To receive apologies for absence.

Apologies were received from Councillors Brigadier P Jones, G Lucas and GA Powell.

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

Councillor PL Bettington substituted for Councillor P Jones.

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 29 March 2010.

RESOLVED:   That the Minutes of the meeting held on 29 March 2010 be confirmed as a correct record and signed by the Chairman, subject to noting that Mr J Wilkinson, Chairman of the Local Involvement Network had been in attendance.

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

A member of the public suggested that the Committee should look at the provision of NHS dental Services in Bromyard.  The Committee agreed to incorporate this issue into its work programme.

To consider the response to the scrutiny review of General Practitioners (GP) Services.

The Committee considered the response to the recommendations made in the scrutiny review of GP Services.

The Chairman reported that the Local Medical Committee had written to congratulate the Committee on what it considered to be a fair and accurate survey of current primary health care.

The Associate Director of Integrated Commissioning introduced the report and invited questions.

The Committee discussed the response to each recommendation.  The following principal points were made:

To note key population health issues in Herefordshire and to seek support for the recommended strategies and actions to address these issues.

The Committee considered the key population health issues in Herefordshire and the recommended strategies and actions to address these as set out in the Annual Report of the Director of Public Health 2009.

The Director of Public Health (DPH) presented the annual report summarising the theme of each chapter.

A Member questioned the continued presence of machines dispensing unhealthy foods in the Council’s leisure centres operated by HALO.  The DPH commented that he had discussed the matter with the Chief Executive of HALO.  There was now a healthy alternative choice on offer at the leisure centres.  The DPH had also commissioned a study to assess what the cost would be to HALO if they were to remove the unhealthy products.

The DPH commented that the problems associated with child obesity were such that action needed to be taken now to deal with them.  He acknowledged that there were children with eating disorders and this was not being overlooked.  He also agreed that it was important to have a balanced diet and that exercise was an important element of a healthy lifestyle.

The Chairman emphasised the importance the Committee attached to the preventive health agenda and invited Members to gather evidence from their communities to help inform the discussions of public health issues scheduled for the Committee’s future meetings.

RESOLVED:

That:   the Director of Public Health’s Annual Report 2009 be noted and the implementation of the report’s recommendations and the proposed approach and actions highlighted in the report be supported to inform service development and commissioning during the next planning cycle and in the medium term.

To consider a timetable for Committee’s consideration of issues relating to population health.

The Committee considered a revised timetable for its consideration of population health issues.

RESOLVED: that reports on population health issues be presented to the Committee in the order proposed in the report.

To receive a further update on the Mental Health Procurement project being undertaken by NHS Herefordshire and Herefordshire Council.

The Committee considered a further update on the Mental Health Procurement project being undertaken by NHS Herefordshire and the Council.

The Project Manager presented the report.  She drew particular attention to the competitive dialogue methodology adopted for the tendering process which had enabled Herefordshire to benefit from the knowledge and expertise of other Mental Health Trusts in developing a service specification.  This process was nearing completion and invitations to tender were expected to be issued shortly with a view to awarding the contract in September 2010 and the new arrangements commencing in April 2011.

She also highlighted the level of consultation with the Mental Health Reference Group, noting that the Chairman of the Group was present at the Committee’s meeting.

The Committee noted the detailed work that had been undertaken and the benefits the project was expected to deliver in terms of increased accessibility to services for service users and their carers, increased range and diversity of services and improved governance and value for money of those services.  It requested that a further report be provided setting out how the new arrangements would deliver these benefits.

RESOLVED: 

That    (a)        progress on the Mental Health Procurement Project be noted;                       and

(b)               a further report be made to the Committee in November 2010 setting out how the new arrangements will improve services and benefit service users and their carers and deliver value for money.

To receive an update from the Trust.

The Committee received an update from the Trust.

Mr N Henry, the new General Manager for the West Mercia Locality, presented the update and informed the Committee of his intention to work with the Primary Care Trust to deliver improvements.

To receive an update from the Trust.

The Committee received an update from the Trust.

Dr Budd (Medical Director) presented the report.  She informed the Committee that some  hospital services had recently been reviewed by the West Midlands Quality Review Service.  The initial feedback had been complimentary.  The formal report was expected in August.

Noting the pressures the hospital was experiencing in accident and emergency activity, a question was asked about concerns expressed in a report by the Association of Surgeons that pressure to meet targets was having a detrimental effect on standards of care.  Dr Budd replied that the report had related to elective surgery.  The Trust was mindful of safety and had postponed and rescheduled operations to maintain a safe system.

Dr Budd acknowledged that the increase in pressure on Accident and Emergency was a concern across the Country.  The severity of the illnesses of those admitted had also increased.  Consideration continued to be given to finding a solution to this difficult problem.

The Assistant Director of Integrated Commissioning commented that the Primary Care Trust acknowledged that the high attendance at A&E was an issue, leading to increased costs as a commissioner and blocking of beds for elective care.  Work was underway examining unscheduled care in both health and social care services.

The Committee noted the Trust’s financial position and that the level of outstanding debtors was a particular concern.  Dr Budd said that the Trust Board was considering these issues.

To receive an update from the Trust.

The Committee received an update from the Trust.

The Director of Public Health presented the report, commenting briefly on each of the key issues set out.

The Committee noted work underway to integrate health and social care provider services.   It was requested that the update to the next meeting should include further information on delayed transfers of care from hospital.

Concern was expressed about performance against targets for stroke care.  Dr Budd commented that the size of the County’s population meant that there was only one Doctor dedicated to the service.  In addition, a number of rural areas, generally, found some of the time-sensitive targets difficult to achieve and even large city centre teaching practices found them challenging.  Outcomes from treatment were however quite good although the aim was to improve.  Additional investment was being made.

RESOLVED:   That updates be provided on delayed transfers of care and Stroke services.

To consider the Committee’s work programme.

The Committee considered its work programme.

It was noted that the programme needed to be amended to incorporate the revised programme for the consideration of population health issues, including consideration of access to dental services.

RESOLVED:   That the work programme as amended be approved and reported to the Overview and Scrutiny Committee.