To receive apologies for absence.

Apologies were received from Councillors: SPA Daniels (Vice-Chairman) GA Powell and PJ Watts.

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

Councillor D Greenow substituted for Councillor PJ Watts.

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 30 March 2007.

RESOLVED: That the minutes of the meeting held on 30th March 2007 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.

To consider the issues and challenges facing the Trusts.

The Chairman welcomed the representatives from the three Trusts and invited them to each give a short presentation on the issues and challenges facing their respective Trust.

Herefordshire Primary Care Trust – Julie Thornby – Director of Corporate Development.

Ms Thornby reported that the Herefordshire Primary Care Trust (PCT) had been formed in 2000 combining the Herefordshire Primary Care Group; NHS Community Trust and Health Authority.  The PCT was responsible for patients registered with Herefordshire General Practitioners (GPs), with 100 commissioning staff, 1200 provider staff, a budget of £233m and facilities throughout the County.  The area covered by the PCT was co-terminus with that of the Council, an advantage of which was the joint working arrangements particularly in the area of Social Care and Health Care.

She highlighted the four key functions of the PCT namely: Commissioning (plan and purchase) health and care services – ranging from contracts for the community as a whole to an individuals specific care needs; Promote and protect public health – through initiatives against obesity, smoking or alcohol; Work with primary care (GPs, dentists, pharmacists, opticians), and the delivery of community and mental health services (provider services).

She outlined the structure of the PCT Board (Executive and Non-Executive Directors), a number of committees and the relationship with the Hereford Hospital Trust (commissioning services) and the West Midlands Strategic Health Authority (responsible for overseeing performance management).

She highlighted a number of challenges namely:

• Patient access to service target of 18 weeks wait (from first referral to treatment);
• Developing and modernising services e.g. unscheduled care and she gave examples of developments in mental health contracts and the use/delivery of A&E services,
• Reducing health inequalities further details of which may be covered by a future presentation to the Committee by the Director for Public Health.
• The national initiative to expand choice and diversity for patients and the need to ensure that local providers provide the sort of services expected. She suggested that the younger generation may more used to shopping around for services and therefore be more inclined to elsewhere for treatments.
• Ensuring financial balance.
• Working with local GPs to further develop practice based commissioning.
• Building on various options that may arise from the Public Service Trust and ensuring that there was a clear separation between commissioner and provider.

Hereford Hospitals NHS Trust – Martin Woodford – Chief Executive.

Mr Woodford reported that it was a small Trust when compared to Trusts nationally (317 beds serving 230,000 population in Herefordshire/Powys) with 1364 full time staff; £91m turnover (2006/07) and a significant overhead (£12m) of PFI hospital.  He put this in the context of: providing patient choice; GP practice based commissioning; payment by results (based on a national scale); competition from independent providers and working towards a Foundation Trust in 2008.  Operating from a PFI building the Trust had two main commissioners namely Herefordshire PCT (85.4% of income) and Powys Local Health Board (9.2% and increasing).  The catchment area had a significantly higher population of over 65s than  ...  view the full minutes text for item 6.

To consider an update on the development of Public Service Trust arrangements for Herefordshire.

The Committee considered a report on the development of Public services Trust arrangements for Herefordshire.

The Director of Adult and Community Services presented a report, enclosed separately with the agenda, which outlined the background to the proposal and set out the current arrangements.  Attached to the report at appendix 1 was a copy of the consultation document and appendix 2 set out the comprehensive communications strategy, agreed by the PST Steering Group, that underpinned the project and the consultation process.  He highlighted that the Public Service Trust, which was still subject to the outcome of the consultation, would not be a legal entity but an innovative partnership that would make new and maximum use of existing legal powers for NHS bodies and Councils to work together in designing and commissioning improved services for local people.  It was already apparent that both the Council and PCT were benefiting from the closer working relationships that were developing as a result of this work and he indicated a number of areas that had already been identified.  He also reported that to ensure appropriate leadership could be in place following any decision in autumn 2007 to proceed, the post of Chief Executive had recently been advertised.

The Committee commented that it was important to ensure proper public consultation and noted that various public and staff meetings were programmed and that information was available in both printed and Website formats. 

Following comment on the likely degree of change, particularly in view of the relatively small number of staff involved from the PCT side (approximately 100) the Committee noted that the PCT had a significant financial capacity (circ £233m) and therefore any arrangement should provide greater opportunities to influence outcomes and would be more strategic, to improve services, rather than cost cutting.

The Committee noted that a briefing on the Public Service Trust for Herefordshire proposals for all Councillors had been arranged and that the Chairman would consider holding a further meeting of the Committee to discuss specific issues on the proposals in due course.

RESOLVED That progress and the next steps in relation to the establishment of a Public Service Trust for Herefordshire, as set out in the report, be noted.

To consider the Committee’s work programme.

The Committee considered its work programme, as set out at appendix 1 to the agenda, and a report on ongoing issues on which the Committee expected actions or outcomes, as set out at appendix 2 to the report.

The Chairman suggested that a short scrutiny review, involving all members of the committee, could be undertaken into “elderly falls” and that this should follow the patient through the whole of the system from the arrival of the ambulance, through treatment at hospital to their after care at home.  The intention of such a review would be to ensure that there were clear pathways through the system and that each element/service provider linked in an efficient way to the next.  It was also suggested that any case studies considered should include the winter months when falls were more likely.

A suggestion was made that the Committee could look at the long-term implications for people in the County of having an inappropriate diet.  While many people were aware of the need to ensure a proper balanced diet, and Herefordshire was acknowledged to be good in the regional league table for this, some for whatever reason continued to have a poor diet and it was suggested this may have long-term implications for both the well being of the person and resource implications for the care services in the future.

RESOLVED That the work programme be noted and a scoping statement for a review of “elderly falls” be considered at the next meeting.