To hold a public accountability session for organisations within the health sector.  This session shall focus on Herefordshire Clinical Commissioning Group and the Arden, Herefordshire and Worcestershire Area Team.

The Committee received a presentation on the work of the Herefordshire Clinical Commissioning Group (HCCG) from the Director of Operations.  During the ensuing discussion the following issues were raised:

·         That work was underway with the NHS Local Area Team (LAT) to undertake co-commissioning work in specialist areas.  The HCCG would shadow the LAT from April 2015, with a shadow transfer of a small number of specialist services.

·         That the budget before the Committee included both work with the third sector and preventative healthcare within the funds spent on community medicine.

·         That the system change for mental health services would allow patients to self-refer.  There had been significant investment in the service during the year, and work was underway with the 2gether NHS Foundation Trust to ensure that the capacity within the service was taken up.

·         That ‘Virtual Wards’ were a concept that had worked well in other parts of the country, and additional staff and community teams were working with parish councils in order to support the most vulnerable patients.  The pilot was only running in Hereford, but additional work was being undertaken in order to decide what model worked best in different communities.

·         That the Hospital at Home provided for care at home. Whilst beds could be provided at nursing homes in the County, this did not necessarily relieve the pressure on A&E or provide the best solution for patients.  The Hospital at Home allowed for planned medical interventions if required, and had the support of the West Midlands Ambulance Service.

·         That simplified access systems were needed, together with more education for patients as to what the appropriate service was that they should use.  It was an uphill struggle to redirect people.

·         Patient engagement was led by both theme and communities, and was a constant process.  There was active involvement with Healthwatch in this area.

·         That there had been no surprises for the HCCG in the CQC report into the Wye Valley NHS Trust, and that there was work for all of the partners in the health and social care arena to do.   The Trust had provided additional access to their Oversight Boards for the HCCG and there were issues around the recruitment of permanent staff.

·         There were pressures on the urgent care system, and the Multi-Agency System Resilience Group was now in place to help address these.

·         That there was a regular daily phone call across the system in order to provide a condition check on the Trust. It should be borne in mind that as the Wye Valley NHS Trust was the smallest acute Trust in the country that there was a collective responsibility within the County to support its operation.

In reply to a question from a Member, the Director of Operations said that if there were to be a major incident in the County, then additional help would be sought as part of the major incident plan.  It was important that long term resilience be built into the system, and a solution to this problem would need to be found as planned care suffered when operations had to be cancelled.  More planned operations were currently being cancelled than in the past.  Additional short term capacity had been provided by way of a portable day care unit.  Non-recurring funding had been awarded in order to recruit more staff and provide more beds, but the County was heavily reliant on expensive agency staff.

The Independent Chairman of Healthwatch concurred, and added that the Trust had undertaken work which indicated that it in order to future proof its operation it would require 250 beds.  It was operating with 208 at the moment.

In reply to a question, the Chairman of Taurus Healthcare said that the company was well placed to be involved in the new systems of integrated health and social care and new models of care.  It had been involved in a pilot project as part of the Prime Minister’s Challenge Fund to trial seven day a week GP provision.

The Director of Operations went on to report on the structural changes that were taking place within NHS England, which were designed to make the it more focused on its core purpose and to build new capabilities within the organisation.

The Chairman thanked her for the presentation.