Apologies were received from Councillor Alan Seldon. 

Apologies were noted from Ian Stead of Healthwatch Herefordshire.

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

Councillor Elizabeth Foxton acted as a substitute for Councillor Alan Seldon.

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 the minutes of the meeting held on 21 June 2021.

Resolved:  That the minutes of the meeting held on 21 June 2021 be approved as a correct record and be signed by the chairperson.

To receive any written questions from members of the public.

No questions had been received from members of the public.

To receive any written questions from councillors.

No questions had been received from councillors.

To consider the attached paper on out of hospital care, including Continuing Healthcare, discharge pathway and self-funders, and to determine any recommendations the committee wishes to make.

The committee considered the report by the acting director for adults and communities and NHS Herefordshire and Worcestershire CCG. The report was introduced by associate director of nursing and quality Hereford and Worcestershire CCG and the acting director for adults and communities Herefordshire Council.

During the debate the committee raised the following principal points:

·         Disappointment was expressed regarding the outstanding responses to recommendations agreed by the committee dating back to 2018. All outstanding recommendations would be combined and forwarded to relevant partner organisations for a response. In particular an update on the status of the NHS England review into continuing Healthcare eligibility was sought.

·         A further report would be brought to the November meeting of the committee with updates on the outstanding recommendations and when more substantive detail could be reported.

·         As the expected report was not available, the Committee focussed on Continuing Healthcare (CHC).

·         The impact on Hospital discharges of residents from Wales at local hospitals was raised and the discharge of Herefordshire patients from Welsh hospitals.

·         The involvement of the voluntary sector in Continuing Healthcare (CHC) arrangements was raised.

·         Outstanding CHC dispute cases in Herefordshire were raised and the current delays to resolving such cases.

·         It was requested that details of the end to end stakeholder review was shared with the committee when available.

·         The importance of ensuring that the service remained person-centred and avoided an excessive emphasis on internal process was highlighted. Such a person-centred approach should be reflected in training programmes and materials.

The recommendations below were proposed and seconded and carried unanimously.

The committee recommends:

that the council and CCG work together to provide a more substantive report to the committee at a time when a greater level of detail on progress can be reported.

that those recommendations previously agreed by scrutiny from 2018 and 2020, and identified in the report, are properly considered by relevant bodies and responses provided.

that detail concerning the number and age of outstanding CHC dispute cases in Herefordshire are provided to the committee.   

that an update on the status of the NHS England review into CHC eligibility is provided to the committee.

To consider the committee’s work programme.

The committee considered its work programme and the task and finish group scoping document on the health impact of the intensive poultry industry circulated as a supplement to the agenda. With respect to the scoping document the following principal points were made:

·         The committee provided minor changes to the scoping document and proposed a delegation to the chairperson and vice-chairperson to make any additional changes to the scoping document in consultation with officers.

·         The committee was supportive of the general outline of the scoping document. There was a discussion concerning the potential inclusion of a focus on antibiotic resistance; there was concern that this inclusion would broaden and dilute the scope of the task and finish group.

·         The scoping document would be circulated to all members of the Council, via the group leaders, and volunteers would be sought to sit on the task and finish group. When the membership of the task and finish group was finalised a chairperson could be considered.

The committee noted its work programme following consideration of the briefing paper on out of hospital care earlier on the agenda. An additional item would be added to the work programme for the next meeting of the committee in November concerning out of hospital care.

The recommendations below were proposed and seconded and agreed unanimously.

Resolved: That the committee:

Notes the recommendation tracker;

Agrees the addition of an item concerning continuing Healthcare be added to the work programme for the next meeting on 1 November;

Agrees the scoping document of the intensive poultry industry task and finish group, subject to the changes outlined at the meeting, and provides a delegation to the chairperson and vice chairperson to make changes to the scope in consultation with officers.