To receive apologies for absence.

Apologies for absence were received from Councillors PA Andrews, Brig P Jones CBE and SJ Robertson.

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

None.

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

None.

To approve and sign the minutes of the meeting held on 11 June 2014.

The Minutes of the Meeting held on the 11 June 2014 were signed and approved as a correct record.

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.)

Ms P Allen, the Arts and Older People Project Manager at the Courtyard suggested that the Committee receive a presentation on the work undertaken by the Courtyard on dementia care in the community.

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). 

None.

To hold a public accountability session to discuss the performance of the Wye Valley NHS Trust.

The Chairman welcomed the Mr R Beeken, Chief Executive, Ms M Clark, Director of Nursing and Quality and Mr A Dawson, Head of Programme Management, Wye Valley NHS Trust, to the meeting.  In his presentation, the Chief Executive highlighted the following areas:

·         That external concern over the quality of services at the hospital had resulted in a Rapid Response Review from NHS England, and an improvement plan had been put in place to address issues that had arisen.

·         Modernisation of the management of urgent care had resulted in the standardisation of care across the Trust.

·         That nursing levels had successfully been increased, and an additional eighteen posts had been delivered into the A&E Department.

·         That there was a 5% growth in pressure on the system and as a result the Trust was seeking to ensure services were more efficient.  Work was in hand to change the shape and function of care services across the County. 

·         Areas of risk included the increase in activity levels related to the urgent care pathway which had seen a rise of 13% in June on the previous year.  Elective care referrals in urgent care areas such as gastroenterology had increased 100% on the previous year.

·         That the Trust was a small organisation and had significant clinical vacancies which made it hard to offer a seven day a week service in all areas as the recruitment and retention of senior staff was problematic. 

In the ensuing discussion, the following points were made:

·         That as part of the Community Services, the district nursing service was working well with GP surgeries, but in many parts of the County the co-ordination of care could be improved.

·         That a societal change was required in order to help meet the expectations of the elderly regarding end of life care.  The Trust was monitoring the percentage of people who died in hospital as opposed to their preferred choice.

The Chief Executive, 2gether NHS Foundation Trust, said that there was more emphasis to ensure people were better informed as to how to stay healthy and how to manage their own care.  Neighbourhood hubs were used to prevent situations arising and minimise concerns for service users.  The focus of care was being shifted to target patients earlier in the care pathway thereby making both economic and health gains.

·         That £1m had been invested as part of the Trust’s long term strategy.

·         That 15% of the Trusts income came from Welsh funders, who were reliant on the services offered by the hospital.  They worked to different outcomes in areas such as waiting times for elective surgery, which meant that the Trust had to manage different systems for patients.

·         European nurses had been recruited into the Acute Hospital and ten newly qualified staff would also be starting shortly.  There were twenty vacancies in Community hospitals, which were proving difficult to recruit to. Alternative ways of staffing them would have to be considered, with different skill mixes of staff. Risk was being mitigated by the use  ...  view the full minutes text for item 16.

To consider the council’s approach to implementing the Children and Families Act 2014, with particular regard to the aspects relating to adoption and special educational needs and disabilities.

To consider how partnership working might enhance the approach to benefit children and young people in Herefordshire.

 The Committee received a report on the Council’s Implementation of the Children and Families Act 2014.

During the subsequent discussion, the following areas were raised:

·         A new approach to Special Educational Needs (SEN) provision would be provided from the 1^st of September which would involve significant cultural changes of practice in education, health and social.  For example, the Council would be expected to offer personal budgets for service users, and the scale of this offer would be increased over the next two years.

·         That current statutory timescales were being met which had been the case for some time, so the team were in a good position to meet new requirements. 

·         That work was underway with parent groups in order to facilitate the introduction of the new processes and approach, and parents would be contacted individually before receiving formal letters.

·         That the joint commissioning arrangements would include a requirement for internal dispute resolution between agencies.

·         That statemented children, and those with education, health and care plans, should be reviewed on an annual basis, but it was incumbent on schools to provide the Council with updated information on individuals.  There was a need to ensure that there was greater clarity regarding the reviewing process to ensure it addressed the needs and development of each child.

In reply to a question regarding the confidence within the Council to be able to effect a change in culture, the Assistant Director, Education and Commissioning, Children’s Wellbeing said that they were confident that it could be achieved, but that it would be two to three years before a more holistic approach would be embedded.

RESOLVED: That the report be noted and that the committee review progress in implementation of the Act in eight months’ time, focusing particularly on the response to the Act by health services in Herefordshire, both commissioning and provider services.

To receive a verbal update on the new management arrangements.

The Director of Adults Wellbeing provided a verbal update on the changes in the management structure for public health.  She highlighted the following areas:

·         That whilst there was no designated Director of Public Health in post, the functions of the Director of Public Health were being covered and the Council was legally compliant.  The Council was receiving weekly support from Public Health England and informal support from Shropshire Council in order to ensure compliance. Appointment of the functions would need to be jointly agreed between Public Health England and the Local Authority, but there would be someone designated to undertake the functions.

·         An additional full time consultant in Public Health would be appointed, as well as a part time post.

·         The focus over the next few weeks would be on commissioning of services, and discussions would be undertaken as to how the Committee should be involved in this process.

In reply to a question from a Member as to whether the Council had strong leadership and a clear vision to deliver public health, the Director said she was confident that it had both.

RESOLVED:  That the report be noted

To consider the committee’s work programme.

The Committee received its Work Programme.

RESOLVED: that the following items be included in the Work Programme:

a)    A Workshop with Communication Leaders from Partner Agencies would be held on the 18^th September.

b)    The impact of housing developments in Herefordshire on Hereford Hospital and other social services, presently on the work programme as an unallocated item, should be considered before debates around the Planning Inspector considers the core strategy.

c)    A report on the action plan arising from the most recent OFSTED inspection

d)    An update on Care Homes should be provided by Adult Social Care; and;

e)    An update on the implementation of the Children’s and Families Act should be provided to the Committee in 9 months’ time.