To consider the Herefordshire Service Integration Programme.

The Committee considered the Herefordshire Service Integration Programme.

Mr M Woodford, Chief Executive of Hereford Hospitals Trust (HHT), presented the report together with the Interim Managing Director of Provider Services (IMDPS). 

Mr Woodford reminded the Committee, which had last received a report on the project on 1 March 2010, that the proposition approved by NHS Herefordshire and HHT involved the creation of:

·         a new integrated model of health and social care provision in Herefordshire, with specific care pathways aimed at providing personalised high quality, safe and sustainable care for local people which promotes personal health, well being and independence; a model which is focused on providing care as close as possible to people’s homes, rather than in an institutional setting; a model which is also aimed at identifying our most vulnerable clients and shifting the emphasis from diagnosis and treatment to prediction and prevention; and

·         an integrated care organisation under one management structure composed of an integrated NHS Trust combining community and acute health services that is also integrated with social care so far as is practicable under current legislation.

The report summarised the Implementation Plan. The appended engagement plan described the engagement process to accompany the implementation phase.

The IMDPS commented on the three main areas of the implementation plan: implementation of the care pathways; development of an engagement strategy to ensure people using the services, their carers, local communities, clinical and social care professionals, independent and voluntary sector providers were all involved in the implementation of the care pathway changes; and development of the proposed Integrated Care Organisation.

She outlined aspects of the engagement strategy as set out in the report and acknowledged the significance of the proposed changes.

In discussion the following principal points were made

·         It was noted that mental health would be provided by a separate organisation, with a decision on who that provider would be due to be taken in the Autumn.

·         That a structure chart showing the various bodies involved in the integration programme should be circulated to all Members.

·         It was suggested that the Council’s Partners and Communities Together Meetings (PACTs) should be added to the engagement plan.

·         That consideration should be given to seeking views from those who had not been to hospital or visited their registered GP with any frequency.

·         It was asked what steps were being taken to ensure the significance of the changes was made clear to service users and cares.  In reply it was reported that Herefordshire Carers Support and the Herefordshire Alliance had been involved in the engagement process.

·         Members emphasised that it was important to make clear what the practical differences would be under the proposed system.  The IMDPS commented, in summary, that the key changes would be that individuals known to the health service would be monitored regularly and if there were signs of a person being unwell, and a trigger point reached, everything would them be done to provide a package of care, in accordance with a previously prepared and documented plan of care, to keep that person at home.  As part of the engagement process an example of how this would work in practice had been prepared.  Recognising that there would be some circumstances in which it would still be appropriate to go to hospital, a further example illustrating this scenario had also been prepared.

·         That the planned engagement event for the Committee to review the proposed service model should be extended to involve all Councillors. It was noted that a formal response to the consultation on the proposals would need to be made by the Committee.  In making this response the Committee could take account of any issues arising from the engagement event.  In addition a report was to be prepared in December 2010 describing the overall engagement process, the responses and any changes made to the services as a result.  The Committee requested that this report also be presented to the Committee at which point the Committee would make further observations as it saw fit.

·         A concern was expressed about the availability of domiciliary workers to provide the level of care at home envisaged under the proposals and the level of pay and training that would be available to ensure that the appropriate quality of care was provided. It was agreed that this would need to be considered as part of the engagement event involving the Committee.

·         The need for the proposals to be explained in plain English was noted.

·         Clarification was sought on IT compatibility.  Mr Woodford commented that this was being considered as part of the project, with an initial focus on what immediate practical steps could be taken, before considering more ambitious changes.  He observed that if a single organisation were to be created as proposed, IT arrangements would become easier.

RESOLVED:

That    (a)        the engagement programme be supported, with the recommendation that it be extended to involve presentations to the PACTs, to seek views from those who had not been to hospital or visited their registered GP with any frequency and to provide an engagement event for all Councillors rather than for the Committee alone;

            (b)       following the planned engagement event for Councillors a report be made to the Committee seeking the Committee’s formal response to the consultation on the proposals, allowing the Committee to take account of any issues arising from the engagement event;

            (c)        that the report to be prepared in December 2010 describing the overall engagement process, the responses and any changes made to the services as a result should also be presented to the Committee, at which point the Committee would make further observations as it saw fit; and

            (d)       a structure chart showing the various bodies involved in the integration programme should be circulated to all Members.