Apologies were received from Councillor PGH Cutter, JLV Kenyon, Miss E Lowenstein Councillor R Preece and Mr P Sell.

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

Councillor AJ Hempton-Smith for Councillor JLV Kenyon.

There were none.

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

(There will be no discussion of the issue at the time when the matter is raised.  Consideration will be given to whether it should form part of the Committee’s work programme when compared with other competing priorities.)

There were none.

To note questions received from the public and the items to which they relate.

(Questions are welcomed for consideration at a Scrutiny Committee meeting so long as the question is directly related to an item listed on the agenda.  If you have a question you would like to ask then please submit it no later than two working days before the meeting to the Committee Officer.  This will help to ensure that an answer can be provided at the meeting). 

There were none.

To receive a presentation on the work of the Wye Valley NHS Trust and an overview of its plans for its future.

The Chairman welcomed the Chief Executive, Wye Valley NHS Trust (WVT) and the Director of Service Delivery to the meeting. 

The Chief Executive provided the Committee with a presentation on the Trust (appended to the Minutes as Appendix 1).  In the ensuing discussion, the following points were made:

The Director of Service Delivery reported that the key to the model was to ensure that care was provided for patients closer to the home and to reduce the numbers of patients admitted to the acute hospital. In reply to questions he went on to say that:

·         There was a target to discharge the elderly sooner from hospital in order to allow them to recuperate in their own homes. This would allow patients to have greater independence. 

·         the Wye Valley Trust didn’t have control over the provision of wardens in sheltered housing, and did not manage Ledbury Community Hospital.  There was a focus on changing this into a resource centre for the community, with the intention of reducing the number of admissions to the acute hospital. These facilities were factored into any considerations of bed numbers in the County.

·         Adult Social Care had been seconded under the purview of the hospital, but that the delivery mechanism remained the same.  There was a great deal of management of the process, which was co-ordinated by the Health and Wellbeing Board, the Clinical Commissioning Group and Adult Social Care. 

·         whilst no-one was turned away from A&E, there was a need to educate the population as to how the service should be used most correctly.  Non-attendance rates at clinics had been reduced from 10% to 5% by sending reminder letters, but further savings could be made in this area.

The Director of Service Delivery reported that there were issues associated with patients leaving hospital, and the discharge planning process was now designed to ensure that prescription were written the day before the planned patient discharge.

The Chief Executive WVT went on to say that a great deal of work had been undertaken with the practitioner led Service Units as it was important to instil the right ethos into the organisation.  In a similar fashion, the staff had been consulted widely on the values of the Trust, and the behaviour that underpinned these values.  The Service offering had been designed to ensure that the Trust was a population based service provider and was not concentrating solely on acute care.  Neighbourhood Teams were working with GPs to devolve care to the patient’s home wherever possible.

In reply to a question, he said that there were alternative models that the Trust had learnt from, a particular example being Torbay, who were prominent in providing zoning teams for their area, which had seen a reduction in A&E admission rates.

He added that it was clear that greater development of community services was important, and an increase in the resourcing of Neighbourhood Teams was being considered.  The Community Hospitals would not be closing, but changing their roles to that  ...  view the full minutes text for item 60.

To receive a presentation on the work of the Clinical Commissioning Group together with an overview of the Groups current plans.

The Committee received a presentation from the Associate Director of Information, Herefordshire PCT

the Associate Director of Information, Herefordshire PCT added that the examples of patient safety and treatment that had been mentioned in the meeting highlighted the need for a clear structure in community and all integrated care organisations.

He went on to say that the walk in centre that had been constructed in an area of deprivation in Hereford had provided a service to the wider community and had provided for a subsequent reduction in A&E admissions.  GP’s were also engaging with the issue of A&E attendance, and were taking care to review patients who attended A&E regularly.

The financial position of the Wye Valley Trust should be taken within the context of the wider health care economy in Herefordshire.  Collaborative working had been very successful in cutting costs, and one-off efficiencies would be brought forward.  It should be noted, however, that the County had the lowest per capita spend on health care in the West Midlands. He undertook to provide the Committee with a briefing note on per capita spend on health care in the County.

He went on to say that Herefordshire Health Care Commissioners (HHCC) was established in shadow form as the Clinical Commissioning Group for Herefordshire in April 2011.  HHCC was then established as a sub-committee of the NHS Herefordshire (PCT) Board with delegated responsibility for the main elements of health care commissioning in Herefordshire.  The HHCC group was led by clinicians and supported by corporate PCT Staff.

From July 2012 HHCC could begin the Department of Health CCG authorisation process which would enable HHCC to be established as a statutory organisation, subject to the enactment of the new Health and Social Care Bill, by April 2013.

He went on to say that in 2011/12 NHS Herefordshire developed a Quality, Innovation, Productivity and Prevention (QIPP) plan that focused on transforming the way health care was delivered in Herefordshire whilst providing £10.8m in savings for reinvestment in frontline services.  By December 2011 £7.8m of savings had been delivered which was a 99.5% achievement against plan. In 2012/13 Herefordshire would need to deliver an additional £11m in QIPP savings in order to ensure the future sustainability of the Health Economy.  Seventy additional suggested opportunities had been put forward to provide input to the plan, of which forty five had been taken up. High impact changes had been flagged up under the twin topics of community services and dementia care.  These would be provided by the community services team and the neighbourhood teams. He was confident that should these two areas be delivered, then the rest of the QIPP plan would be delivered.

The Assistant Director went on to report on the structure of the Herefordshire Health Care Commissioners.  The structure had been seen at a national level, and the work with GPs had been held up as an example of best practice.  He said that the authorisation process consisted of 6 domains  ...  view the full minutes text for item 61.