To receive an update on both the commissioning and the work of Healthwatch Herefordshire, and to consider areas that Healthwatch has raised for inclusion in the committee’s work programme for further scrutiny.

The director for adults and wellbeing introduced the item. In setting some context, he explained that Healthwatch was commissioned by the council and, through the Health and Social Care Act 2012, was the third iteration of arrangements since Community Health Councils were abolished in 2003 that had been established formally to provide a function for public involvement in health.

There had been long standing arrangements in place for such a function through the establishment of community health councils in 1974. Councils were required to commission Healthwatch services from a third sector body, through non-ring fenced funding. The commissioning relationship was complex as it was established on behalf of the system but also the council was subject to review by Healthwatch, and so it was important to maintain the right balance between being an effective commissioner and not disabling Healthwatch’s role to hold the council to account. The new arrangements represented a significant step forward in fulfilling this role.

The chair of Healthwatch provided some background to the current arrangement, and explained that the previous iteration of Healthwatch was formed as a subcommittee through Herefordshire Voluntary Organisations Support Service (HVOSS) but was now recommissioned as a standalone organisation. It was an established company, with a new board of directors and a developing team led by a new chief officer. Further appointments to engagement and communication roles were underway.   There was still work to do in continuing to improve the performance of the organisation from these good foundations and in continuing to monitor health and care provision. Accountability was established through the formal contract with the council and in the relationship with the public as users of health and social care, in taking their views and helping them to understand what is happening within local services. It was a challenge to maximise engagement but Healthwatch continued to make progress, supported by a valued volunteer network and an established stakeholder group. The Healthwatch chair acknowledged the significant role of volunteers including two who had been co-opted to the board. The Healthwatch chair also acknowledged the support that had been provided by Healthwatch Worcestershire to help establish Healthwatch Herefordshire so that it was able to become a standalone organisation. 

The chief officer of Healthwatch gave an account of the work of Healthwatch over the past year, which commenced with asking the public what they thought Healthwatch should focus on. This had identified: GP access; public health and prevention; palliative care; complex conditions; adults social care pathway; and accident and emergency services.

The resulting plan was to focus on two areas at a time, making use of groups and gathering feedback and information, which had led to further emerging issues to be addressed at the same time as the key priorities.

The key point this year would be to evaluate what contact was the most effective and to develop relationships with key organisations to ensure ongoing dialogue to inform the work. An example included working with the CCG about public concerns over Hillside. Positive and more effective relationships were developing in the work to represent patients and the public. 

The chair asked about the issues that the public raised the most.

The most frequently cited issue was ear syringing, which was no longer provided as a free service by GPs and which was reported as difficult to access because of price and location of service providers for those who required it. Healthwatch had responded by talking to the CCG and responding with public information about the changes. It was noted that for some people a lack of treatment could have significant impact or impairment especially when combined with other health issues. Conversely, there were people for whom syringing could have serious negative health impact or where it was of marginal benefit.  It was also noted that there were elements of self-care that were appropriate for some people, and that the CCG was looking at placed-based provision for those who required essential treatment and could not easily get to Hereford. The CCG offered to provide a briefing note for members on this topic.

The chief officer described the other most frequently raised topics:

For mental health, there had been limited ways in to speak to people so a forum was set up which had identified issues including joining up services for substance misuse and emotional support. This had led to work between Addaction, 2gether NHS Foundation Trust and the CCG.  The mental health forum was working well and Healthwatch was supporting the group to be self-directed, with Healthwatch raising issues on its behalf.  It was noted that although the initial work with the public did not identify mental health, it came up regularly and was an important issue for Herefordshire. It was therefore important to ensure that any such emerging topics could be included in Healthwatch’s work. 

The director of engagement and integration, 2gether NHS Foundation Trust, welcomed the feedback that Healthwatch had provided and acknowledged the value that Healthwatch could provide to help address some of the issues.  The trust now had link workers in place to connect and build on what Healthwatch had helped to raise. 

The chairman welcomed this work.

The Healthwatch chief officer turned to the topic of access to dental services.  A focus on children’s dental health was to start in March. Feedback had suggested that in some areas such as market towns, not everyone was able to register with an NHS dentist. This had been raised with NHS England to check that there was sufficient commissioning activity, but more exploration of this issue was needed to be clearer on the situation. 

The chairman commented on the significant public health concern regarding children’s dental health.

The chief officer explained that Healthwatch was asking how people felt about water fluoridation and to promote awareness that children’s dental healthcare was free. 

The CCG chair declared an interest in the matter as his wife was a dental practitioner in the county and commented that the health and wellbeing board had identified children’s dental health as a priority focus, adding that poor dental health was a marker for health issues in later life.

A member commented that people did not realise that water supplies in the county were not fluoridated and this was not something that people tended to check when looking for a place to live. She added that some people did not want compulsory medication via their water supply, and asked if there had been any publicity on this so that parents could seek to replace it. The member also questioned whether there was evidence to support that, as role models, the public’s approach to adult dental care was poor.

The chief officer responded that outcomes from the work were awaited, but some responses suggested that people did not look after their children’s teeth and so Healthwatch was looking at numbers who although were registered themselves, had not registered their children, and was working with public health to increase the evidence base.

The director for adults and wellbeing explained that the council had lead responsibility for this matter, and the data for children’s dental health stood out in comparison with adults and which indicated surprisingly poor dental health in the county. The public health team had been tasked to look at water fluoridation and although this was not straightforward to address, it was coming up the agenda very quickly. Public health was looking at causes of poor dental health and what the best solution might be, clinically and in terms of practicalities, which would then be brought through the democratic process to ensure the solutions were acceptable to the public. He added to the CCG chair’s earlier advice by confirming that this was a priority of the health and wellbeing board to address as a strong indicator of other health issues and also in later life.

A member suggested that there was not always a correlation between fluoridation and dental health because of people moving into the county who had grown up elsewhere, and that consideration should be given to challenging peoples’ ethical viewpoints and whether they researched the presence of fluoride in water supplies before they moved somewhere.  

On another theme, the member also asked about the diagnosis of autism and whether this related to children or adults. The chief officer confirmed that this referred mostly to adults. The member confirmed that the children and young people’s scrutiny committee would be looking at the autism strategy in April.

The chief officer reported on work that had been completed regarding GP access, on which recommendations had been presented to the CCG for response.  It was noted that many opinions had been gathered regarding access to primary care which included suggestions to standardise services across all general practices, and to be able to book follow-up appointments in advance. Other feedback referred to the out of hours service, the approach to triage for appointments, access to pharmacies and requests for assistance for people with additional needs when visiting surgeries. A lot of positive feedback had been gathered which highlighted good practices. 

In summarising Healthwatch’s other projects, the chief officer summarised the following areas of work:

Regarding public health, the chief officer confirmed that a Healthwatch report on palliative care would contribute to regional work around end of life care. 

Work on adult social care commenced this week, by identifying service users to hear about strengths based assessment, and conducting a staff survey, which would be reported back to the committee once the outcomes became available in April.

It had been decided to temporarily suspend the accident and emergency project given the current pressures but this will resume later in the year.

For complex multiple conditions there was a series of focus groups to gather views and to find out how organisations worked in an integrated way.

The chair commented on the proactive and dynamic approach Healthwatch had taken to the work and on the importance of hearing from service users.

The vice-chairman welcomed the report and noted the monthly e-bulletins, which he felt were very to the point and clear, as were articles in the Hereford Times such as on dental health. He noted that the work around the priorities had demonstrated that Healthwatch had been very active.

A member particularly expressed support for the work on mental health.

A member remarked on the high level of representation of Healthwatch at different meetings and fora. It was noted that this did not capture all Healthwatch activity and that this would be reviewed to ensure ongoing effectiveness. 

RESOLVED

That:

(a)  performance of Healthwatch Herefordshire to date be commended;

(b)  a report be presented on outcomes from the Healthwatch review of the adult social care pathway and strengths based assessment at a future meeting;  and

(c)  a Healthwatch performance update be included in the committee work programme for 2018-19.