To receive apologies for absence.

There were no apologies for absence.

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 23rd and 28th June, 2004.

RESOLVED:   That the Minutes of the meetings held on 23rd June 2004 and on 28th June 2004 be confirmed as a correct record and signed by the Chairman.

To consider the Director of Public Health’s Annual Report 2003.

The Committee considered the Director of Public Health’s Annual Report for 2003.

Dr. Mike Deakin, Director of Public Health (DPH) for Herefordshire, informed the Committee that as Director he was statutorily required to produce an independent Annual Report on health in Herefordshire.  The report commented on health issues in the County and made a series of recommendations designed to generate improvements.

Dr. Kathryn Millard, Consultant in Public Health for Herefordshire Primary Care Trust (PCT), gave a presentation on the Annual Report.  She informed the Committee that the Annual Reports were designed to be read as an ongoing series reporting on health issues in Herefordshire.  The reports did not feature every topic each year and she explained the main issues in each chapter of the 2003 report.

During the discussion the following principal points were made:

·         Dr. Deakin explained that whilst the report was submitted to Government the intention was that the messages contained within it would be read and acted upon by the public.  It was suggested to him that the document might be made more accessible if an executive summary was produced.

·         The statistics presented in the DPH Annual Report could not be used to assess health improvements year on year and it was not a progress report in that sense.  The only way to observe improvements in health was over an extended period of time.  For example, the 2001 DPH Annual Report contained a 40-year historical review which showed the significant improvements in life expectancy and decline in child mortality rates.  Chapter 1 provided a review of the recommendations in the previous 3 Annual Reports.

·         It was noted obesity was high on the health agenda and was set to feature in a specific chapter in next years DPH Annual Report.

·         It was noted that a number of services were no longer provided by the Council.  Leisure Services were, for example, provided by HALO.  Dr. Deakin confirmed that mechanisms were in place to ensure health messages reached such bodies.

·         It was noted that with the ever increasing cost of health services, improving public health and reducing the call on those services was an important objective.  Dr. Deakin acknowledged that more resources would be beneficial noting how Herefordshire had spent more on reducing smoking than any other PCT in the region and had a success rate way above the average.

·         Dr. Deakin felt that his recommendations did have an impact and cited examples of his previous Annual reports being quoted by others when the need for service improvement was being discussed.  Articles had also appeared in the Hereford Times publicising the key issues.

·         Members noted that a person would only have to cease from smoking cigarettes for four weeks to be recorded as a non-smoker in NHS statistics.  The Committee felt that this target was too low as a person who had registered as a non-smoker could have resumed smoking after this short period.  Dr. Deakin informed Members that this was a nationally set target which was practical to work  ...  view the full minutes text for item 18.

To consider further issues regarding the provision of cancer services.

The Committee gave further consideration to issues concerning the provision of Cancer Services.

The report noted that in June the Committee had been informed that the Three Counties Cancer Network Board (CNB), responsible for overseeing the provision of cancer services across part of Gloucestershire, Herefordshire and South Worcestershire, was working on a series of action plans for each of the main types of Cancer.  An action plan for the Upper-Gastrointestinal (UGI) Cancer service had so far been agreed.  This proposed the centralisation of treatment at Gloucester.

At an informal meeting between the CNB and representatives of the relevant Overview and Scrutiny Committees some concern was expressed to the CNB about the lack of any consultation on the service change.  The CNB’s view was that the change was not significant enough to warrant a formal consultation exercise.  However, it had agreed that further information would be circulated to each of three affected Scrutiny Committees and their views on the way forward requested by September 2004.

The Director of Social Care and Strategic Housing had expressed the view that, in the circumstances, there was little to be gained by seeking to request a formal consultation exercise in this instance.  She did, however, think that the Committee might wish to request the opportunity to comment on issues flowing from the proposal, which should be set out in the action plan.  As the additional information promised by the CNB had not yet been received she sought authority to respond to the CNB along those lines on the Committee’s behalf, subject to nothing in the additional documentation from the CNB suggesting a need to reconsider this proposed approach. 

The Director added that the discussions had highlighted the importance of proposals by the CNB, and other networks in the County, being notified to the Scrutiny Committee at an early stage to enable it to assess whether or not emerging proposals were substantial, and the need for protocols governing consideration of future proposals to be agreed.  Members proposed that these points should be brought to the attention of the CNB and other networks and that consideration should be given to developing protocols which would be generally applicable.

The Committee also requested that, in working on the establishment of a Joint Committee to respond to any formal consultation on Cancer Services, consideration be given to whether that Committee could be created as a standing Joint Committee with the ability to respond to consultations on other joint services.

In the course of discussion concern was raised regarding hospital transport arrangements and how an already problematic area would be affected by the centralisation of UGI cancer treatment in Gloucester.  It was proposed that the CNB should be asked to afford the Committee the opportunity to comment specifically on this as one of the issues flowing from the proposal.

That(a)   the Director of Social Care and Strategic Housing be authorised to submit the view to the Three Counties Cancer Network Board on the Committee’s behalf that it does not at  ...  view the full minutes text for item 19.

To give further consideration to the review of how the outbreak of legionnaires disease in Hereford City was managed.

The Committee considered the draft report of its review of the management of the outbreak of legionnaires’ disease in Hereford City in November 2003.

It was suggested that the review’s findings in relation to the benefits of local expertise, local knowledge and local working relationships and the importance of making legionnaires disease a notifiable disease were worthy of particular note. 

For the avoidance of doubt it was requested that the penultimate bullet point of the summary of lessons learned, appended to the review report, be amended, deleting the first sentence and replacing it with the following: “Every outbreak of legionnaires disease is different, so that expert advice applicable to one outbreak may not be relevant to a different outbreak.”

RESOLVED:   That the report of the review, as amended, be approved and recommended to Cabinet and partner agencies affected.