To receive a presentation on the work of the Wye Valley NHS Trust and an overview of its plans for its future.

The Chairman welcomed the Chief Executive, Wye Valley NHS Trust (WVT) and the Director of Service Delivery to the meeting. 

The Chief Executive provided the Committee with a presentation on the Trust (appended to the Minutes as Appendix 1).  In the ensuing discussion, the following points were made:

The Director of Service Delivery reported that the key to the model was to ensure that care was provided for patients closer to the home and to reduce the numbers of patients admitted to the acute hospital. In reply to questions he went on to say that:

·         There was a target to discharge the elderly sooner from hospital in order to allow them to recuperate in their own homes. This would allow patients to have greater independence. 

·         the Wye Valley Trust didn’t have control over the provision of wardens in sheltered housing, and did not manage Ledbury Community Hospital.  There was a focus on changing this into a resource centre for the community, with the intention of reducing the number of admissions to the acute hospital. These facilities were factored into any considerations of bed numbers in the County.

·         Adult Social Care had been seconded under the purview of the hospital, but that the delivery mechanism remained the same.  There was a great deal of management of the process, which was co-ordinated by the Health and Wellbeing Board, the Clinical Commissioning Group and Adult Social Care. 

·         whilst no-one was turned away from A&E, there was a need to educate the population as to how the service should be used most correctly.  Non-attendance rates at clinics had been reduced from 10% to 5% by sending reminder letters, but further savings could be made in this area.

The Director of Service Delivery reported that there were issues associated with patients leaving hospital, and the discharge planning process was now designed to ensure that prescription were written the day before the planned patient discharge.

The Chief Executive WVT went on to say that a great deal of work had been undertaken with the practitioner led Service Units as it was important to instil the right ethos into the organisation.  In a similar fashion, the staff had been consulted widely on the values of the Trust, and the behaviour that underpinned these values.  The Service offering had been designed to ensure that the Trust was a population based service provider and was not concentrating solely on acute care.  Neighbourhood Teams were working with GPs to devolve care to the patient’s home wherever possible.

In reply to a question, he said that there were alternative models that the Trust had learnt from, a particular example being Torbay, who were prominent in providing zoning teams for their area, which had seen a reduction in A&E admission rates.

He added that it was clear that greater development of community services was important, and an increase in the resourcing of Neighbourhood Teams was being considered.  The Community Hospitals would not be closing, but changing their roles to that of a resource centre.  This would providew an opportunity to  promote home based care and extend healthcare with concommitent savings.  If the changes were focussed and clinically sustainable then the bed base number would reduce as a result. 

In reply to a comment that in an apparent desire to free beds within the Hospital elderly patients were being discharged late at night, the Chief executive said that such practice did not accord with the Trust’s own policy and best practice, and should not occur.

The Chief Executive went on to say that additional short stay surgery could now be undertaken in line with requests from Commissioners, and private healthcare facilities were being looked at to complement the work of the Trust.

The committee noted the key performance indicators that were highlighted by the chief executive.  He reported that the summary hospital-level mortality indicator (SHMI) for the hospital was at 108, when the national average was 100 and that there had been no MRSA infections for over a year.  There had been a CDiff outbreak in the spring last year, and the action plan that had resulted had been delivered against.

Material improvements had been made in stroke services, and they were well above the benchmark in this area.He chief executive concurred with a comment from the vice-chairman that this was a challenging area for a rural county.

In reply to a question regarding access targets, the director of service delivery said that there were a number of reasons why these figures had fallen slightly.  Clinical urgency meant that a high volume of cases were being seen quickly and he wouldn’t have expected to see a lower figure.  In reply to a further question, he said that the action plan that was in place would deliver by the 31 march 2012.  All available capacity had now been identified, and there was sufficient capacity within the system to accommodate patients.   Risks that mitigated against a successful outcome for the plan included a bout of severe winter weather or an outbreak of influenza.