Trust were forming a partnership to address the issue of mental health in the County above and beyond service provision. She suggested that the Committee should consider how a resilient County could be created as the emotional wellbeing of children was one of the priorities of the Health and Wellbeing strategy.

·         In reply to a Member, it was noted that the emotional resilience and wellbeing of children was a priority, and early years support and intervention would be part of the pathway.  There would also be support for secondary schools as well as the sixth form college.  It was also noted that there was a buddy system operating at the Sixth Form College, as some young people did not want to utilise services, but needed someone to talk to.

·         That care should be taken to ensure that veterans and forces personnel were not excluded from any initiatives.

A Member said that a pilot initiative had been undertaken by three of the Parish Councils in Bircher Ward to help address loneliness and isolation. A volunteer telephone service had been set up to allow people to call and discuss issues that they might have. The Director of Adults Wellbeing welcomed this, and suggested that funds from the Council’s Wellbeing Innovation Fund might be available for local projects of this nature.  

·         That, as many young people did not talk to their parents about concerns they might have, consideration be given to a mental health smart phone app.

Resolved:

That

a)    The report be noted; and;

b)    An updated report be bought to the Committee on 29 January 2016.

To seek the comments of the Committee on the Children and Young People’s Partnership Plan 2015-2018.

The Committee received a report on the Children and Young Peoples Plan 2015-2018.  The following points were highlighted by the Director of Children’s Wellbeing:

·         That the Plan set out the priority area for partners that would be focused on and improved on over the next three years.  The Health and Wellbeing Board had delegated responsibility for the development of the Plan to the Children and Young People’s Partnership, which had undertaken development work on it using the joint strategic needs assessment, and with consultation with partner stakeholders.  

In reply to a question she said that contract management was always an issue for the Partnership.  Programme management would be subject to oversight by bodies such as the Health and Social Care Overview Scrutiny Committee.

In reply to a further question, the Director went on to say that the expectation of the mental health work in the Plan did include children up to five years.  This would be made clearer in the document.

Resolved:

That the Children and Young People’s Partnership Plan 2015-2018 be noted and the partnership approach to addressing the needs of children, young people and families in Herefordshire be endorsed.

To receive a report on issues of concern to Healthwatch Herefordshire.

The Committee noted a report on the activities of Healthwatch Herefordshire.

Resolved: That the report be noted.

To consider the Committee’s work programme for the year and to allocate activities to task and finish groups, as deemed necessary.

The Committee noted its Work Programme.

The following matters would be added to the Programme:

·         A one day spotlight review of Short respite Breaks be held.  The Group would consist of Councillors ACR Chappell, PE Crockett and MD Lloyd-Hayes and be chaired by Councillor J Stone.  The review would be held on the 10 September.

·         A Task and Finish Group be commissioned to review the Multi-Agency Safeguarding Hub (MASH).

·         That a report on GP Recruitment would be added, and NHS England would be invited to attend the meeting, as commissioners of primary care services.

·         That the Chairman of the Herefordshire Children’s Safeguarding Board be invited to present the Board’s Annual Report.

Resolved: that subject to the above additions, the Work Programme be approved.