To receive apologies for absence.

Apologies for Absence were received from Councillors  PL Bettington, Brig P Jones CBE, NP Nenadich and CA North.

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 27 May 2014.

The Minutes of the Meeting held on the 27 May 2014 were approved and signed as a correct record.  The Chairman thanked Councillors J Jarvis and WLS Bowen for all their work on behalf of the Committee over the years.

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 for issues for future scrutiny. 

A Member suggested that items and questions submitted by the public should be recorded and that any written answers from Officers should also be included as an appendix to the minutes.

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 West Midlands Ambulance Service.

The Committee received a presentation on the West Midlands Ambulance Service from Ms M Brotherton General Manager (West Mercia) West Midlands Ambulance NHS Foundation Trust.

During her presentation, Ms Brotherton highlighted the following areas:

·         The transformational change agenda that the Service had been undertaking over the previous year that had embedded the implementation of the Make Ready ambulance service.  This allowed for faster treatments of patients and maximised the efficient use of the ambulance fleet.

·         The success of the Community Ambulance stations, which allowed ambulances from the main hub in Hereford to be based in the Market Towns. 

In the ensuing discussion, the following points were raised:

That the service had achieved 66.7% against a 75% target for Red 1 calls.   These were the most time critical and cover cardiac arrest patients who were not breathing and did not have a pulse, and the target was to get an ambulance on to the scene within eight minutes.  This was a challenging target in a rural county but these were relatively uncommon calls in Herefordshire, and the Service only received approximately one a month.  Work had been undertaken with local councils to promote the community defibrillation scheme and the Community First Responder schemes For Red 2, which were serious but less immediately time critical calls, the Service had achieved 75.7% response against a national target of 75%.  Red 19 calls, which required an ambulance to respond within nineteen minutes,  had a target of 95%, and the Service had missed this by .3%.  An ambulance had now been stationed in Leominster in order to be able to achieve this target.  It was important to note that demand for services was rising by around 5% a year.

In reply to a questions she said that:

·         Green 2 targets were 30 minutes, and 90%, both of which had been reached. This category was for falls and similar injuries.

·         The triage of calls was on the whole effective, but when the paramedic arrived on the scene the situation could vary from what had been expected.

·         That demand did fluctuate in rural areas, and Leominster had proved to be challenging in April, whilst Hay-on-Wye had in May.

·         There was a concern around the transfer of patients from the acute hospital to others in the area, as this reduced the resources available for calls.

·         That the conveyance rate of patients to hospital was 58%, which meant that 42% were treated at home or on alternative clinical pathways.

·         There was mandatory training for all staff of two days a year, and virtual learning was used.  Clinical team mentors were employed to work directly with crews.  The crew were trained to look at care pathways that did not involve the hospital.

·         The Service undertook a great deal of campaigning to keep calls to a minimum, and were active in print and social media.

·         That whilst the Fire Authority had a budget to invest in visiting the community, the Ambulance Service was run on a much leaner model, and  ...  view the full minutes text for item 7.

To hold a public accountability session to discuss the performance of the 2gether NHS Foundation Trust.

The Committee received a presentation on the work of the 2gether NHS Foundation Trust.  Mr Clee, Chief Executive of the Trust, presented the report, and highlighted the following areas:

·         That there was a national increase in mental health which was largely as a result of four main factors.  The population growth within the country; the demographic shift that had seen an increase in elderly; a decrease in the stigma associated with mental illness and increased access to services; more prevalence amongst the population as a result of old age, substance misuse and other factors.

In the ensuing discussion the following issues were highlighted:

·         That all the Department of Health Key Performance Indicators had been met apart from the ‘no children under the age of 18 to be admitted to adult in-patient wards’.  That this had been necessary was an undesirable state of affairs, and had taken place because it was the least worse option for the patient.  The Trust had not been commissioned to provide any under 18 services, as this was dealt with at a regional and national level by the NHS Local Area Teams.  This was a serious issue for the Trust, and it had been raised with NHS England as there was a nationwide bed shortage for children. 

·         That the adult bed base number had not been reduced from 29 to 16.  This had been a contractual obligation, but the number of beds had only been reduced to 21 as little progress had been made with mental health service liaison services in the community, and the crisis teams had been obliged to spend time supporting work in A&E, rather than in the home.  There had been no change in the triage arrangements, and patients who had needed to be admitted had been provided with a bed. The percentage of patients admitted had been reduced from 12% to 8% and no patients had been sent out of area.

·         Mr Clee undertook to provide a briefing paper to the Committee outlining the headline detail behind the Performance Indicators.

·         As there was no forecast for a reduction in demand, 2gether would look to work in different ways with partners and commissioners. The Director of Children’s Wellbeing undertook to provide the Committee with a briefing note on changes to the services.

·         That 2gether was working on awareness around suicide risk, and talking to a wide variety of services to this end.   Areas such as building planning was being discussed to make planners aware of potential hazards around tall buildings.

·         That there was an issue with the A&E Department of the hospital, where patients needed mental health assessments, especially for the over 65 age group, where dementia was an increasing issue.

·         Assessments were done within four weeks and based on individual need and clinical process. 

·         That work was put into socially inclusive initiatives that were funded by 2gether as well as Council funded ones such as the Healthy Lifestyle programme.  Workshops were held in the colleges on mental health issues  ...  view the full minutes text for item 8.

To Consider the Committee’s Work Programme.

The Committee noted its Work Programme.

Resolved:

That:

a)    A Task and Finish Group be held to help inform the Council’s response to the Government’s consultation on the draft regulations on the level of care, funding and self-funding under the Care Act 2014. Members would include Councillors PA Andrews, MD Lloyd-Hayes and GA Vaughan-Powell; and;

b)    The Task and Finish Group on Children’s Safeguarding should reconvene to follow up on the Action Plan that had been provided by the Executive following the submission of its initial report to the Committee on the 11 October 2013.  Members would include Councillors MD Lloyd-Hayes and SJ Robertson (Chair).