To consider what Herefordshire Public Services are doing to improve access to health services.

The Committee considered what Herefordshire Public Services are doing to improve access to health services.

The Assistant Director Public Health, the Associate Director of Integrated Commissioning and the Consultant in Dental Public Health presented the report. 

The Assistant Director highlighted the role of the Rural Access Partnership which oversaw a number of programmes to address access to services in rural areas.

He also noted the role the Committee and all Members of the Council could play in developing and improving access to rural services, particularly around transport; supporting local projects within their wards; and lobbying for changes on a wider basis that would improve the health and wellbeing of the population of Herefordshire.

The report contained a detailed appendix on access to dental health services in response to a request from a member of the public to the Committee in June 2010 that this aspect be scrutinised.

The Associate Director emphasised the improvement made to access to dental care following an exercise to procure additional dental capacity with effect from 1 October 2010.  In September 2010 the percentage of the resident population of Herefordshire who had accessed NHS dental care within the previous 24 month period was 52.16%, compared to 56% in England as a whole.   The statistics quoted in the appendix to the report were not yet able to reflect the additional capacity provided from October 2010.  The picture was therefore brighter than shown in that report.

In discussion the following principal points were made:

·         The report stated that the percentage of Herefordshire households within set distances for most key services was much lower than for the West Midlands Region and England as a whole.  Access to GP surgeries within the nationally set distance of 4km had increased from 76% in 2007 to 83% in 2008.   It was requested that a further report be made to the next meeting on access, based on distance, to GPs, community hospitals, Hereford Hospital and other specialist hospitals out of the County. As a general principle it was requested that reports showed distances in both metric and imperial measures.

It was asked whether there was any intention to make additional provision to increase the percentage of people within the set distance of GP surgeries.  The Associate Director replied that the list size of GPs within the County was better than the West Midlands average with no single-handed practices.  Coverage was considered good given the rural nature of the County.

·         The implications for access to services of the Government’s reduction in the bus subsidy were noted.

·         The role played by the voluntary sector, for example in providing community transport, and the potential implications of a reduction in support to that sector because of the financial situation was discussed. 

The Grants and Partnership Officer commented that the community transport service was provided by independent charities that were dependent on grant and subsidy.   The cost of replacement vehicles was significant and the availability of external grants to finance this expenditure was decreasing.  Currently the Council provided some support for running costs.  The resources currently available were not sufficient to support the continuation of the current level of community transport, a service that provided access to services to one of the most vulnerable sections of the community.

It was requested that further information be provided to the Committee on the proposed level of future support for community transport.

·         Clarification was sought on a report in the Hereford Times that the GP Walk in Centre was to be relocated to a site adjacent to the Accident and Emergency Unit.  The report had contained no mention of whether any form of provision would be retained on the site of the current facility at the Asda store in Belmont although requests had been made that this be considered.

The Associate Director commented that the original intention had been that the provision at the Asda site in Belmont would be temporary, pending the development of permanent provision adjacent to the Accident and Emergency Unit.  However, the demand at the Asda site and the fact that some of those attending the Centre were from traditionally hard to reach groups had led NHS Herefordshire (NHSH) to review this decision.  Plans were being drawn up, as part of the unscheduled care workstream, to provide some form of provision at Belmont. 

It was requested that a press release be issued to this effect to correct any possible misunderstanding as a result of the original newspaper report.

·         The work to improve the provision of Broadband within the County was welcomed.  It was requested that a briefing note be provided providing assurance that in pursuit of more integrated working the joint needs of health and social care were being fully taken account in this work, including, for example, the need for satellite GP surgeries to have access to Broadband.

The Chairman of NHSH confirmed that the Joint Director of ICT was considering how the use of both the Council’s and NHSH’s infrastructure could be maximised.

·         Concern was expressed about figure 1 in the appendix that showed the highest numbers of people on the NHSH dental waiting list by ward of residence were in Ross on Wye East and Ross on Wye West.   The Consultant in Dental Public Health confirmed that additional provision had been procured for the Ross Area with effect from October 2010.

·         The Consultant confirmed that the recent procurement exercise for dental care had been undertaken to address current demand and acknowledged that the proposed increase in housing in the County would need to be addressed.  This was recognised in the Local Development Framework currently under development.

·         Noting that the percentage of the resident population of Herefordshire who had accessed NHS dental care within the previous 24 month period was 52.16%, clarification was sought on the dental care accessed by the remainder of the County’s population.  The Consultant commented that there were 6 private dental practices in the County but data on dental care provided by private practices was not collected locally or nationally. She reiterated that NHSH recognised the need to increase access to NHS dental care and had already introduced measures as described both in the report to the Committee and in the Committee’s discussion of that report.

It was suggested that NHSH or the Council should include a question on access to private dental care in one of their forthcoming surveys.

·         The proposal in the Health White Paper: Equity and Excellence - Liberating the NHS to expand the regulatory role of the Care Quality Commission and require all independent health contractors such as GPs and dentists to register with the Commission was discussed.  Concern was expressed that this would prove a bureaucratic burden.  The Associate Director commented that NHSH had had local arrangements in place to satisfy itself that services being provided were of the appropriate quality.  It had previously provided advice and some resources to support independent contractors in meeting regulatory requirements.  Further advice would be provided to assist independent contractors in meeting the requirements of the new national regulatory regime.

·         Further information was sought on the finding in the Joint Strategic Needs Assessment that dental health of children was poor.  The Consultant informed the Committee of a number of preventative measures that were being taken in conjunction with dental practices and schools and with pre-school children through health visitors.  She considered that the next nationally co-ordinated surveys of the dental health of children should show an improvement.  The next survey of five year olds was due to take place in 2011/12 and the next survey of 12 year olds in 2012/13. 

The work undertaken to improve access to dental health was welcomed, whilst noting the need for further improvement in the dental health of children in particular.  It was emphasised that the Committee needed to be assured that investment in both preventative measures and increased access were beneficial in particular in the case of children’s dental health.  The Committee requested updates when the results of the next nationally co-ordinated surveys were known.

RESOLVED:

That (a)           a further report be made to the next meeting including information on access, based on distance, to GPs, Community Hospitals, Hereford Hospital and other specialist hospitals out of the County to enable the Committee to understand how the difficulties of distance are overcome or mitigated to ensure appropriate attention at health facilities;

            (b)       further information be provided to the Committee on the proposed level of future support for community transport and how any reduction would affect the access to health care;

            (c)        a briefing note be provided giving assurance that in pursuit of more integrated working the joint needs of health and social  care were being fully taken account in the work being pursued to improve broadband coverage for the County, including, for example, the need for satellite GP surgeries to have access to Broadband;

            (d)       NHS Herefordshire be requested to issue a press release making clear that it was intended to retain some form of provision at Belmont once a permanent Walk In Centre was operational adjacent to the Accident and Emergency Unit;

            (e)        NHS Herefordshire or the Council should include a question on access to private dental care in one of their forthcoming surveys; and

            (f)        updates be provided on dental health care of children in the County when the results of the next co-ordinated national surveys were published.