To receive apologies for absence.

Apologies were received from Councillors Mrs W.U. Attfield, G.W. Davis, T.M. James, R. Mills, Ms G.A. Powell, and J.B. Williams.

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

Councillor Mrs P.A. Andrews substituted for Councillor T.M. James and Councillor B. Hunt for Councillor Ms G.A. Powell.

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 12th October, 2006.

RESOLVED:  that the Minutes of the meeting held on 12th October, 2006 be confirmed as a correct record and signed by the Chairman.

To consider suggestions from members of the public on issues the Committee could scrutinise in the future.

There were no suggestions from members of the public.

A Member asked for comment on a rumour that the Accident and Emergency Unit at Hereford Hospital was to be closed.  In reply it was stated on behalf of the Hospitals Trust that the Trust was not aware of any such proposal.

To consider a response to consultation proposals by the Primary Care Trust.

The Committee considered a response to consultation proposals by the Primary Care Trust (PCT) on the development of a new centre for children’s community based specialist services in the County.

A draft consultation document had been considered by the Committee in September 2006.  The published consultation document had been circulated to them with the agenda papers.

A report by the Director of Children’s Services suggesting important themes for consideration by the Committee was attached at appendix 1 to the report together with a report by the PCT’s Director of Corporate Development summarising the responses to consultation to date.

The Director of Corporate Development commented on the consultation process and the main conclusions from the responses to date.  These were that the majority favoured the development of a new central facility; there were a range of views on the mix of services which should be provided; and concerns had been expressed about outreach services and access.

In relation to the themes identified by the Director of Children’s Services the Director of Corporate Development reported that the PCT was moving in the same direction as the Council in seeking to integrate working.  It was also recognised that further work needed to be done on the re-modelling of the respite service and the development of a short break strategy.

In the ensuing discussion the following principal points were made:

·          A question was asked about the level of response to the consultation.  In reply the Director of Corporate Development reported that some 43 questionnaires had been returned to date.  A number of people had also attended meetings to discuss the proposals but had not completed the questionnaire.  She reiterated the steps taken to publicise the proposals and generate responses commenting that she considered the PCT had made every effort to consult.  A higher response rate would, however, have been welcome.  The intention was to continue to seek to involve people in developing the proposals.

·          That the proposals affected a vulnerable group of people and publicity should be given to the development of proposals at every stage.

·          In response to a question about outreach services it was advised that consideration was being given to this issue.  It was recognised that it would be important to be clear about what services would be provided locally and what would be provided centrally.

RESOLVED:

That       (a) a response to the consultation proposals be submitted on the basis that the development of a new children’s services building at a different central site is the preferred option which should be pursued as a priority and that the themes identified in appendix 1 to the report be incorporated into the final response;

   and

               (b) authority be granted for the final response to be submitted by the Director of Adult and Community Services following consultation with the Chairman.

To consider an update on the development of stroke services within the County.

The Committee received an update on the development of Stroke Services in the County.

In March 2006 the Committee had been informed of the outcome of a review of stroke service provision and proposals developed by the Primary Care Trust (PCT) to improve stroke services within existing resources.  In supporting the proposals the Committee had made a number of observations and requested that the implementation of the proposals should be carefully monitored.  An update prepared by the Hospitals Trust and Primary Care Trust was appended to the report.

The PCT’s Director of Corporate Development drew attention to the comment in the update that, “although it was too early to determine any statistically significant changes, early data demonstrated some positive early trends in the number of deaths occurring from stroke every year”.

She reported that initial concerns that allocating beds to acute stroke rehabilitation at Hillside would reduce the available beds for other local people needing admission for intermediate care did not seem to have been borne out. 

She also noted the work completed on longer term support available for people who had survived a stroke.

The Chief Executive of the Hospitals Trust said that the development of a dedicated Stroke Unit in the hospital was fundamental in providing care for stroke patients.  Improvements in outcomes were beginning to be seen but it was important to continue to make progress and to keep reviewing the position.

A question was asked about capacity at the Stroke Unit and reference made to a specific instance where it was said that a bed in the Unit had not been available for a patient.  It was requested that the details of specific problems needed to be provided to the Hospitals Trust to allow it to investigate properly and decide whether it needed to provide more beds for stroke patients.

The position on bed capacity in the hospital as a whole was also discussed.  It was noted that occupancy remained high.  A decision had been taken not to reduce beds further and to work to ensure appropriate assessment of patients and improve patient flow.

RESOLVED:  that the development of Stroke services within the County be kept under review.

To receive a briefing paper on palliative care.

The Committee received a report on the provision of palliative care in the County.

Sally Mirando, Macmillan Nurse Consultant in Palliative Care for the Primary Care Trust presented the report commenting in detail on each section.

In the course of discussion the following principal points were made:

·          It was noted that the County was most lacking in hospice at home services and asked what development was proposed.  An explanation was given of work which had been undertaken and it was noted that the intention was that when preparing the Local Development Plan there would be investment in developing hospice at home services.

·          The provision of beds at St Michael’s Hospice was raised in response to the comment that the current 16 beds were slightly more than required.  It was replied that the calculation was based on a national formula which did take account of demographics.  As much use was made of the beds at St Michael’s Hospice as possible.

·          A question was asked about the procedure for transferring patients from acute hospital beds to a hospice noting the need to provide appropriate care and reduce the pressure on acute hospital beds where possible and a specific case where a transfer had not been made in time.  The procedure was explained, noting efforts which had been made to improve the process.

·          It was noted that the provision of palliative care for children would form part of the overall strategy for the provision of Children’s Services.

The Committee noted the report.

To receive a report on the development of proposals for the establishment of a Public Service Trust for Herefordshire.

The Committee considered an update on the development of a Public Service Trust for Herefordshire.

The summary proposal resulting from the work of an independent consultant and the response of Cabinet on 26th October were appended to the report. 

The Director of Adult and Community Services presented the report.  The Chief Executive expanded on the rationale regarding the timing for the establishment of the Trust.  He added that one of the main benefits of the proposal was the integration of planning and delivery making the identification of key workstreams of particular importance.

In the ensuing discussions the following principal points were made:

·          The need to have regard to the implications for the Hospitals Trust.

·          That whilst in principle the proposal was a good idea there were a number of significant issues to be addressed if the proposal was to succeed.

·          It was cautioned that it may prove difficult to realise savings from the development of the Trust, particularly in the short term.

·          The Chief Executive reminded the Committee that the proposal had originated from the desire to ensure the continuation of the Herefordshire Primary Care Trust in the context of the Government’s reconfiguration of the Health Service.  In seeking to develop the proposal he was keenly aware of the cautionary points which the Committee had made.

·          It was requested that the Committee should receive regular updates on the development of the proposal.

RESOLVED:  that progress and next steps in relation to the establishment of a Public Service Trust for Herefordshire be noted and regular updates be provided to the Committee.

To consider the Committee’s work programme.

The Committee considered its work programme. 

The addition to the Programme of regular updates on the development of a Public Service Trust and the Hospital Trust’s bid for Foundation Trust Status was agreed.

RESOLVED:  that the Committee’s work programme be approved and reported to the Strategic Monitoring Committee.