To provide a summary update on neighbourhood health progress in Herefordshire.

Dr Nigel Fraser introduced the report and delivered the presentation 'Herefordshire Neighbourhood Health' (link).  The main points included:

i.             The population of Herefordshire was older and ageing faster than the national average.  Combined with the dispersed geography, this created challenges for service delivery.

ii.            Herefordshire was one of 43 sites participating in the National Neighbourhood Health Implementation Programme.  Attention was drawn to the vision statement ‘Together we're creating a Herefordshire that is the best place to grow up, thrive, grow older and die well - enabled by Integrated Neighbourhood Teams, empowered communities, where the person's goals or needs are prioritised’.

iii.          The local model of care focused on earlier identification and coordinated support for people at greatest risk, with neighbourhood response teams and a single point of access to provide alternatives to hospital admission where appropriate; work was underway to extend the single point of access to a 24-hour, seven-day service.  Dr Fraser estimated that reducing hospital admissions by around five each day could eliminate corridor care at the County Hospital.

iv.          A bid had been submitted through the national neighbourhood health centre estates programme, using a hub-and-spoke approach suited to Herefordshire’s rural geography; Nelson House in Hereford was identified as the central hub.  An overview was provided of the development work being undertaken within the Primary Care Networks.

v.           Eleven delivery workstreams had been established, supported by enabling work on estates, digital and data, and finance and contracting.  Dashboards were being developed to monitor metrics and outcomes.

vi.          Emergency admissions for Herefordshire patients had reduced during 2025/26 (down 3%) but this had been offset by increased activity from Powys (up 6%).

vii.         The Integrated Care Board (ICB) had made £1.5m available for Neighbourhood Health in Herefordshire, with business cases being developed for the single point of access hub and for the expansion of preventative and proactive care.

The principal discussion points included:

1.           The Chairperson noted that local people would welcome the reopening of community hospitals.  Sarah Shingler reported that a strategic review of community hospitals was nearing completion.  The intention was for the hospitals to develop as local hubs, while retaining appropriate inpatient and ambulatory services, with voluntary sector space.  Later in the meeting, it was clarified that the review was expected to be completed by September/October 2026, with a view to implementing changes from March/April 2027.

2.           The Chairperson highlighted rural transport and access constraints, including the absence of evening bus services.  Dr Fraser acknowledged the model would need to take account of Herefordshire’s dispersed population.

3.           The Chairperson sought assurance about cross-border arrangements for residents using services in Powys and about activity to address discharge delays associated with patients from Wales at the County Hospital.  Sarah Shingler outlined discussions with the Welsh Government and Powys Teaching Health Board, including strategic work on admission avoidance and discharge-to-assess pathways; financial matters continued to require national-level discussion.

4.           The Leader of the Council made the following observations: preference was expressed for wording such as ‘living well to the end of your life’, rather than ‘die well’; the hub-and-spoke model map compressed the shape of the county and placed some of the neighbourhoods at incorrect compass points; the future of the community hospitals should form part of the strategy; and case studies would help the public better understand the proposed changes.

5.           In response to a question about how access to primary carewould be transformed, Dr Fraser said GP access was one workstream within a wider integrated model and emphasised the intention to provide targeted, proactive support for residents with the highest needs; it was noted that Herefordshire was generally performing well in terms of national targets for GP appointments.

6.           In response to questions from Jo Newton, Dr Fraser said that safeguarding was embedded in the new ways of working at Primary Care Network / neighbourhood level and acknowledged that people with complex needs should not be expected to navigate complex health and care systems themselves; services should instead identify needs and coordinate support around them.  Sarah Shingler added that the single point of access hub was intended to allow patients and families to make direct contact.

7.           Stephen Brewster emphasised that voluntary and community sector involvement would need appropriate resources.  Sarah Shingler commented on opportunities for voluntary sector participation, including a pilot placing voluntary sector support alongside call handlers and clinicians within the single point of access.

8.           The Chairperson noted that some rural GP practices operated from small and outdated buildings, potentially limiting the scope for flexible space for visiting practitioners.  Dr Fraser acknowledged that one size would not fit all, particularly for rural communities, and there would need to be inventive solutions using a mixture of health and community assets.

9.           Zoe Clifford commented on the potential to shape the model at a local level around the needs of Herefordshire communities and emphasised that prevention and reducing the number of people entering the highest-risk cohorts should remain central to the programme.

10.        Simon Trickett commented on positive feedback from the national priority programme director for neighbourhood health during a recent visit to the ICB cluster.  There was a brief discussion about the potential implications of Local Government Reorganisation for the future footprint of the ICB.

Resolved:      

That local progress in developing neighbourhood health be noted.