To receive apologies for absence.

Apologies for absence were received from Councillor Carole Gandy (committee member) and from Councillor Pauline Crockett (Cabinet Member Health and Adult Wellbeing).

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

There were no named substitutes.

To receive 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.

No declarations of interest were made.

To receive the minutes of the meeting held on 22 July 2022.

The minutes of the previous meeting were received.

RESOLVED:

That the minutes of the meeting held on 22 July 2022 be confirmed as a correct record and be signed by the Chairperson.

To receive any written questions from members of the public.

No questions had been received from members of the public.

To receive any written questions from members of the council.

No questions had been received from councillors.

To present background information for the committee to consider the ways in which the council and partners currently tackle obesity in the local population and to make any recommendations around future provision.

On behalf of the committee, the Chairperson commented that this was an excellent report, thanked the Director of Public Health and the other officers involved for the high standard of work, and welcomed the participants to the meeting.

The Leader of the Council commented on the implications of people being overweight for the health and care system, and the need to take full advantage of the opportunities for walking and exercising in the county.

The Director of Public Health gave a presentation on ‘Tackling Obesity’, as published in a supplement to the agenda (link to the presentation).  This included slides showing:

·             Epidemiology statistics, identifying that 67% of adults in Herefordshire were overweight or obese (2020/21);

·             A system map from the Foresight, Tackling Obesities: Future Choices – Project report (2007) (link to the report), illustrating different determinants that can lead and influence body weight; an overview of current action to tackle obesity, highlighting national and local programmes, and recognising that there were some gaps in weight management support across Herefordshire’s child and adult healthy weight pathways;

·             An infographic reflecting the different level of healthy weight interventions from a universal provision through to services to meet individual care needs, and across life stages; and

·             A summary of the recommendations detailed in the conclusion and key areas for policy development section of Appendix A (agenda page 39).

The principal points of the discussion included:

1.           Professor Gately commented that: the system map demonstrated the complexity of the interactions between the key variables; the needs, strengths and challenges of each area were different and had to be considered at a local level; it was clear from the evidence that investment in a good provision of services was critical; a whole systems approach needed to be relevant to the local authority, to be cognisant of recent public health, political and economic events, and to be prepared for the emergence of new issues; in addition to reflecting the key strategic goals of the council and of the health system, there was a need to involve other local stakeholders, such as businesses and education providers; a series of workshops could help to pull information together and develop a plan; local practitioners could follow the Whole systems approach to obesity: A guide to support local approaches to promoting a healthy weight (2019) (link to the guide), with appropriate support and resources committed to do it well.

2.           The Chairperson commented on the need for improved coordination to achieve seamless service provision and questioned whether a healthy weight strategy, using the whole systems approach, would be beneficial. 

The Director of Public Health commented on the work already being undertaken, including on the physical activity strategy and in relation to sustainable food, and on the need to avoid duplication.  The workshop approach advocated by the guide could provide an opportunity for collating key information but also to identify where to best focus effort and maximise value.

The Chairperson suggested that a healthy weight strategy  ...  view the full minutes text for item 16.

The report attached at Appendix A provides an update on NHS Herefordshire and Worcestershire ICS on stroke services across Herefordshire and Worcestershire.  This includes a paper on Improving Stroke (including TIA) Services across Herefordshire and Worcestershire, September 2022. The committee is asked to consider and comment on the information provided and seek assurance that the wider public engagement undertaken on this will be focused on delivering the required improvement further inform possible solutions.

The Managing Director and Chair of the Stroke Programme Board for the Herefordshire and Worcestershire Integrated Care System (ICS) gave a presentation on ‘Stroke Services: Pre-consultation Engagement Autumn 2022’, as published in a supplement to the agenda (link to the presentation).  This included slides showing:

·             Welcome and introduction, identifying that around three people each day had a stroke in Herefordshire, Worcestershire and Powys, the number was set to rise as the population aged, and the ICS was looking at the way in which stroke and TIA (transient ischaemic attack or ‘mini-stroke’) services were organised and run;

·             The National Stroke Pathway and current acute hospital treatment, rehabilitation and after care settings;

·             The case for change which included the difficulty to recruit stroke specialist consultants, resulting in reliance on support from outside the ICS area to ensure 7-day access, and keeping services as locally accessible as possible but balanced with providing the best care for patients;

·             The identification of four potential solutions [1. No change to current service / 2. One hyper-acute stroke unit (HASU) and two acute stroke units (ASU) / 3. HASU and ASU out of counties / 4. HASU and ASU on one site], with ‘potential solution 4’ being the preferred solution by the clinicians and following the options appraisal but this would not be taken forward until there had been full engagement with the public and with stakeholders;

·             Diagrams of the potential solution (with movement to HASU / ASU at Worcestershire Royal Hospital) for Herefordshire and Powys patients where Herefordshire County Hospital was the nearest imaging centre, and for Worcestershire and Herefordshire patients where Worcestershire Royal Hospital was the nearest imaging centre; and

·             People were being invited to have their say during September – November 2022, it was acknowledged that previous engagement had highlighted that some families in Herefordshire had expressed concerns about being able to visit Worcestershire Royal Hospital, especially if they did not have access to their own transport.

The principal points of the discussion included:

1.           In response to a question from the Chairperson, the Stroke Consultant said that the infrastructure and workforce issues meant that it was unlikely that two HASU sites could be operated in the near future and the ‘hub and spoke’ model was considered the best way to move forward.

2.           A committee member commented on the difficulties for the ambulance service to meet demand currently.  In response, the Managing Director outlined the dedicated pathways for suspected stroke, intended to reach assessment imaging within the ‘golden hour’, and said that the ICS would work with the ambulance service on the agreed model to support the movement of patients.  The committee member considered that this would be a concern for the public and suggested that this should be referenced in the consultation.

Another committee member questioned whether there was confidence that the ambulance service had the capacity for the extra journeys.  The Managing Director said that more capacity would be commissioned and this might only involve a small number of  ...  view the full minutes text for item 17.

This report provides a brief summary update on issues previously considered by the Health, Care and Wellbeing Scrutiny Committee, including responses to information requests made by the committee, updates on resolutions made by the committee, including reports and recommendations to the executive and the executive response and executive decision made in respect of scrutiny reports and recommendations.

The Statutory Scrutiny Officer advised that this would be a standing agenda item to provide updates on matters previously considered by the committee.

Referring to minute 8 of 22 July 2022, it was reported that an informal meeting had been held with the Vice-Chairperson of the committee and representatives of the Task and Finish Group, and a further iteration of the report on ‘The impact of the intensive poultry industry on human health and wellbeing’ would be reported to a future meeting.

Committee members requested that the Annual Work Plan feature as an appendix to progress report going forward.  The following adjustments to the plan were identified:

·             The Chairperson requested a briefing note on dementia provisioning, with the potential to expand the scope of the agenda item on Domiciliary and Residential Care in Herefordshire (6 March 2023) to include this topic.

·             A committee member requested that the scope of the agenda item on ‘Access to council wellbeing services – signposting’ (23 January 2023) be expanded to include the provision made for, and communications with, employees of the council.

It was requested that the progress report feature as an earlier item in future agenda.

A committee member requested that the Chairperson update committee members on budget scrutiny for 2023/24 in due course, particularly given the emerging pressures in the Community Wellbeing Directorate.

RESOLVED:

That the progress report be noted.

Friday 25 November 2022, 10.00 am

The next scheduled meeting was to be held on Friday 25 November 2022.