To receive apologies for absence.

None received.

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

None.

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

Cllr PE Crockett declared a disclosable pecuniary interest in item 7 as an employee of Wye Valley NHS Trust.

To approve and sign the minutes of the meeting held on 14 November 2016.

RESOLVED

That the minutes of the meeting held on 14 November 2016 be approved as a correct record and signed by the chairman.

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.)

None received.

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). 

None received.

To review the performance of Wye Valley NHS Trust (WVT) in the light of the recent Care Quality Commission (CQC) re-inspection.

Councillor PE Crockett left the meeting for this item having declared a disclosable pecuniary interest as an employee of Wye Valley NHS Trust.

The interim director of nursing, NHS Herefordshire Clinical Commissioning Group (CCG), introduced the item and explained that CCG had been working with NHS Improvement to ensure there were plans in place following the previous inspection of Wye Valley NHS Trust (WVT). There was close working with WVT’s plan to ensure continued improvement.

The managing director, Wye Valley NHS Trust, gave a presentation which highlighted the following points:

·         this was the second inspection of WVT by the Care Quality Commission (CQC), the first of which took place in January 2016 with a finding of Inadequate;

·         WVT had joined up with South Warwickshire NHS Foundation Trust (SWFT) to share good practice;

·         the hospital and the community services gave a good impression, although it had subsequently become clear that the level of focus that WVT had devoted to the CQC inspection appeared to have distracted the organisation from robust financial management, and so the scale of the challenge was to reduce overspending by almost a half;

·         management was working on agreed priorities and taking these forward;

·         SWFT was a stable organisation as a result of redesign and integration of acute services, supported by collective experience and expertise, and so the intention was to draw on this expertise to support improvement by WVT;

·         there was a 10-point plan, focusing on developing A&E safety and quality to bring it in line with the standards of the national A&E plan. SWFT was one of a small number of trusts nationally currently meeting this standard;

·         community redesign was key to improvement, with well integrated pathways and the right capacity to meet demand for services, such as caring for people at home;

·         there was close working with the council to take out duplicated processes and aligning community services

In response to a number of members’ questions regarding waiting times performance, the managing director explained that some waiting times had built up, and it was necessary to address some backlogs. She recognised that this could take at least a year to resolve and that in order to meet certain targets, it was necessary to refer people to other centres.  An impact of the waiting lists was that some pre-operation assessments were repeated to ensure they were up to date.

A member asked if it was a condition of special measures for WVT to form a relationship with SWFT. The managing director clarified that the relationship between WVT and SWFT was in order to ensure a positive journey towards improvement and avoiding a return to special measures.  In terms of financial assurance, the two trusts were believed to have a similar demographic with significant rurality and an urban district general hospital. SWFT remained in balance, with a small surplus and there was confidence in maintaining a good level of service to South Warwickshire residents.  It was possible to turn around the finances in Herefordshire but  ...  view the full minutes text for item 125.

The director of primary care, NHS Herefordshire Clinical Commissioning Group (CCG), explained that the CCG’s governing body was preparing to engage and consult with patients, public and wider stakeholders on the delivery of 7-day primary care medical services in Herefordshire.

Views on the redesign of the urgent care pathway had been sought and the key message was that a more streamlined pathway into care was required.  There were 24 GP practices in the county plus 3 hubs provided by Taurus, and an out of hours service. There was an opportunity for redesign for a number of reasons:

·         a pilot for 7-day Taurus hub pilots was coming to an end;

·         funding was transferring to the CCG in April 2017; 

·         a new out of hours provider was in place under a new contract from November.

A timeline for the consultation process was set out, to March 2017.

The proposal centred around moving a GP practice into the walk-in centre space at Asda giving full access to primary care till 8pm, and to provide planned care through a Taurus hub in the same facility. It also recognised that there was a need for increased primary care access in South Wye to serve an increased population.  

A member commented that the current walk-in centre operated from 8am until 8pm and is used by people from all areas, not just South Wye, and gave encouragement for early consultation with community leaders. He made the point that people would not expect to have to make a ‘phone call to be directed to that centre because they were used to going straight there without an appointment. 

The chairman noted that there were few GP practices south of the river, and asked if the proposals meant that people outside the area would be excluded from access.

The director explained that people could go to any practice but it was necessary to tailor the primary care and to support the population that is there.

The chairman commented further that altering access to the walk-in centre would be a sensitive issue.  It was noted that the service would be extended to provide planned care and walk-in facilities, along with signposting.

A member suggested that the overall object would seem to be to stop people accessing A&E inappropriately in order to take some pressure off that service, and it was not clear how successful that had been so far. It was a challenge to educate and change peoples’ mind-set from making 999 calls.   The director concurred that this was part of the driver for change and a consistent message was needed. Patients would be able to phone and be seen through triage and may be directed to other support such as pharmacy or nursing care, with the emphasis on clinical need.

Referring to the report, a member asked for clarification on what the end offer would look like, and the impact on minor injury units around the county. It was important to ensure the consultation was county-wide and to be  ...  view the full minutes text for item 126.