To receive apologies for absence.

0777Apologies were received from Councillors JM Bartlett, KS Guthrie, PL Bettington, JLV Kenyon, NP Nenadich and DB Wilcox.

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

Councillor J Norris for Councillor JLV Kenyon.

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 24 November 2014.

The Minute of the meeting held on the 24^th November 2014 were approved and signed 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.)

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). 

None.

Presentation on the Dementia work undertaken by the Courtyard, Hereford

The Committee received a presentation from Ms P Allen, in which she highlighted the following points:

·         That Herefordshire had the lowest diagnosis rate for dementia at 32% of people living with dementia having a formal diagnosis which was below the national average of 48%.

·         In 2010 The Courtyard secured EU and Council funding to establish its Arts and Older People project, the aim of which was to reduce the isolation of older people through direct access to the arts.

·         The Project undertook training aimed at unpaid carers, carer professionals and artists around specific themes such as Creativity and Communications

·         The Courtyard had been involved in awareness raising undertaken with the Alzheimer Society and was the first arts centre to become involved with the initiative. It had been part of the Prime Ministers Challenge Group which had designed a series of industry standards to support arts venues to become more dementia friendly.

·         That there had been over 14,000 attendances to the projects, events and training and that these numbers rose every year. The Courtyard was committed to its older people’s agenda and was hoping to expand its provision.

In the ensuing discussion the following issues were raised:

·         That the programme was engaged with local third sector partners, but had less interaction with GP surgeries.

·         Funding was mainly from the Big Lottery, but the paid for activities also helped to keep it going.  The Courtyard was keen for the programme to be self sufficient and income generating, but it was hard to put a monetary value of the services that were offered.

·         That the work would be part of the Dementia Implementation Plan, of which the Courtyard was a major participant.

·         That this work fell into the area of ‘social prescribing’ and Dr Watts undertook to direct fellow GPs toward the Courtyard’s programmes.

·         That other programmes such as the Rural Pub Arts had suffered from inconsistent funding which meant that it had not been possible to keep running it.

The Chairman thanked Ms Allen for her presentation,

To receive a report from the Chief Executive of the Wye Valley NHS Trust on the recent CQC Inspection and report.

The Committee received a presentation on the recent Care Quality Commission report of its Inspection of the County Hospital by Mr R Beeken, Chief Executive and Mr M Takolia, Interim Chairman of the Trust. The following points were raised:

·           That there were significant service challenges around the Urgent Care Pathway. There was a lack of depth of leadership across A&E, and that the Trust as a whole was an immature organisation which did not learn from its mistakes.

·           That whilst demand had exceeded supply for some time, the County Hospital had not made itself more efficient in order to meet the needs of the patients. There had been a 7% increase in admissions to A&E over the year, and a concomitant 23% increase in emergency admission to the hospital.  Recruitment of consultant staff was a problem for the Trust, and the working hours of existing staff had been extended in order to ensure that a consultant would be present in A&E. New ways of working were being looked at, including introducing advanced care practitioners and advanced nursing staff.

·           Patient length of stay in hospital was good compared to other hospitals, but bed occupancy was higher than the hospitals peers.  This meant that here was a huge problem when there was a surge in demand.

·           The concerns raised by the Care Quality Commission were being taken seriously and had been addressed in an overarching improvement plan, attached to the Agenda.

·           The Urgent Care System was being improved by the introduction of the ambulatory care system, was a patient focused service where some conditions could be delivered on an outpatient basis. Ambulatory emergency care cases were averaging 11 a day.

·           Work was in hand with external partners on the System Resilience Plan.  Mobile day surgery units were in place in order to ensure that elective routine surgery could be continued.  There were insufficient specialist staff to be able to offer a seven day a week discharge, and the Trust would need to be creative in order to be able to offer this service

·           That there would be improved capacity in outpatient units through a capacity planning process of human resources and the available physical space.  Work had been undertaken with the HCCG to reduce demand on secondary care.

·           That the Executive Board would develop twelve key outcomes against which the Hospital would deliver in order to ensure that the process had been successful.

In the ensuing discussion, the following points were made:

·           That non-recurrent funding from central government was not helpful in this situation, as it did not allow for long term planning and it was not possible to build resilience with such funding.

·           That the Hospital had worked with the Council regarding the plans for economic and population growth within the city and the County.

·           That the role and membership of the Trust’s Board had been strengthened in order to ensure that they would have better oversight of the operation of the Trust.  New members  ...  view the full minutes text for item 46.

To receive a verbal report on any issues of concern to Healthwatch.

The Committee noted an updated report from the independent Chairman of Herefordshire Healthwatch.

The Independent Chairman said that the report was designed to assure the Committee that Healthwatch was active across the health and social care landscape in the County, and to highlight that it was working collaboratively with all agencies to ensure the best outcomes for Herefordshire.

In the ensuing discussion, the following points were made:

That there was sufficient contact with the Wye Valley NHS Trust, and a series of enter and view visits were in place, as well as regular consultations with

That there was a programme of visits to community hospitals in place, and Leominster and Ross would be visited in the New Year.

Resolved: That the report be noted.

To note a report on the Adult Social Care Local Account.

The Committee noted the Adult Social Care Local Account 2013/14.

In the ensuing discussion the Director of Adults Wellbeing said that the culture around Direct Payments was changing in order to ensure that service users were in a position to make the best choices for themselves.  There were some areas that the market was not yet ready to provide, and a clear demand for some services was required in order for the market to be in apposition to fulfil them.

Resolved: That the report be noted.

To note the outcome of the Adult Social Care Peer Challenge undertaken in June 2014 and to consider the council’s response to the areas for improvement identified.

The Committee noted a report on the Adult Social Care Peer Challenge.

In the ensuing discussion the Director of Adults Wellbeing said that the process had been critical but fair, and had highlighted areas that had been done at people; work was now required to be undertaken with people. In response, a year-long consultation and dialogue for change was in place in Adult Social Care.

It was noted that there should not be a claw back of any funds from direct payments in adult social care.   If users were not able to find the appropriate services, then the Council would commission them on their behalf.  There was a full assessment before any claw back took place, which was why this action was a low priority for the service.

Resolved:

That:

a)    The Committee note the outcome of the review attached at Appendix 1 of the report, and;

b)    note the action plan attached as Appendix 2 as the response to the areas for improvement that had been identified.

To note the Committee’s Work Programme.

The Committee noted and updated its Work Programme.

Resolved: That the report be noted.