Agenda and minutes
Venue: Committee Room 1, Shire Hall, St. Peter's Square, Hereford, HR1 2HX
Contact: Ben Baugh, democratic services
Apologies for absence
To receive apologies for absence.
All the committee members were present. It was noted that Councillor Felicity Norman, cabinet member children and families, had forwarded her apologies for the meeting.
To receive details of any member nominated to attend the meeting in place of a member of the committee.
There were no substitutes.
Declarations of interest
To receive any declarations of interests in respect of schedule 1, schedule 2 or other interests from members of the committee in respect of items on the agenda.
Agenda item 7 (minute 17) - One Herefordshire and Integration Briefing
Councillor David Summers, other interest, Council appointed governor on the NHS Gloucestershire Health and Care NHS Foundation Trust Council of Governors.
To approve and sign the minutes of the meeting held on Monday 24 June 2019.
That the minutes of the meeting held on 24 June 2019 be approved and be signed by the chairperson.
Questions from members of the public
To receive any written questions from members of the public.
For details of how to ask a question at a public meeting, please see:
The deadline for the receipt of a question from a member of the public is Monday 14 October 2019 at 5.00 pm.
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No written questions had been received from members of the public.
Questions from councillors
To receive any written questions from councillors.
The deadline for the receipt of a question from a councillor is Monday 14 October 2019 at 5.00 pm.
To submit a question, please email firstname.lastname@example.org
No written questions had been received from councillors.
To provide an updated overview of the Sustainability and Transformation Programme (STP), One Herefordshire and the integration agenda for health and social care.
The chairperson invited Jo-anne Alner, managing director of NHS Herefordshire Clinical Commissioning Group (CCG), to provide the briefing. Ms Alner delivered the presentation ‘Integrated Care Systems and One Herefordshire’ and the principal points are summarised below.
Integrated Care Systems (ICSs)
1. ICSs represented an evolution of the Sustainability and Transformation Partnership (STP) model, where health and social care partners worked collaboratively across a geographic footprint, so that ‘… commissioners will make shared decisions with providers on how to use resources, design services and improve population health’ (NHS Long Term Plan, paragraph 1.51).
2. This was not required in legislation currently but was government policy and seen as the direction of travel. The aim for Herefordshire and Worcestershire was to become a true ICS from April 2021.
3. Streamlined commissioning arrangements would typically involve a single CCG for each ICS / STP area and these would become leaner, more strategic organisations. It was reported that a formal letter had been received that morning confirming the merger of the four CCGs across Herefordshire and Worcestershire into one CCG from April 2020. This would provide costs savings of £2m to be redirected to frontline staffing and healthcare at a national level.
4. There would be emphasis on supporting providers to partner with local government and other organisations on population health, inequalities and service redesign.
5. There would be changes to funding flows and contract forms, with the aim of moving to a system control total.
Herefordshire and Worcestershire STP Vision
6. The joint vision would remain ‘Local people will live well in a supportive community with joined up care underpinned by specialist expertise and delivered in the best place by the most appropriate people’.
7. An outline was provided of the building blocks to enable the transformation, through an integrated approach, from ‘A system too reliant on emergency access and beds where people believe that hospital is the best place to be when you are unwell’ to ‘A system that is built around care close to home, where hospital beds are only used where somebody cannot be cared for safely in their own environment’.
The tiers in an ICS
8. The system-wide (Herefordshire and Worcestershire), place (Herefordshire), and neighbourhood (Primary Care Network) tiers were outlined. Within Herefordshire, there would be five Primary Care Networks (PCNs), each led by a clinical director.
9. One Herefordshire was the place based integration plan, involving partners working together locally. The principles of functional integration included integrating at the point of delivery, looking for shared efficiencies, and not shifting risk.
10. A five year plan was being developed, aligned to the NHS Long Term Plan.
Integrated care in Herefordshire
11. It was expected that integration would remove workforce and leadership boundaries, address financial sustainability, and deliver quality improvement.
2019/20 delivery and assurance
12. The delivery and assurance structure of One Herefordshire was outlined, from the health and care executive alliance down to programme groups (with executive leads) focused on medicines optimisation, integrated community alliance, ... view the full minutes text for item 17.
To consider the committee’s work programme for 2019-20.
The chairperson introduced the item and drew attention to the following:
1. NHS Herefordshire Clinical Commissioning had agreed to all the committee’s recommendations in relation to the item on ‘The future of the Herefordshire and Worcestershire NHS Clinical Commissioning Groups (CCG) consultation’ considered at the last meeting (minute 7 refers).
2. The work programme had been updated for the committee’s consideration and would be further amended to reflect the resolutions of the committee at this meeting.
3. To manage the number of items on the work programme, it was proposed that an additional meeting be held on Monday 16 December at 9.30am.
4. The chairperson suggested that scrutiny briefings be arranged for committee members to explore issues informally with commissioners, providers, support groups and other stakeholders. In particular, the chairperson was keen to hear service users’ perspectives. She added that informal briefings would also provide an opportunity to decompress the committee’s work programme.
5. In view of the need for flexibility in the work programme, it is proposed that the statutory scrutiny officer be authorised to add items to the work programme, as necessary, between meetings.
Mr Stead observed that the ‘One Herefordshire and integration briefing’ received earlier in the meeting was similar to a presentation received by the health and wellbeing board. The statutory scrutiny officer advised that the committee determined its own work programme and there was a need for both bodies to look at future plans. He added that the current review of the health and wellbeing board could provide the opportunity to connect the work programmes more coherently.
The chairperson suggested that, in view of concerns expressed by councillors representing the communities affected, the temporary winter closures for the Ross and Leominster Minor Injuries Units (MIUs) needed to be explored in a spotlight review. This suggestion was supported by committee members, especially to assist in deeper understanding about the reasons why those decisions were made, the information taken into account, and the potential impact on other service providers. Ms Brooks agreed to provide a presentation on urgent care, in order explain the context of the MIUs and the scale of the change involved. The director of public health suggested that the item could also explore what could be done differently to prevent people being in an urgent care situation in the first place. It was agreed that this item be brought to the next appropriate committee meeting.
(a) the work programme (appendix 1), as amended at the meeting, be endorsed;
(b) the statutory scrutiny officer be authorised, following consultation with the chairperson and vice-chairperson, to add items to the work programme where it is necessary to ensure their timely consideration where there is no scheduled meeting to approve their inclusion;
(c) the responses of NHS Herefordshire Clinical Commissioning Group to the committee’s recommendations on ‘The future of the Herefordshire and Worcestershire NHS Clinical Commissioning Groups (CCG) consultation’ (appendix 2) be noted;
(d) an additional meeting be scheduled on Monday 16 December 2019; and
(e) urgent ... view the full minutes text for item 18.
Dates of future meetings
Monday 18 November 2019, 10.30 am
Monday 16 December 2019, 9.30 am (provisional)
Monday 13 January 2020, 2.30 pm
Monday 2 March 2020, 2.30pm
Monday 11 May 2020, 2.30 pm
It was noted that the date of the next scheduled meeting was Monday 18 November 2019 at 10.30 am.