To receive apologies for absence.

There were none.

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

There were none.

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 1 March 2010.

RESOLVED: That the Minutes of the meeting held on 1 March 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.

A member of the public speaking on behalf of the Mental Health Reference Group thanked the Committee for its support in connection with the location of the Equitable Access Centre.

The Director of Public Health commented that the successful negotiations to locate the Centre on the hospital site, rather than taking part of the grounds of the Stonebow Unit as required by an alternative proposal, generating a number of objections, was an outcome to be welcomed.

To consider an update on the response to the efficiency review of the West Midlands Ambulance Service NHS Trust and the response to the findings of the Committee’s scrutiny review of the ambulance service in the light of the Lightfoot Review.

The Committee considered an update on the response to the efficiency review of the West Midlands Ambulance Service NHS Trust (the Lightfoot Review) and the response to the findings of the Committee’s scrutiny review of the ambulance service in Herefordshire, taking account of the inter-relationship between the findings of the scrutiny review and some of the findings of the Lightfoot Review.

Mr M Gough, A&E Operational Service Delivery Manager (South),presented the report discussing progress in the areas covered by the Committee’s recommendations. 

In discussion the following principal points were made:

·         It was observed that response times in Ledbury and Ross-on-Wye remained below target.  Asked about steps to improve performance Mr Gough commented that the appointment of a Community Response Manager for Herefordshire would improve the focus on hotspots in the County where response times were below target.  Two new standby points had also been identified for ambulances.  He noted that the severe winter weather had had an effect on response times.

Members commented on the importance of the County receiving a service that was comparable with other parts of the Region and requested a further report on performance in six months time.  It was acknowledged that performance against targets might not tell the full story and information on patient outcomes should therefore be included in the report.

The practicality of meeting the national targets in parts of the County was discussed, noting that at the moment the targets were consistently not met in some areas.  It was confirmed that the ambition remained to meet the national targets within all areas of the County.   A more detailed breakdown of performance was requested showing by what margin targets were being missed, enabling the Committee to judge the scale of the challenge faced in seeking to meet the national targets.

The Director of Public Health commented that ultimately the level of performance was dependent on the resources available.  The findings of the Lightfoot Review and the Scrutiny Committee’s review were consistent and negotiations over the commissioning contract recognised the desire to ensure that no part of the County was disadvantaged and that capacity was increased.

·         The WMAS response to the scrutiny review commented that the Community First Responder (CFR) schemes were significantly funded by charitable arrangements.  Members acknowledged that charitable funding was welcome.  However, they considered the Scheme should not be dependent on such funding and provision should be made by the NHS.  It was requested that the Committee be provided with information on contractual arrangements with Community First Responders and the overall funding arrangements. 

·         It was noted that CFRs were issued with mobile phones but these did have shortcomings as a communication tool.  Mr Gough said the matter was under review, but a digital radio system carried a significant cost.  Members requested that the report on Community First Responders include details of the communication links with CFRs.

·         That the Local Involvement Network was undertaking a survey of the patient transport service and if any issues came to light these would  ...  view the full minutes text for item 37.

To receive an update from the Trust.

The Committee noted the update from the Trust.

Mr Gough highlighted the essential contribution made by voluntary services during the severe winter weather.

To receive a presentation on housing and the health of the population.

The Committee deferred consideration of this issue.

To brief the Committee on the World Class Commissioning Strategy.

The Committee was briefed on the World Class Commissioning (WCC) Strategy.

The Director of Public Health outlined the strategic priorities and cross cutting objectives of NHS Herefordshire’s Strategic Plan 2010-2015, as set out in the executive summary of the Plan included with the agenda papers.

The interim Director of Integrated Commissioning and the Director of Resources (NHS Herefordshire (NSHH)) gave a presentation on the Strategy. 

The interim Director highlighted the following elements of the Strategic Plan:

·         Programme budgeting to be used as a basis to match investment with outcomes

·         Procurement of  a new provider for mental health services

·         Establishment of a Transition Board to develop a recommendation on potential provider reconfiguration involving provision of high volume/high value pathways, locality based health and social care systems, urgent care system design, viable futures (eg Hereford Hospitals NHS Trust and divesting PCT provider Services.)

It was noted that five pathways had been identified as priorities: stroke, frail elderly, chronic obstructive pulmonary disease, diabetes and lower back pain.  The Stroke pathway was then discussed in more detail.

Plans for working with partners were outlined including: practice based commissioning – clinical leadership of change and quality improvement, active listening with patients and customers, positive engagement with all stakeholders, work with the Voluntary Sector, and with Hereford Hospitals NHS Trust and Herefordshire Provider Services.

The Director of Resources (NHSH) outlined a number of proposals designed to drive out efficiencies in 2010/11 to prepare for reduced investment in 2011/12 onwards:

·                     Reinvestment of savings from care pathway reviews into screening and care closer to home and to meet demographic and technological demands

·                     Disinvesting in low priority and ineffective treatments ensuring value for money for the taxpayer, benchmarking Herefordshire against good practice indicators

·                     Ensuring the long term sustainability of high quality, clinically safe services in Herefordshire

·                     Ensuring that investments are made only on the basis of programme budgeting priorities and data, and even then only when sustainable financial resources are available

·                     Achieving the target of transferring 5% of activity from the secondary to the primary sector and community services in each of the coming five years

·                     Upstream investment in Health and Wellbeing e.g. Smoking cessation

·                     More efficient use of the Estate to meet the new pattern of services

·                     Rationalisation of back office functions ( Shared Service Review)

·                     Reducing Management costs

In discussion the following principal points were made:

·         The proposed reduction in the number of hospital beds was questioned.  In reply it was stated that a lot of people were in hospital beds for whom alternative forms of care would be better.  Investment in health and social care would enable care to be provided in other settings.  The transformation of community services was being considered by the Transition Board.  It was suggested that the reasons for reducing hospital bed numbers needed to be effectively communicated.

·         That the scrutiny review of GP services had identified that GPs had some reservations about the operation of the practice based commissioning (PBC) arrangements.  The Integrated Director of Commissioning said that the establishment of  ...  view the full minutes text for item 40.

To consider the Committee’s Work Programme.

The Committee considered its work programme.

It was agreed that the work programme needed to incorporate the following additional matters:

·         Progress reports on West Midlands Ambulance Service reflecting the points raised in discussing the review of the Trust (Minute no 37refers)

·         Progress reports on the implementation of the World Class Commissioning Strategy (Minute no 40 refers)

RESOLVED:  That the work programme be approved and reported to the Overview and Scrutiny Committee for its approval.