Apologies for absence had been received from Councillors Bowen and Summers (committee members).  In relation to agenda item 7 (minute 35), apologies were also noted from Councillors Marsh, Norman and Watson (ward members).

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

There were no substitutes.

To receive any declarations of interests in respect of schedule 1, schedule 2 or other interests from members of the committee in respect of items on the agenda.

No declarations of interest were made.

To approve and sign the minutes of the meeting held on 18 November 2019.

Resolved:  That the minutes of the meeting held on 18 November 2019 be approved as a correct record and be signed by the chairman.

To receive any written questions from members of the public.

For details of how to ask a question at a public meeting, please see:

www.herefordshire.gov.uk/getinvolved

The deadline for the receipt of a question from a member of the public is Tuesday 7 January 2020 at 5.00 pm.

To submit a question, please email councillorservices@herefordshire.gov.uk

No questions had been received from members of the public.

To receive any written questions from councillors.

The deadline for the receipt of a question from a councillor is Tuesday 7 January 2020 at 5.00 pm.

To submit a question, please email councillorservices@herefordshire.gov.uk

The questions received and the responses provided are attached as appendix 1 to these minutes.

To consider the temporary winter closures of the Ross-on-Wye and Leominster minor injury units (MIUs), in the context of urgent and emergency care, and to determine any recommendations the committee wishes to make to a responsible NHS body and / or to the executive.

The chairperson invited Jade Brooks, acting director of operations of NHS Herefordshire Clinical Commissioning Group (CCG), and Jane Ives, managing director of Wye Valley NHS Trust (WVT), to introduce the item.

The key points included:

i.           The paper (agenda pages 25-51) detailed the current position on urgent and emergency care in the county and provided information on the temporary closures of the minor injury units (MIUs).

ii.         The arrangements adhered to national guidance on urgent and emergency care, with an accident and emergency (A&E) delivery board in place to oversee developments and a programme of transformation, and to ensure that system partners came together to provide a good standard of care for the population.

iii.        The NHS planned for surges in demand during the winter period and patient safety was paramount.

iv.        This was the third year where a decision had been taken to close the Leominster and Ross-on-Wye MIUs temporarily during the winter period in order to maintain patient safety across Herefordshire and mid-Powys.  The first year was described as an ‘ad hoc’ arrangement, with people uncertain about the opening times.  For the second and third year, proactive and earlier decisions had been taken.

v.         The winter pressures were due to the increase in demand and the acuteness of illnesses, particularly in terms of respiratory and cardiovascular diseases, which resulted in longer lengths of stay.  This limited the availability of beds and resulted in congestion in the hospital.

vi.        It was reported that, over the last two years, adult emergency demand had increased by 70 admissions per week.  To manage the additional demand, WVT had opened 24 more beds and had improved ways of working but there were still significant pressures during the winter period.

vii.       There was a workforce of emergency nurse practitioners, who largely worked autonomously, and could see three to four patients per hour.  It was reported that the demand at the Leominster and Ross-on-Wye MIUs was around one patient per hour and it was not considered that the emergency nurse practitioners were working at full capacity in the MIU settings.  In addition, there was a shortage of nurses generally and emergency nurse practitioners in particular.

viii.      A range of measures over the last two years had improved triage times, maintained ambulance turnaround times, and reduced mortality rates.

The chairperson welcomed the reduced mortality rates and made the following observations:

i.           Illustration A (A&E attendances at Wye Valley NHS Trust April 2017 to November 2019, agenda page 25) showed attendances declining during the winter period.

Ms Ives said that there was a difference between attendances and admissions.  Attendances were higher in the summer months, due to minor injuries, but adult admissions were higher in the winter months, as demonstrated by Illustration B (ambulance conveyances to Wye Valley NHS Trust April 2017 to November 2019).

ii.         The framing of the attendances in Table 2 (Total attendances at MIUs September 2017 – August 2018, agenda page 30) which incorporated the winter closure period in the calculations  ...  view the full minutes text for item 35.

To seek the views of the adults and wellbeing scrutiny committee on the budget proposals for 2020/21 and on the draft corporate plan as they relate to the remit of the committee.

The chairperson reminded the committee that the budget and corporate plan proposals had been considered initially at the 18 November 2019 meeting of the committee (minute 26 refers) and the purpose of this item was to reconsider the proposals following the conclusion of public consultation.

The chief finance officer presented the report, the principal points included:

1.         The updated corporate plan summary was appended to the report (agenda page 69) and the full corporate plan would be presented to the general scrutiny committee on 20 January 2020.

2.         The public consultation on the priorities for additional investment indicated that a high proportion of respondents supported investment in council-owned care homes or villages (81%), and publicly-owned affordable housing (79%).

3.         51.5% of respondents considered a 4% increase in Council Tax to be ‘about right’ (36.9%) or ‘too little’ (14.6%).

4.         53% disagreed with the allocation of Council Tax as set out in the budget till receipt.  Comments that expressed an opinion mostly said that not enough was allocated to particular services, especially services related to environment and place.

5.         The settlement from government had confirmed the provisional settlement, provided an increase in the revenue support grant (£635k), and confirmed the rural services delivery grant (£5.101m).  This resulted in an updated total net budget (£157.117m).  In addition, the settlement included funding in relation to new homes bonus (£2.2m); this had not be part of the budget assumptions.  Consultation on the settlement would end on 17 January 2020.

6.         The base net budget requirement for adults and communities remained the same (£56.282m).  Increases were identified for corporate services in relation to legal services (£700k) and to meet additional costs of borrowing (£318k) due to an increase in the public works loan board interest rate.

7.         It was clear that this was a one year settlement from government, with further policy announcements and changes expected later in the year.  This would enable Council to set a balanced budget for 2020/21 at its 14 February 2020 meeting.

8.         Work was ongoing on the models for delivering council housing which could lead to an investment of up to £100m in housing in the four years from 2022/23.  The funding from new homes bonus was earmarked to facilitate the delivery of houses.

9.         The 2020/21 assumptions had been adjusted, reflecting a 3.9% increase in Council Tax (1.9% general, 2% adults social care).  It was reported that the improved better care fund (£6.6m) and public health grant (£9.2m) would continue for another year.  It was noted that work was continuing on calculating the impact of the rise in the national living wage, including conversations with providers.

The chairperson invited contributions from the director for adults and communities and the attending cabinet members, the key points included:

i.           The director commented on the budget setting process and on the continuing development of the business cases to support the capital investment proposals.

ii.         The cabinet member - finance and corporate services welcomed suggestions and challenge in order to inform  ...  view the full minutes text for item 36.

To consider the committee’s work programme.

The chairperson suggested that items on community services redesign and NHS Continuing Healthcare be brought forward to an earlier meeting.  It was also suggested that the remainder of the work programme be reorganised, potentially to include an additional meeting in April 2020.

Resolved:  That officers, in consultation with the chairperson and vice-chairperson, be authorised to update the work programme accordingly.

The next scheduled meeting in public is Monday 2 March 2020 at 2.30 pm.

The next scheduled meeting was Monday 2 March 2020 at 2.30 pm.