To receive apologies for absence.

Apologies were received from Councillors PGH Cutter and GA Powell.

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

Councillor D W Greenow substituted for Councillor PGH Cutter.

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

There were none.

To approve and sign the Minutes of the meeting held on 25 September 2009.

RESOLVED:   That the Minutes of the meeting held on 25 September 2009 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 outcome of the efficiency review of the West Midlands Ambulance Service NHS Trust.

The Committee considered the outcome of the efficiency review of the West Midlands Ambulance Service NHS Trust (WMAS).

The report noted that the Regional Specialised Commissioning Team, responsible for commissioning the ambulance service on behalf of the 17 Primary Care Trusts (PCTs) in the West Midlands Strategic Health Authority area, had commissioned an independent review looking at the operational and financial effectiveness of the ambulance service across the region. 

The findings of the efficiency review undertaken by Lightfoot Solutions (the Lightfoot Review) had been  published on 30 September 2009.  A summary and analysis by NHS Herefordshire was appended to the report.  The Lightfoot Review had been circulated separately to Members of the Committee.

Representatives of WMAS attended the meeting to present the findings of the Lightfoot Review.

The presentation provided some background statistical information on the service and some of its recent achievements, including being Ambulance Service of the Year 2007, 2008 and 2009.

It was reported that the main issues to be addressed by the Independent Review had included demand, performance, the implications of the urban/rural mix of services, ambulance resources, the Paramedic skill mix, the status of urgent care provision

and the cost of the service.

Demand on WMAS was consistently above both the contract level and previous year

April ’08 to March ’09: +3.5% above previous year and 1.9% above contract, April - October ’09: +7.2% above previous year and 4.5% above contract.  There were

not enough ambulances across the region

In terms of performance, despite achieving national targets for the last three years WMAS performance was not sustainable due to high demand and was not consistent across the region.

Performance varied between urban and rural areas.  In Herefordshire performance against the national target of responding to Category A calls within 8 minutes of 75% was 72% and the Lightfoot review recommended a target of 68%.  This compared with performance across the Region as a whole of 75% with the Lightfoot Review recommending a target of 80%.  It was stated that WMAS was still seeking to hit the 75% target in Herefordshire and had not adopted the Lightfoot recommendation of a target of 68%.

The fact that demand was above the level provided for in WMAS contract with the commissioning bodies meant there were not enough front line ambulance staff and WMAS was unable to complete mandatory training updates.

The Paramedic skill mix of 52% meant WMAS could not put a paramedic on every ambulance.  This meant too many patients were taken to hospital and there was insufficient use of alternative care pathways

Urgent care provision varied across the region.  Emergency ambulance demand increased when patients could not access urgent care

WMAS costs were amongst the lowest in England.  Rural costs would always be higher than urban costs but there was a wide variation in payments made by PCTs with some paying proportionately more than others.

The main recommendations of the review were summarised.  Immediate action taken in response to the review  ...  view the full minutes text for item 14.

To note the performance of the West Midlands Ambulance Service NHS Trust in relation to the Annual Health Check results for 2008/9.

The Committee noted the performance of the Ambulance Trust in relation to the Annual Health Check results for 2008/9.

To note the performance of the Primary Care Trust in relation to the Annual Health Check results for 2008/9.

The Committee considered the performance of the Primary Care Trust in relation to the annual health Check results for 2008/9.

This showed that the Health Check conducted by the Care Quality Commission had given the Trust a rating of fair for both quality of commissioning and for financial management.  A table showed how the ratings compared with other Primary Care Trusts within the West Midlands Region.

The Director of Public Health presented the report, the findings of which had highlighted nothing unexpected.  He acknowledged that some targets had proved challenging but emphasised that there was clear commitment to deliver improvement.  The planning and integration of services provided an opportunity to achieve this aim.

He expressed particular concern about smoking, as one of the major preventable issues; the provision of mental health services and stroke care and commented briefly on work underway to address each of these areas.

In discussion the following principal points were made:

·         In response to a question about the PCT’s commitment to maintaining local hospital provision at Bromyard the Director of Public Health stated that he was unaware of any change in approach but would clarify the position.

The Chief Executive of the Hospitals Trust commented that an exercise was underway on the integration between the community hospitals and the acute hospital and if there were under-utilisation this would be picked up as part of this exercise.

·         It was requested that further detail be provided on performance against targets summarised on page 32 of the agenda papers, describing the various targets and providing a progress report on those targets that had not been met and plans to generate improvement.

·         It was noted that the health service performance framework was to be changed and proposed that a seminar be arranged for Members when details had been confirmed.

Resolved:

That    (a)        the Chief Executive’s update to the next meeting include a progress report on targets in the Health Check that had not been met and plans to generate improvement; and

            (b)       a seminar be arranged for Members on the new health service performance framework when that is confirmed.

To note the performance of the Hospitals Trust in relation to the Annual Health Check results for 2008/9.

The Committee considered performance of the Hospitals Trust in relation to the Annual Health Check results for 2008/09.

The report stated that the Health Check, conducted by the Care Quality Commission had given the Trust a rating of good for quality of services and fair for use of resources.

Since the publication of the agenda papers the Annual Hospital Guide, produced by Dr Foster, an independent provider of information, analysis and communications to health and social care organisations, had been published (on 29 November 2009) and received national publicity.  This had included a ranking of hospitals for patient safety which had ranked Hereford Hospital as the twelfth worst in England.

Mr Woodford, Chief Executive of the Trust, presented the report on the Health Check.  He noted that it was an exception report and did not therefore include comment on a range of areas where the Trust had improved. 

In terms of areas for improvement he considered Stroke Care was the one requiring most attention.  The Health Community Stroke Pathway was being reviewed by the Hospital Trust and the Primary Care Trust as Commissioner.  It had been agreed that additional resources would be made available.  He agreed to provide an update to the Committee on Stroke Care.

Members asked Mr Woodford to comment on the publication by Dr Foster.  Mr Woodford commented that the assessment covered the same period as the Health Check but had looked at different things.  In 2008/09 the hospital’s mortality rate had been 93.4, the national average being 100.  He therefore considered that overall safety at the hospital was very good.  The report by Dr Foster did raise some issues and the Trust would consider these and seek to understand the basis for the findings and respond constructively to them.  It was proposed that the Trust’s response should be submitted to the Committee’s next meeting.

The Director of Public Health commented on the importance of there being a safe, local hospital providing a range of care.  There was a clear quality assurance framework in place and the Dr Foster’s report needed to be viewed within that context.  It was important to acknowledge the service areas where improved outcomes were being achieved and to ensure the hospital remained safe by working collectively on those areas where it was recognised there was a need to improve.

RESOLVED:

That    (a)        once an action plan has been prepared in response the findings of the Dr Foster survey this be circulated to Members and reported to the next meeting; and

            (b)       an update on Stroke services be provided to the next meeting.

To receive an update from Hereford Hospitals NHS Trust, West Midlands Ambulance Service NHS Trust and NHS Herefordshire.

The Committee considered interim updates from Hereford Hospitals NHS Trust, and NHS Herefordshire.

West Midlands Ambulance Service NHS Trust had no additional information to submit.

In discussion the following principal points were made:

Mr Woodford, Chief Executive of the Hospitals Trust acknowledged that the significant increase in A&E attendances for August 2009 looked odd and reported that it was being investigated.

It was asked what progress had been made in determining a site for the GP led walk in health centre.  The Director of Public Health reported that interim arrangements had been made to provide a walk in GP service at the ASDA store in Hereford.  Discussions were continuing on the location of a permanent site and what services could be integrated within it.

Consultant cover at the A&E Unit was raised.  It was replied that consultant cover was available 24 hours a day at the A&E Unit.  The Trust was seeking to develop the role of nurse practioners and increase their skills to enhance cover.

It was requested that the Committee should be provided with an update on the procurement of a strategic partner to deliver mental health services.

A Member reported concerns that the “Choose and Book” system being used by all Herefordshire GP practices was cumbersome to use.  The Director of Public Health replied that it was a national system and he was not aware of any particular difficulties locally.

Asked for an update on swine flu the Director of Public Health said that whilst measures remianied in place locally it appeared that the worst case scenario had not materialised.  The Director of Quality Assurance reported on progress with the vaccination programme.

To consider the Committee’s work programme.

The Committee considered its work programme.

The following additions to the work programme were noted: provision of mental health services, Stroke care, Hereford Hospital Trust’s response to the findings of the Dr Foster’s Annual Hospital Guide, progrees in response to reviews of the ambulance service; and the need for a seminar on the new health service performance framework.

RESOLVED:   That the Work Programme as amended serve as a basis for further development.