All committee members were present. 

Apologies were noted from Dr Ian Tait of NHS Herefordshire Clinical Commissioning Group, Christine Price and Ian Stead of Healthwatch Herefordshire, and Stephen Vickers (Director of adults and communities) and Mandy Appleby (Assistant director of adults social care) of Herefordshire Council.

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 13 January 2020.

In response to a question from a committee member about an undertaking given by representatives of NHS Herefordshire Clinical Commissioning Group and Wye Valley NHS Trust to provide further information in relation to the data on attendances at Minor Injury Units, the democratic services officer advised that there had been some correspondence following the last meeting but a definitive statement which could be circulated to committee members was awaited.

Resolved:  That the minutes of the meeting held on 13 January 2020 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 25 February 2020 at 5.00 pm.  To submit a question, please email:

councillorservices@herefordshire.gov.uk

A question received, a supplementary question asked at the meeting, and the responses provided are attached as appendix 1 to these minutes.

To receive any written questions from councillors.

The deadline for the receipt of a question from a councillor is Tuesday 25 February 2020 at 5.00 pm.  To submit a question, please email:

councillorservices@herefordshire.gov.uk

No questions had been received from councillors.

To consider a briefing paper on NHS Continuing Healthcare by NHS Herefordshire Clinical Commissioning Group.

The chairperson said that the purpose of this item was for Herefordshire NHS Clinical Commissioning Group (CCG) to report on progress since NHS Continuing Healthcare (NHS CHC) was last considered by the committee on 20 September 2018; minute 15 of 2018/19 refers.  Linda Allsopp, associate director of nursing and quality, and Nikki Warman, head of CHC, were invited to introduce the briefing paper on behalf of the CCG.

The principal points of the introduction included:

i.             NHS CHC was a package of care that was funded solely by the NHS for an individual that had been assessed as having a ‘primary health need’; the associated test focused on nature, complexity, intensity and unpredictability.

ii.            There was a national framework, updated in October 2018, and the CCG’s CHC process was fundamentally a whole system approach, working with local authority colleagues in terms of assessing an individual's need and whether that goes beyond the responsibilities of the local authority.

iii.          This update focused on NHS England key performance indicators, including:

·              The target was being met in Herefordshire and Worcestershire for making a decision on eligibility within 28 days of a referral.

·              The target was being met for no more than 15% of assessments taking place in an acute hospital setting; there was an expectation that no assessments would be undertaken in this setting but fast track referral for an individual entering the terminal phase of life could be accepted.

·              The target was being met for accepting all appropriately completed fast track applications.

iv.          In line with the national framework, only when there was deemed to be a change in healthcare need would a review of eligibility take place.

v.           As part of the merger between the Herefordshire and Worcestershire CCGs, the CHC policies would be reviewed to ensure that systems were working as efficiently as possible to provide quality of service to all patients.

The chairperson drew attention to the recommendations made at the 20 September 2018 committee meeting and invited officers to provide appropriate updates:

a)           a small number of senior social workers be upskilled to ensure that there is a common understanding of the medical terminology when dealing with disputes

The assistant director all ages commissioning advised that interactions between the council and the CCG on CHC were progressing well.  The associate director of nursing and quality advised that adult social care employed social workers to work on CHC and there were positive working relationships.  The head of CHC added that the joint training of multidisciplinary teams on the national framework was being explored.

b)           the CCG be requested to commit to seeking to lift Herefordshire out of its current position of 6th from the bottom in the national CHC eligibility by 50k population and to report its progress against this commitment at a future adults scrutiny committee

c)           the CCG be called back to the committee to report on progress made against their action plan recommendations in six months’ time

d)           the CCG be requested to influence the report  ...  view the full minutes text for item 45.

To consider a report on performance monitoring by NHS Herefordshire Clinical Commissioning Group.

The chairperson said that the purpose of this item was to consider a report on performance monitoring by NHS Herefordshire Clinical Commissioning Group (CCG), as requested by the committee following consideration of ‘The future of the Herefordshire and Worcestershire Clinical Commissioning Groups consultation’ item at the 24 June 2019 meeting; minute 7 refers.  In addition, details of the One Herefordshire priorities and outcome measures had been requested by the committee following consideration of the ‘One Herefordshire and Integration Briefing’ item at the 18 October 2019 meeting; minute 17 refers.  Scott Parker, director of performance, was invited to present this report on behalf of the CCG; presentation slides had been circulated in a supplement to the agenda.

The principal points of the presentation included:

a.         The differences between Appendix 1 (CCG performance dashboard 2019/20) and Appendix 3 (presentation slides) were partly due to variations in timing and the distinction between CCG data (for services provided for the population of Herefordshire) and Wye Valley NHS Trust data (including attendances by patients from Herefordshire, Wales, and elsewhere).

Arrangements for performance oversight

b.         With the merger of the four Herefordshire and Worcestershire CCGs, assurance was provided that performance information for Herefordshire (and the other constituent areas) would still be recorded and there would be an oversight structure which would consider quality, performance and finance, overseen by the Governing Body.

c.         A brief overview was provided of the development of Primary Care Networks, including oversight by a local performance forum.

d.         It was reported that there was a Sustainability and Transformation Partnership (STP) performance forum, involving system partners with collective ownership and responsibility for the delivery of performance.

Presentation slides

Urgent care

e.         Accident and Emergency (A&E) four hour waits performance (c. 76%-78%) was below the national target (95%) but performance for the most severely unwell patients was stronger.

f.          For overall performance, Wye Valley NHS Trust was c. 14-16^th out of the 21 trusts in the West Midlands.  It was reported that there were challenges with substantive post fill but vacancies were being managed and recruitment plans were in place.

g.         Within national guidance, there was a 92% general and acute bed occupancy benchmark and it was one of the functions of the A&E delivery board to achieve this.

h.         In order to achieve 92% acute bed (general and acute) occupancy there was a projected bed gap of approximately 20 beds.  The bed gap was being closed through opening additional beds and initiatives to support reduced length of stay.  It was reported that Wye Valley NHS Trust was performing well at ‘zero day’ length of stay, i.e. working with the patient to help them to return home, avoiding the need for admission to an inpatient bed.

i.           Ambulance conveyance was a key challenge for the system, with Herefordshire having the highest conveyance rate for West Midlands Ambulance Service (WMAS).  The causal factors, including geographic size and population sparsity, and alternatives to conveyance were being examined for the purposes of service  ...  view the full minutes text for item 46.

To consider the committee’s work programme.

The chairperson drew attention to the following: an additional meeting in April 2020 was proposed; provisional meeting dates for 2020/21 were noted; and, in view of committee members’ expressed interest, an informal briefing would be arranged on the transfer of responsibility for the delivery of Herefordshire’s mental health and learning disability services to Worcestershire Health and Care NHS Trust.

The vice-chairperson suggested that, in view of previous discussions about frailty and about ambulance conveyances, that an item be added to the work programme on ambulance services.  The chairperson suggested that this could be in the form of a briefing on broader urgent and emergency care pathways.

In response to a comment from a committee member, the assistant director all ages commissioning said that he understood that draft organisational structures for the Herefordshire and Worcestershire Clinical Commissioning Group had been prepared and this could form part of a future work programme item.

A committee member felt that the rationale and justification for the closure of ambulance stations, resulting from decisions at a regional level, should be explored in more depth.  The chairperson acknowledged the point and said that the format and timing would be considered as part of the ongoing review of the work programme.  The assistant director all ages commissioning suggested that this could be accompanied by the mapping of commissioning decisions, as it did not appear that all stakeholders had been consulted.

Resolved:  That

1.           Officers, in consultation with the chairperson and vice-chairperson, be authorised to update the work programme accordingly.

2.           The provisional meeting dates for 2020/21 be agreed.

An additional meeting has been scheduled for Monday 6 April 2020 at 2.30 pm.

The next scheduled meeting was Monday 6 April 2020.

[Note: due to the coronavirus outbreak and related social distancing measures, this meeting was cancelled subsequently]