To receive apologies for absence.

Apologies were received from Councillors Mrs J.A. Hyde and Brigadier P. Jones.

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

There were no named substitutes.

To receive any declarations of interest by Members in respect of items on this agenda.

There were no declarations of interest.

To approve and sign the Minutes of the meeting held on 9th December, 2004.

RESOLVED: That the Minutes of the meeting held on 9th December, 2004 be confirmed as a correct record and signed by the Chairman.

To receive an update on the local delivery plan, NHS dental services and primary care led commissioning.

The Committee received an update on three areas of NHS interest upon which it had been briefed in December 2004: the Local Delivery Plan Process, NHS Dental Services and Primary Care Led Commissioning.

A briefing paper prepared by Mr Hairsnape, Director of Development at the Herefordshire Primary Care Trust (PCT) had been circulated with the agenda papers.

Mr Paul Bates, Chief Executive of the PCT, had been invited to attend the meeting.  He commented that he had nothing to add to the briefing note but proposed to  elaborate on the recently published executive summary of the PCT’s Local Development Plan: A Strategy for Success: a Statement of Intent.

He explained that the Strategy had been produced in response to the number of national health initiatives currently underway.   It sought to clarify the policy context within which the PCT was working, described the PCT’s role and key functions, and commented on the current main NHS reforms and the main issues which needed to be addressed in the local agenda.

Since publication of the Strategy the PCT had received confirmation of the funding which would be available to the PCT over the next three financial years. This indicated increases in funding of 9% in 2005/06, 9% for 2006/2007 and 11% for 2007/2008.   Mr Bates commented that these were significant sums.  However, these headline figures did not necessarily mean that the PCT would have that level of additional resources available to it locally, because the headline figures might assume contributions from those sums to initiatives being conducted at national level or additional responsibilities being carried out by the PCT.  It was important to exercise some caution in planning improvements, recognising that in future years the level of growth in funding may not be sustained at those levels.

He added that in response to the Government White Paper:  Choosing Health, the PCT proposed, at its discretion, to reinforce its work on public health initiatives, ring fencing half a million pounds in 2006/07 and a further half million pounds in 2007/08 to fund measures to address public health issues.  These measures would need to be delivered in conjunction with the Council and other partners.  The Government had not explicitly identified either the PCT or the Council as the senior partner.

He noted the changes to the PCT’s core functions since its establishment and the emphasis on improving and protecting public health, providing patient choice and commissioning services from a diverse range of providers.

Section 7 of the Strategy set out the system reforms taking place within the NHS to deliver the objectives contained in the NHS Plan.  Mr Bates highlighted in particular:

·         The requirement that the PCT must offer more choice to patients about the type of care they received, and where they received it from, and support the development of a market place which included a greater range of high quality providers.

·         The Government’s intention that large volumes of services should be procured from the private sector, and the question of how such services  ...  view the full minutes text for item 33.

To note the interim report on the work of the Patient and Public Involvement Forum for the Primary Care Trust and future support for patient and public involvement in health.

The Committee received an interim report on the work of the Patient and Public Involvement Forum for the Primary Care Trust (PCT PPIF) and on future support for patient and public involvement in health.

The report set out the Government’s response to a consultation exercise it had conducted on the system for patient and public involvement in health, as considered by the Committee in December 2004.  The PCT PPIF’s interim report was appended to the report. 

Mrs Ann Stoakes and Mr Jim Wilkinson, Chairman and Vice-Chairman respectively of the PCT PPIF were present, together with Mr Nick Comley PPI Project Manager.  Mrs Stoakes informed the Committee of the difficulties the Forum had faced in seeking to establish itself and the progress which had been made.  She explained how the PCT PPIF had accepted invitations to explain its role, including one from the Council’s Local Area Forums and had sought to engage with groups of people traditionally recognised as being hard to reach.

In taking matters forward Mr Wilkinson commented on the need to work with the Scrutiny Committee to avoid duplication and focus on the health of people in Herefordshire. He informed the Committee that a PCT PPIF survey questionnaire was to be included in the Council’s newsletter: Herefordshire Matters.

Mr Comley explained that the contract for providing support to the Patients Forums in Herefordshire was due for renewal and the current providers Herefordshire Community Care Alliance were not bidding for the contract.  A tendering exercise was currently underway.

In response to a question it was confirmed that the Criminal Records Bureau (CRB) checks had now been completed for PCT PPIF Members, enabling them to exercise their power to enter and inspect certain health premises.  The PCT PPIF representatives expressed some doubt as to whether such checks had in fact been necessary, given the precautions it had itself put in place. 

The Committee was firmly of the view that CRB checks were both appropriate and essential.  It was proposed that this view should be highlighted to relevant organisations as appropriate.

The Chairman concluded by echoing the remarks made on behalf of the PCT PPIF for the Committee and the PCT PPIF to work closely together, noting the potential benefits the Committee could derive from the Forum’s work.

RESOLVED: That the Director of Social Care and Strategic Housing be authorised, following consultation with the Chairman to, highlight as appropriate to relevant organisations the Committee’s view that CRB checks for PPIF Members were both appropriate and essential. 

To consider the Committee’s work programme.

The Committee considered its work programme.

A draft programme was appended to the report at appendix 2.  It was suggested that consideration of the GP Out of Hours service should be added to the programme.

RESOLVED:   That the work programme as set out at appendix 2 to the report be approved as amended and recommended to the Strategic Monitoring Committee.

To consider arrangements for responding to proposals for service development and variation by local NHS bodies.

The Committee considered arrangements for responding to proposals for service development and variation by local NHS bodies.

The report set out the statutory requirement upon local NHS bodies to consult the Committee on proposals for any substantial development of the health service or any substantial variation.  It explained how proposals had been dealt with to date and proposed a mechanism to formalise those arrangements.

It was noted that there was no definition of the word “substantial” in this context, although Government guidance identified some general issues which might be considered in determining whether or not a matter was substantial.  It was suggested that the need to agree a specific local definition, as some authorities had done, should be kept under review.

RESOLVED:

      THAT        (a) the Director of Social Care and Strategic Housing be authorised, following consultation with the Chairman, to confirm on the Committee’s behalf whether proposals by local NHS bodies are considered to be substantial developments or variations to services, subject to the proposed response having been circulated to Members of the Committee and no objection having being received within one week of the response being circulated;

                  (b) in the event of an objection being received from a Member of the Committee to a proposed response and that objection proving incapable of resolution the matter be referred to the Committee for consideration;

                                                and

                  (c)      the need to develop a detailed framework for determining          whether or not a matter represents a substantial variation       or development should be kept under review.

To receive an update on the Primary Care Trust’s proposal.

The Committee received an update to the proposed changes to nursing respite services for older people with mental health problems.

The report set out the background to the issue, which had been brought to the Committee’s attention informally in September 2004.  The Primary Care Trust (PCT) had been advised on behalf of the Committee that the proposal did not constitute a substantial change upon which the Committee would need to be formally consulted.  In expressing this view it had been noted that the PCT was to consult patients and their families and it had been requested that the Chairman of the Committee be kept informed of progress.

The report set out the outcome of the PCT’s consultation exercise and the course of action determined by the PCT.

RESOLVED: That the report be noted.