Apologies were received from Cllr CA Gandy, Cllr RL Mayo and Cllr D Summers.  

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

Cllr A Seldon substituted for Cllr D Summers.

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

There were no declarations of interest.

To approve and sign the minutes of the meeting held on 21 September 2017.

RESOLVED:

That the minutes of the meeting held on 21 September 2017 be confirmed as a correct record and signed by the chairman.

To receive questions from members of the public.

Deadline for receipt of questions is 5pm on Monday 13 November 2017.

Accepted questions will be published as a supplement prior the meeting.

There were no questions from members of the public.

To receive questions from councillors.

Deadline for receipt of questions is 5pm on Monday 13 November 2017.

Accepted questions will be published as a supplement prior the meeting.

There were no questions from councillors.

To review the performance of West Midlands Ambulance Service NHS Foundation Trust (WMAS).

To enable the committee to fulfil its function to review and scrutinise the planning, provision and operation of health services (not reserved to the children and young people scrutiny committee) affecting Herefordshire, and to make  reports and recommendations on these matters.

Officers from West Midlands Ambulance Service gave a presentation to provide an overview of the key issues for the service including:

·         Activity in Herefordshire for the year to date: this had risen by around 3%, broadly consistent with overall activity for the region.

·         Non-conveyance: although the approach was to try and keep people at home, non-conveyance of patients was below the regional average. This was due to a tendency to address risk and ensure that patients’ ongoing health needs were met and appropriate pathway were followed.  

·         Ambulance usage per head of population: across the 22 commissioning groups for the region, Herefordshire did not have the highest level of use in comparison.

·         Response Programme trial: the service had taken part in this national trial designed to ensure that response standards were being met and this had informed national standards that were now in place. In Herefordshire a key challenge was to meet the 7-minute response time, and this was now measured as an average figure in recognition of the rurality of the county.

·         Response categories: changes had been made by NHS England, including differing response times for each category.

·         Performance for Herefordshire:  this was improving; category 1 responses remained a challenge, although the response programme trial had led to improved performance for every category.

·         Nature of calls: referred to as ‘chief complaints’, in Herefordshire, these were predominantly under the ‘medical / generally ill’ classification.

·         Service achievements:  the trust was the highest performing ambulance service. Estates rationalisation to develop operational hubs had led to better facilities to support response times and efficient working, and the service was working with commissioners to address demand management to ensure that calls were not being ‘stacked’.

Members responded with a number of questions and comments.

Commending the service for the achievement of a paramedic on every shift, a member asked about how this had been possible. It was explained that a graduate training scheme had brought paramedics through and their deployment supported each vehicle to be autonomous to make clinical decisions, supported by a clinical network for wider decision making.

Regarding a question on the impact of the national standard for responses to category 1 calls on staff morale, officers described that expectations were communicated to staff who were encouraged to make suggestions and provide feedback.

A member asked how the impact of moving the call centre from Worcester to the base in Dudley had been addressed as regards local knowledge and directing vehicles to calls. Officers explained that there was a despatch team working with the area to become familiar with it. There were good communications with the call centres and a dedicated Herefordshire desk to provide local focus which had improved integrated urgent care. The clinical hub was working to provide better care to make the most of care pathways.

The commissioner from Sandwell and West Birmingham Clinical Commissioning Group added that in order to support patients to access the most appropriate care there were links with the local hub and the GP out  ...  view the full minutes text for item 23.

To consider the findings of NHS Herefordshire CCG’s recent public engagement on transforming Community Health Services: “Let’s plan health and care in your community”

To identify the committee’s preferred approach to the programme as it progresses.

To enable the committee to fulfil its function to review and scrutinise the planning, provision and operation of health services (not reserved to the children and young people scrutiny committee) affecting Herefordshire, and to make  reports and recommendations on these matters.

The director of operations, NHS Herefordshire Clinical Commissioning Group (CCG) introduced her report and reminded members that the CCG presented information on the engagement approach around developing community services to the committee on 23 August 2017. The approach had been adapted in response to the committee’s recommendations. Healthwatch had contributed to the work, by running some of the events and attending the public meetings.

A lot of information had been provided for the meeting, although it was structured for officers to guide through.

The deputy director of operations presented the report, drawing attention to the following:

·         the process of engagement commenced at the start of July, and ran through to the end of October. 

·         There had been inter-agency involvement between 2gether NHS Foundation Trust, Wye Valley NHS Trust and Herefordshire Council in facilitating the discussions.

·         The approach to engagement recognised the diversity and rurality of the county and sought to get to the depth of conversations at various locations including doctors’ surgeries and supermarkets.  It was intended to hear from people who did not tend to come to public events so social media were used.  All types of care experiences were heard and the process explored what healthcare looked like. Parish and town council were attended and an ongoing dialogue was established.

The findings from the engagement exercise and locality information were shown in appendices 2 and 3 and all information had been shared with participants.  The key areas of interest were summarised as:

·         barriers to accessing services, such as transport, and perceived barriers such as not wanting to be a burden on system.

·         overwhelming feedback for services not to rely on the internet. There was too much information so it was hard for people to filter out unhelpful information, and other people wanted to speak to someone to check their problem out.  

·         prevention was a key activity and it was important to recognise that the NHS was not a finite resource.

·         Addressing rurality and how to identify issues regarding frailty and mental health was part of the community resilience approach. 

The chairman noted that the 803 members of the public who participated amounted to 0.5% of population and represented a statistically limited representation of the county’s demographic. She particularly noted the deficit in responses from younger people and commented that the choice of venues was not user friendly.  It was acknowledged that this was a small number over a 3 month period, and experience showed that it was difficult to engage with the diversity of people who did not think the subject was relevant to them.  A range of venues were visited, including children’s centres and maternity clinics as well as making use of social media.  

A member commented that the flaw in the exercise was that people who were not users would not engage, and wondered where this approach originated from if it were a waste of time.  He commented further that some of the issues were not being taken seriously enough, such as population growth in  ...  view the full minutes text for item 24.

To consider revisions to the committee’s work programme from January to May 2018.

Members reviewed that work programme and it was suggested that the workshop to be held in early 2018 be designed to cover themes relating to the sustainability and transformation partnership and NHS reconfiguration.

Attention was drawn to the proposed changes to the Spring 2018 dates, those being 27 March 2018 and 8 May 2018.

It was agreed that it would be arranged for members to visit the air ambulance hub.

RESOLVED

That the proposed amendments to the work programme and committee dates for 2018 be approved.