To receive a presentation on the work of the Clinical Commissioning Group together with an overview of the Groups current plans.

The Committee received a presentation from the Associate Director of Information, Herefordshire PCT

the Associate Director of Information, Herefordshire PCT added that the examples of patient safety and treatment that had been mentioned in the meeting highlighted the need for a clear structure in community and all integrated care organisations.

He went on to say that the walk in centre that had been constructed in an area of deprivation in Hereford had provided a service to the wider community and had provided for a subsequent reduction in A&E admissions.  GP’s were also engaging with the issue of A&E attendance, and were taking care to review patients who attended A&E regularly.

The financial position of the Wye Valley Trust should be taken within the context of the wider health care economy in Herefordshire.  Collaborative working had been very successful in cutting costs, and one-off efficiencies would be brought forward.  It should be noted, however, that the County had the lowest per capita spend on health care in the West Midlands. He undertook to provide the Committee with a briefing note on per capita spend on health care in the County.

He went on to say that Herefordshire Health Care Commissioners (HHCC) was established in shadow form as the Clinical Commissioning Group for Herefordshire in April 2011.  HHCC was then established as a sub-committee of the NHS Herefordshire (PCT) Board with delegated responsibility for the main elements of health care commissioning in Herefordshire.  The HHCC group was led by clinicians and supported by corporate PCT Staff.

From July 2012 HHCC could begin the Department of Health CCG authorisation process which would enable HHCC to be established as a statutory organisation, subject to the enactment of the new Health and Social Care Bill, by April 2013.

He went on to say that in 2011/12 NHS Herefordshire developed a Quality, Innovation, Productivity and Prevention (QIPP) plan that focused on transforming the way health care was delivered in Herefordshire whilst providing £10.8m in savings for reinvestment in frontline services.  By December 2011 £7.8m of savings had been delivered which was a 99.5% achievement against plan. In 2012/13 Herefordshire would need to deliver an additional £11m in QIPP savings in order to ensure the future sustainability of the Health Economy.  Seventy additional suggested opportunities had been put forward to provide input to the plan, of which forty five had been taken up. High impact changes had been flagged up under the twin topics of community services and dementia care.  These would be provided by the community services team and the neighbourhood teams. He was confident that should these two areas be delivered, then the rest of the QIPP plan would be delivered.

The Assistant Director went on to report on the structure of the Herefordshire Health Care Commissioners.  The structure had been seen at a national level, and the work with GPs had been held up as an example of best practice.  He said that the authorisation process consisted of 6 domains wherein competency had to be demonstrated, together with a number of case studies that showed where an impact had been made on the health economy.  It was important that those outside the County that HHCC should be in apposition to demonstrate an understanding of all aspects of commissioning.

In the ensuing discussion the following points were made:

That the Herefordshire Health Care Commissioners was led by clinicians and the views of the local population by way of consultation.

That of the 94 competencies that were required for the Department of Health authorisation to establish HHCC as a statutory organisation, there were 61 longer term measures and 58 key lines that were emerging around the QIPP plan.   It was expected that these areas would be considered on a quarterly basis.

A Member said that there was concern regarding the way in which the performance of the Ambulance Service was judged, as the present system meant that the service was liable to target response times in urban areas, where distances were shorter.  The Ambulance Trust needed to be more engaged in the County as there were real concerns as to how standards of response times could be raised in rural areas. 

In reply to a question, the Assistant Director said that there was evidence that access to services in areas of deprivation in the County could be improved.  A public patient engagement meeting was set up to explore the issues, especially concerning children, young people, and white working class males, but the audience had been made up of those involved in the public sector.

The Assistant Director said that there was an over medicalisation of births in the County as the average cost of a birth in the West Midlands was £678, whilst in Herefordshire it was £1,500.  This pathway would be looked at to find ways of reducing costs.

He concurred with the suggestion from a Member that more use should be made of the Third Sector, and said that some of the services that had to be delivered by HHCC could be provided more efficiently by that sector.  Personal budgets would help support these organisations.  The HHCC commissioned large medical pathways, and consideration would be given as to how these could be reduced into smaller units that would enable third sector organisations to bid for them.

In reply to a further question, the Assistant Director said that management reductions were being achieved by mapping staff to alternative organisations.  The Clinical Commissioning Group would not have more than thirty staff once it was in place.  He went on to say that the GP Parliament was elected by the 24 practices in the County and it had four representatives on the Herefordshire Health Care Commissioning Board who were elected by specialist field.

He added that when the PCT ceased to exist, responsibility for the health of the population of the County would fall to the Council, not the Clinical Commissioning Group. He concurred with comments that public engagement with public health service was important, especially in areas such as South Wye and Leominster.