To receive apologies for absence.

There were no apologies received for absence.

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.

Councillor PE Crockett declared a disclosable pecuniary interest in agenda item number 7 as an employee of Wye Valley NHS Trust. 

To approve and sign the minutes of the meeting held on 14 December 2015.

RESOLVED

That the minutes of the meeting held on 14 December 2015 be approved as a correct record of the meeting.

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 received.

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 received.

To consider a presentation following the Care Quality Commission (CQC) inspection of Wye Valley NHS Trust.

Councillor PE Crockett left the meeting for this item having declared a disclosable pecuniary interest as an employee of Wye Valley NHS Trust.

The Wye Valley Trust chairman, the medical director and the chief executive attended the meeting. The trust chief executive gave a presentation which described the Care Quality Commission’s (CQC) ratings, the trust’s response, the quality improvement plan for exiting special measures, and the challenges faced.

The scrutiny chair observed that the CQC’s report made depressing reading and that it suggested the trust was seemingly not engaged and needed more leadership.

The trust chief executive challenged some aspects of the CQC report, giving the example of mandatory safeguarding training; whilst there was room for improvement, there was greater engagement than reflected with regard to the board. The role of corporate parents and plans for improvement were in place.

Members made a number of comments and observations which in summary were that:

•           staff at the hospital were thanked for ensuring that the criterion of care was rated as good and it was important to recognise this; 

•           whilst there were genuine areas of concern, the CQC report appeared to pick up on some rather specific issues;

•           the extent of the relationship between financial pressures, the impact of the private finance initiative and the CQC’s findings were noted;

•           the impact of morale on recruitment and retention of staff was noted;

•           the absence of press to hear the facts presented at today’s meeting was noted. It was positive that things were moving forward which should not be glossed over, and this needed to be communicated to the press;

•           the CQC appeared to have made comparisons with other west midlands hospitals without taking into account the different geography and demographics such as an above-average population of older people impacting on mortality rates;

•           whilst complexities of the NHS were understood, assurances were given in October 2014 that the trust was doing all it could do to improve, but remained in special measures. There was therefore an imperative to ensure that the NHS in county was properly funded, bureaucracy reduced and investment made in front line services;

•           in terms of joint working and funding between public services, the concept of one Herefordshire was little understood by the public and more information was needed on this. There should be closer working between council and health colleagues so that the next CQC visit was more positive;

•           in some cases, for example 1 Ledbury Road,  there was a lack of communication with the public which the trust was trying hard to address, and attention needed to be given to the use of language which was meaningful to the public; 

•           patient advocacy was an important consideration as carers often had a different view on care provided in hospital and consideration was to be given to the use of independent people to take issues up with management;

•           the executive team had a lot to address, which was daunting, and  ...  view the full minutes text for item 55.

To note the quarter 3 performance report for adults and wellbeing.

The performance report was presented by the director of adults and wellbeing, highlighting key points and areas for future exploration.

Key achievements were identified as:

•           a new approach in dealing with complex cases to ensure they were person-centred and giving greater ability to assess and review;

•           new contracts for sexual health and substance misuse and seeing benefits of new approaches;

•           responding to closure of a care home with 5 days’ notice which presented pressure and complexity in assessing and moving residents safely. The team performed well and all residents were placed safely; and

•           care service recruitment presented a challenge in responding to the vibrancy of the county.

Aims were summarised as:

•           to actively work to ensure Care Act responsibilities were met and case reviews fulfilled. This would provide a solid baseline that all have proper assessment; and

•           moving forward following delays in launching the WISH service to ensure a quality service was being provided. The service was working on ensuring it covered the whole population. The service would be going live in the next few days and officers were working closely with the operator, SIL (Services for Independent Living).

Members’ attention was drawn to the dashboard information in the report. In particular, residential care numbers, as placements were never the preferred option over people remaining in their own homes. Officers were working to ensure staffing was structured to ensure ongoing engagement for early intervention and provide support at suitable points.

An overspend of 0.1% of the gross budget was forecast and whilst few other services were working within budget, there was discomfort with an £88,000 overspend.

The director for adults and wellbeing identified items for focus:

•           provider failure/closure of residential homes as a common issue due to financial circumstances. There was close working to ensure that there are mechanisms to ensure that homes can stay open or residents have a smooth transition to new accommodation;

•           promoting independence and no longer commissioning visits of less than thirty minutes; New arrangements would be in place early in 2017-18 in order to take time to get the service right and not rush implementation. 

A member commented on the commissioning of home support services as being the ideal way forward although there was concern regarding rurality and how costs were identified in carrying out provision in rural areas.  Isolation was also a concern and it was considered that this was the primary reason for lonely people going into residential accommodation.

The director for adults and wellbeing acknowledged that loneliness was a key factor in reducing wellbeing and deterioration and could be as harmful to health as smoking and this was being addressed.  Growth in residential care was a national phenomenon and benchmarks were being considered.   More needed to be done to address community resilience to support people and avoid decline.  Rurality was a factor in providing domiciliary care and from 1 October 2015 there had been a rural premium for those people living more than 5  ...  view the full minutes text for item 56.

To note the performance in relation to children’s safeguarding for the month of October 2015, together with trend data over the previous 12 months.

Adam Scott was welcomed as the new assistant director for safeguarding.

The director of children’s wellbeing introduced the safeguarding performance report, which included an update on performance, including responses to any whistleblowing concerns.

The cabinet member for young people and children’s wellbeing commented on the report’s reference to recruitment and retention and the ratio of permanent to agency staff. Improvements were welcomed as testament to the recruitment and retention policy being implemented. Although there was more to do, great strides were being made in relying more on permanent staff through the social worker academy. This provided stability for service users and team strength but also made a £600,000 saving.  The cabinet member congratulated the team for this outcome. 

The chairman welcomed the establishment of permanent staff based in the county.

A member commented on the figures contained in the performance report regarding the number of child protection plans, questioning whether or not this was positive.

In clarification, the assistant director explained that for a child to remain the subject of a child protection plan for more than two years it showed that the intervention was not effective and that the child was still at risk of significant harm.

It was agreed that whilst numbers were higher at this point in the year compared to this point in the previous year, compared with national standards, this was at a low level.

A member acknowledged the pressures on the multi-agency safeguarding hub (MASH) and issues regarding child protection plans and suggested this be an area for scrutiny in light of concerns around communication and people not getting feedback action taken in response to referrals. He gave an example of school safeguarding leads being uncertain of what action was being taken following a referral to the service.

The assistant director explained that there was a service standard to feed back on MASH action. There had been a multi-disciplinary audit on quality and timeliness summarised in the report, with positive outcomes. However, he clarified that if professionals were not getting feedback on referrals they could escalate the matter through the service.  The member commented that schools were aware of pressures in the service and were reluctant to escalate matters. In response, the importance of escalation was emphasised.  

A member referred to a recent report to the audit and governance committee on the risk register and asked about the risks associated with pre-appointment checking of workers. The director for children’s wellbeing confirmed that there had been a recent audit on agency workers and their appointment arrangements. Whilst reasonable assurance had been given, Changes were being made to how agency workers were appointed to strengthen arrangements further.

In answer to a further question in relation to overseas workers, it was clarified that this was a discrete group appointed through a specific agency and the most up to date references were used.  Work was being undertaken with regional directors to improve quality and references were being addressed as a particular concern. Some employers were reluctant to provide  ...  view the full minutes text for item 57.

To consider an update from Healthwatch Herefordshire.

The chair of Healthwatch Herefordshire presented an update. He gave assurance that Healthwatch was engaging with 1 Ledbury Road carers and users and could bring information back to committee. In identifying areas for scrutiny, the following were put forward:

•           Wye Valley Trust;

•           urgent care service future and public consultation;

•           seven-day GP service;

•           mental health recommissioning;

•           public health budget; and

•           adult social care

The vice-chairman requested that public health included the take up of inoculations in relation to ‘flu effectiveness, the knock-on effects and spikes in cases putting pressure on emergency services. It was noted that this year’s vaccine was more effective but had not been not taken up by the public due to loss of confidence.

Commenting on ‘flu vaccinations, the director of public health noted that services were seeing an increase nationally this time as expected but take-up was not especially high in the county. The identification of top ‘flu strains were better matched this year and risk groups were being encouraged to come forward. There were additional clinics for people to get vaccinations and advertising to promote the benefits of having them.

RESOLVED

THAT:

the report be noted.

To consider the committee’s work programme for 2016-17. 

The chairman confirmed that a seminar would be arranged for members to discuss the work programme in order for it to be more proactive. 

RESOLVED

THAT:

the work programme be noted.