To receive apologies for absence.

Apologies were received from Councillors MJ Fishley and GA Powell.

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

Councillor WLS Bowen substituted for Councillor GA Powell.

To receive any declarations of interest by Members in respect of items on the Agenda.

GUIDANCE ON DECLARING PERSONAL AND PREJUDICIAL INTERESTS AT MEETINGS

The Council’s Members’ Code of Conduct requires Councillors to declare against an Agenda item(s) the nature of an interest and whether the interest is personal or prejudicial.  Councillors have to decide first whether or not they have a personal interest in the matter under discussion.  They will then have to decide whether that personal interest is also prejudicial.

A personal interest is an interest that affects the Councillor more than most other people in the area.  People in the area include those who live, work or have property in the area of the Council.  Councillors will also have a personal interest if their partner, relative or a close friend, or an organisation that they or the member works for, is affected more than other people in the area.  If they do have a personal interest, they must declare it but can stay and take part and vote in the meeting. 

Whether an interest is prejudicial is a matter of judgement for each Councillor.  What Councillors have to do is ask themselves whether a member of the public – if he or she knew all the facts – would think that the Councillor’s interest was so important that their decision would be affected by it.  If a Councillor has a prejudicial interest then they must declare what that interest is and leave the meeting room.

There were no declarations of interest.

To approve and sign the Minutes of the meeting held on 18 June 2008.

It was pointed out that the last line of page 4 of the Minutes was incorrect and should read: “staff required to man a car 24 hours a day 7 days a week”.  Members requested that it be recorded that they otherwise welcomed the Minutes as a clear, good record of the meeting.

RESOLVED: That the Minutes of the meeting held on 18 June 2008 be confirmed as a correct record and signed by the Chairman, subject to the correction of the final line of page 4 of the Minutes.

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

The Chairman reported that she had received a number of requests from the public that ambulance response times should be scrutinised and proposed to address this during discussion of the response times under agenda item 8: West Midlands Ambulance service NHS Trust – Response Times.

To consider an update on the commissioning of services in Herefordshire.

The Committee received a presentation on behalf of the Primary Care Trust (PCT).

Mr Chris Bull, Chief Executive of Herefordshire Council and Herefordshire Primary Care Trust introduced the report, commenting on the commissioning agenda and the provider services review. 

Dr Ian Williams, Director of Integrated Commissioning, elaborated on progress with the provider services review, emphasising the consensus on the need to integrate health and social care services and to develop clinical networks.  He said that the review report from the Health Services Management Centre, Birmingham was due on 31 October 2008.

He then provided an update on the requirements of the national world class commissioning programme with its clear focus on delivering improved health outcomes.  There was a national assurance process to review PCTs' progress towards world class performance and achievement of better health outcomes and provide a common basis for agreeing further development.  The PCT had to make a submission to the Strategic Health Authority by October, with the results being known by March 2009.

He further reported on progress made by the Council and the PCT in making appointments to the Joint Management Team, bringing together management processes across the two organisations, and the Herefordshire Public Services review of governance arrangements.

He updated the Committee on the provision of radiotherapy services reporting that Worcestershire County Council’s Health Scrutiny Committee had confirmed that they would not require a public consultation on the Three Counties Cancer Network’s (3CCN) recommendation to site one Linear Accelerator at both Worcester and Hereford.  Work was now underway to plan the development of the service in Herefordshire.

He also reported on success in reducing waiting times in pursuit of achieving an 18 week referral to treatment time; continuing focus on dealing with healthcare acquired infections; intermediate care; sexual health; that there were still GP practices where extended hours had not been provided; and progress in relation to the letting of a contract for the GP out of hours service and the GP led Health Centre.

In relation to the GP led Health Centre he said that the contract being let would provide for the delivery of essential primary care services and for the delivery of additional and enhanced services as defined in the national GP contract.  On clinical governance grounds it had not been feasible to restrict the Centre to only providing “essential” services.

Dr Akeem Ali, Director of Public Health, gave a presentation on Health in Herefordshire.  He reminded the Committee that health in Herefordshire was good with low childhood and infant mortality rates and life expectancy already close to 2010 national targets.  However, there were challenges, including an unequal experience of poor health and early deaths, poor oral health compared to the regional average and avoidable differentials in the County in the following: admissions for coronary heart disease, respiratory illnesses, psychiatric admissions, children admissions, smoking quit rates and admission rates for alcohol related matters.

An update report had also been included with the agenda papers.

In the course of discussion the following  ...  view the full minutes text for item 20.

To receive an update from the Trust.

The Committee received an update on the operational and financial performance of the Trust up to September 2008 together with a summary briefing on key developmental issues for the organisation.

Mr Martin Woodford, Chief Executive of the Trust, commenting briefly on performance and developments as set out in the report.  He highlighted that the Trust was under pressure with a significant increase in referrals. 

The Chairman thanked Mr Woodford for his concise and helpful report.

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

·         Asked about the pressure the hospital was under Mr Woodford replied that the hospital was 98% full and discussions were taking place with clinicians about how to deal with this capacity issue.  The view was that more could be done to manage the number of admissions.

·         One of the cost containment measures identified in the report was closer scrutiny of non-pay orders.  In response to a question seeking clarification Mr Woodford confirmed that there were measures currently in-place. It was proposed to strengthen those measures.

·         In reply to a question about discharge of patients and links with the social care services Mr Woodford said that there were no particular difficulties at the moment.

The Director of Provider Services said that there was some pressure in discharging patients from Community Hospitals.  Two new social worker posts would help to improve matters.  The emphasis had to be on safe discharges.

·         The expenditure on refurbishing the hutted wards, rather than replacing them at once, was questioned.  Mr Woodford said that the Trust Board had agreed to their replacement. The intention was to do this within 3 years, the timing being dependent on the availability of capital finance.  In the meantime the Healthcare Commission had said that the huts were not up to the required standard and they had therefore had to be refurbished.

·         Regarding Foundation Trust status Mr Woodford said that he had agreed with the Primary Care Trust that no application would be submitted pending the outcome of the review of provider services.  However, preparatory work was being carried out in line with the Government’s policy that all Hospital Trusts should achieve Foundation Trust Status by 2010.

·         It was asked how many readmissions there were. Mr Woodford said he could supply the detail if required.  However, he knew the figure was low.  The figures were monitored by the Board and there were clinical governance arrangements in place to ensure standards were maintained.

·         Reassurance was requested that patients were not under pressure to be discharged.  Mr Woodford confirmed that discharge dates were planned with the patients to provide clarity to the process.

The Chairman thanked Mr Woodford for his attendance.

To consider performance in meeting targets for response times.

The Committee considered the Service’s performance in meeting targets for response times.

Mr Derek Laird, Locality Director, presented the report.  He said that performance in responding to Category A calls in September so far, at 81.3%, was the best Herefordshire had ever had.  In response to the new standardised performance reporting system introduced with effect from April 2008 Herefordshire Primary Care Trust had provided additional funding that had allowed additional resources to be deployed in Herefordshire.  He described a number of service enhancements.  He added that Members were welcome to make appointments to visit local ambulance stations or visit the control centre at Bransford.

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

·         It was noted that when a call was received allowing for, on average, 90 seconds to process the call this left only 6 and a half minutes to meet the response target.  Mr Laird acknowledged that this was challenging.

·         Asked about the deployment of Community First Responders (CFR), Mr Laird stated that CFRs were never deployed without having sent a vehicle.  The CFR scheme was successful but was not a replacement for the service.

·         A question was asked about an incident in Ledbury where someone had needed assistance 150 yards from the ambulance station but no one had been available.  It was asserted that the first detail for the Ledbury ambulance each morning was to be deployed to Malvern, It was asked how much time the resource based at Ledbury was out of the County.

Mr Laird replied that 1 car and 1 ambulance were based at Ledbury and available between 9.00 am and 9.00 pm .  Of 22 Category A calls in Ledbury in August the response target had been missed on 6 occasions, all of them out of hours.  Twenty-four hour cover in all the Market Towns would be ideal but there was a clear resource implication for the Commissioners. 

Five emergency vehicles were deployed out of hours.   These were based at Hereford and Leominster.  Ledbury received 8% of calls and it was therefore hard to justify deploying this resource there.

·         It was noted that the Committee had previously formally requested that CFR Schemes be funded.  Mr Laird said that he agreed with this view.  He was urged to pursue the matter.

·         Asked about deployment of the air ambulance Mr Laird advised that Herefordshire was the largest user of the air ambulance.  The main costs were tied up in the lease and staff, so cost was no disincentive to its use.  The ambulance was deployed whenever it was thought it might be needed. 

·         Mr Laird noted that there would always be times when response times would be missed, for example Friday and Saturday nights when there were a number of drink related incidents that had to be dealt with.

·         It was asked what the process was for addressing underperformance citing response times for category A calls in the HR8 Ledbury postcode in May–July 2008 of 50%, 57% and 57% respectively.  Mr  ...  view the full minutes text for item 22.

To receive a presentation on how NICE can help with scrutiny.

The Committee received a presentation from Mr Chris Connell, Implementation Consultant, on the work of the National Institute for Health and Clinical Excellence (NICE) and how this could be of help to scrutiny.

He noted NICE’s responsibility for providing national guidance on the promotion of good health and the prevention and treatment of ill-health and described the organisation and its role in issuing guidance on interventional procedures, technology appraisals, assessments of cost effectiveness, appraisal guidance, clinical guidance and public health guidance.

He noted the comprehensive evidence base and expert input that informed NICE guidance and work in association with the Centre for Public Scrutiny on a series of guides designed to help Health Scrutiny Committees.

The Committee discussed aspects of NICE’s work including the process for approving drugs for use.  It was noted that if NICE considered that a drug was not cost-effective this did not preclude a Primary Care Trust from using the drug.  However, the Trust would face questions over the evidence it had taken into account and have to justify the expenditure against the many competing priorities

To consider a progress report on the development of the Herefordshire Local Involvement Network (LINk).

The Committee considered a progress report on the development of Herefordshire Local Involvement Network (LINk).

Mr Mike Vials, Herefordshire Team Leader for the LINk, presented the report.  

The Committee noted the progress to date.  The  Chairman said that the Committee looked forward to working closely with the LINk.

To consider the current status of the Joint Commissioning Plan for people with Mental Health problems and future reviewing process.

The Committee did not consider this item.  It was proposed that a revised report would be made to the Committee.

To consider the current status of the Joint Commissioning Plan for health and social care services 2008 – 2012 for adults with physical disabilities ages 18 – 64 yrs and future reviewing process.

The Committee did not consider this item.  It was proposed that a revised report would be made to the Committee.

It was noted that there was the potential for some overlap between the reports called for by the Adult Social Care and Strategic Housing Scrutiny Committee and the Health Scrutiny Committee.

The Chief Executive suggested that the respective Chairmen should discuss the matter with the Chairman of the Strategic Monitoring Committee.

To consider the Committee’s work programme.

The Committee considered its work programme.

The following additions to the programme were proposed:

·         ICT – linkages between Health and Social Care

·         Oral Health/Fluoridation

·         Ambulance Service Review

RESOLVED:  That the work programme as amended be approved and reported to the Strategic Monitoring Committee.