Apologies for absence were received from Councillor PJ Watts.

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

There were no named substitutes.

There were no declarations of interest.

To approve and sign the Minutes of the meetings held on the 16th and 18th January 2012.

The Minutes of the Meetings on the 16^th and 18^th January 2012 were approved.

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 no suggestions from the public.

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 no questions from the public.

To receive a presentation on the work of the ²gether NHS Trust over the previous year, and an overview of its future plans.

The Committee received a presentation from the Shaun Clee, Chief Executive, ²gether NHS Trust, on the work of the Trust over the previous year.  The presentation is appended to the Minutes at Appendix 1.

In his presentation, Mr Clee highlighted the following areas:

·         That the number of agency staff being used was being reduced in order to improve the patient experience, as many often didn’t  know the staff who were looking after them.

·         That the number of beds within the service had been reduced from 29 to 16, allowing for a greater focus on care within the community.

·         That reductions had also been made in readmissions and waiting times.

·         That added value had been provided thorough psychiatric liaison.  For those over 65, a quarter of patients did not go home after admission to the acute hospital in an unplanned way.  Of the 80% of those in this age range, 40% were suffering from undiagnosed dementia.  A bid had been made to the NHS West Mercia PCT Cluster for acute and community liaison services in order to try and ensure that patients were not admitted in this manner

·         That joint working between providers and commissioners within the Quality, Innovation, Productivity and Prevention (QIPP) Delivery Board was proving beneficial.

·         That GP’s were actively working with ²gether though the GP Parliament, and there was a willing process of engagement.

·         That more patients were being seen faster than the number seen in the year to date in 2011.

In the ensuing conversation, the following points were raised:

·         That there were signs and symptoms that GP’s were aware of which would result in a referral of mental health patients though the Improving Access to Psychological Therapies (IAPT) care pathway.  There were referrals to the County’s mental health team from twenty four care clusters across twenty one spectrum mental health areas.  It had been ensured that GP’s were sighted on what the areas were, and all Practices had access to the Clinical Director.  There were variations in rates of referral between practices, but it was not possible to quantify why this was as there was no electronic record system.  The GP mental health leads were very proactive, and understood that such variations were important and should be considered by their colleagues. 

·         In reply to a question, Mr Clee said that the spend on Agency nursing staff had been reduced by approximately 5%.  It was the intention that no agency nurses would be used at all, and staff would be taken from an in-house bank of nurses.

·         In reply to a further question, he said that it was difficult to ensure that mental health patients received the optimal care in the Wye Valley Trust A&E Department, which was why a bid had been made to the PCT Cluster for acute and community liaison services to help provide additional resources.

·         That there was a clear link between economic wellbeing and suicide rates, which had increased nationally as unemployment had risen. A 1% rise in unemployment  ...  view the full minutes text for item 68.

To receive a presentation on the work of the Midlands & East Specialised Commissioning Group together with an overview of the Groups current plans.

The Committee received a presentation from Stephen Washbourne, Director of Operations, Midlands & East Specialised Commissioning Group (MESCG). The presentation is appended to the Minutes at Appendix 2.

During his presentation, Mr Washbourne highlighted the following areas:

·         That specialised commissioning groups would be clustered along the same footprint as the Strategic Health Authorities (SHAs).  This was part of the transition into a single nationwide function following the publication of the Shared Operating Model for PCTs.

·         That specialised services, which were required for rare and complex cases that were high cost, needing specialist interventions with expensive equipment, would be provided in relatively few specialist centres to a population of more than one million people.

·         That services would be commissioned by the NHS Commissioning Board (NHSCB) rather than individual Clinical Commissioning Groups.  The budget and service portfolio for the Board would be determined nationally.  One of the challenges going forward would be to mitigate risk to patients during the transition period.

In the ensuing discussion, the following points were made:

·         In reply to a question, Mr Washbourne said that there was no question that Herefordshire would be marginalised within the new structure.  Across the West Midlands area there was a budget of £925m, of which Herefordshire had an allocation of £24m. This should be seen in the context of the allocation for Birmingham, which was £90m.  The Chair of NHS Herefordshire, the West Midlands NHS West Mercia PCT Cluster and the Midlands & East Specialised Commissioning Group (MESCG) was Joanna Newton.  She was always looked to rural issues, and ensured that the populations under the aegis of the Midlands & East Specialised Commissioning Group were treated equitably.

·         That one of the main challenges for the new structure was effective communications with elected Members.  This had been an issue in the past, and was one of the roles of that would be taken on by the Health & Wellbeing Board.

·         Mr Washbourne added that there was a need to ensure the correct access to cardiac, neurosurgery and dialysis, and how patients should be integrated back into the community from acute beds. There was often a focus by commissioners on commissioning numbers, rather than identifying outcomes.  NHS Herefordshire was the body accountable for ensuring the delivery of the portfolio of services from the MESCG.

·         The Vice Chairman pointed out that the Health and Social Care Bill was still under discussion in Parliament and that it would be appropriate to assume that the changes laid out would take place.  It was imperative that the local PCT should still have a voice in the decision making process.  It was important that at least 80% of available funds for commission should be provided to the Clinical Commissioning Group, whilst the rest could be handled by the MESCG.  There was a quarterly meeting of Overview and Scrutiny Committee Chairmen within the area covered by the Group, and it was important that this should continue to take place.  He added that it had been suggested to this committee that a review of  ...  view the full minutes text for item 69.