Agenda and minutes

To confirm the minutes from the previous meeting

The minutes of the meeting from 13 December 2017 were agreed by the Members present and signed by the Chairman.

To receive any apologies for absence

Apologies for absence were submitted on behalf of Cllrs Brown and C Wyatt-Lowe.  The Chair commented that Cllr C Wyatt-Lowe is unwell and noted the Committees best wished for a speedy recovery.

Cllr Birnie was not present.

To receive any declarations of interest

A member with a disclosable pecuniary interest or a personal interest in a matter who attends a meeting of the authority at which the matter is considered -

(i)            must disclose the interest at the start of the meeting or when the interest becomes apparent

and, if the interest is a disclosable pecuniary interest, or a personal interest which is also prejudicial

(ii)           may not participate in any discussion or vote on the matter (and must withdraw to the public seating area) unless they have been granted a dispensation.

A member who discloses at a meeting a disclosable pecuniary interest which is not registered in the Members’ Register of Interests, or is not the subject of a pending notification, must notify the Monitoring Officer of the interest within 28 days of the disclosure.

Disclosable pecuniary interests, personal and prejudicial interests are defined in Part 2 of the Code of Conduct For Members

[If a member is in any doubt as to whether they have an interest which should be declared they should seek the advice of the Monitoring Officer before the start of the meeting]

The Chair declared a personal interest that her practice as a community pharmacist does occasionally take her to Hertfordshire now because the area boundaries of the area that she work in for her company do include Tring, so she occasionally works in Hertfordshire now but there’s nothing on the Agenda looking at community pharmacy tonight. 

An opportunity for members of the public to make statements or ask questions in accordance with the rules as to public participation

There was no public participation.

The Chair advised that action points can be found on pages 4 to 5 of the report and advised that the consultation on the opening hours for the Urgent Care Centre is live at the moment so would be good if we can come up with our thoughts on it so then we can put them to Full Council so Dacorum Borough Council, a community leadership organisation, can take a view on it, asking, has anyone got any thoughts on the opening hours of the Urgent Treatment Centre?

Cllr Taylor commented that he would like to outline to the Committee is the following:  It is quite apparent from the feedback that we have received from a number of different sources, not least from people that have attended some of the consultation meetings that we know are going out when Helen was here with her Chief Executive and six other senior members of the various trust bodies that the feeling in Dacorum is that they want the Urgent Treatment Centre to be a 24/7 provider and with the doctors on call at Hemel Hempstead, not at Watford.  We feel that our residents want to see that Urgent Treatment Centre being a provider of as many of the NHS services as are available to the general public. 

There are a number of the Councillors here who attended the confidential conversational meeting that again Helen was ably supported by her Chief Executive and six other senior management representatives as to what they were going to deliver in the road show that they were taking around the area. 

Now it’s pretty obvious to me that the feeling of the general public in Dacorum is that they want as much as they can possibly have in a hospital that is providing less and less and less.  I use the example many times in this plea that when I first came to this area in 1982, there were two hospitals and there was, if you want to really massage the figures, there was a third, I think it was called Hill End at that time, which was the mental hospital that served this particular area.  Now in those thirty-six years that I’ve been in Hertfordshire it’s pretty obvious to me that our hospital services have decreased and our population has more or less doubled in those thirty-five, odd, years. 

I don’t think it unreasonable, Madam Chairman, and you may like to take this in your own words, as a proposition, but I would feel it appropriate that we, as Dacorum Borough Council put forward a proposition in Full Council that we will champion the Urgent Treatment Centre to provide as much and as many of the services that the NHS can offer at the Urgent Treatment Centre.  I would suggest, Madam Chairman, that if you want to put that forward as a proposition in your own words, I will, if those own words coincide with what I’m thinking of, will be pleased to second it.  We  ...  view the full minutes text for item 5.

Cllr Guest introduced the item; she asked the committee members if they had any issues, or wished to highlight any issues on behalf of other Councillors.

Cllr Hicks asked if the Committee will be we looking at the various reports that are sent out to us, at Scrutiny Committee meeting.

The Chair confirmed that yes, we will come to those at the appropriate items.  We’re not at the work programme yet, we altered the running order of the meeting to bring forward the items that HBrown was dealing with; the issue of the opening hours of the Urgent Care Centre and the CQC inspection and the Delayed Discharges but we’ve gone back on the Agenda to the other actions points, we are now on item 6, Issues from other Councillors.  Has anybody got any issues in their Ward or any issues that Councillors from other Wards have reported?

Cllr Howard, guest Member at the meeting, advised the only Health issue in her ward relates to pollution, which she believes has been dealt with in various ways by various Committees and actions underway, so not anything more to say on that item.

An opportunity for Councillors to ask Helen Brown and Esther Moors (WHHT) questions about the presentation delivered to the Membership on 25 January 2018. (presentation slides are included in pack for reference)

HBrown advised that an update was provided when they attended just after Christmas and Katie spoke to the CPC report.  I think that most of the people in the room were here and heard that or have probably picked up some of the key messages since then.  I wasn’t proposing to do a big representing of the findings but I’m very happy if people have got questions that they would like to ask me about to take those and if necessary to go and find the answers if I can’t answer them today.

Cllr Taylor added that that because following that private conversational meeting, the slides, together with the slides for the Herts County Council, the two Herts County Council reports as well, were distributed, so they are in the pack before us all tonight.

HBrown further commented that overall we’re pleased to have come out of special measures, made a lot of progress in a lot of areas.  Emergency care is our big pressure point and improvements at Hemel in the services that are rated by the CQC but that’s a relatively small part of the overall CQC picture because they focus more on the services that are offered.

Cllr Timmis referred to A&E services and asked whether, as in Luton and Dunstable, there is a GP service running alongside? To siphon off the patients who are neither accident nor emergency?

HBrown responded that we don’t have exactly the same service model as Luton, but we do have GPs working in our Minors’ section of A&E, and we have quite a complex kind of set of triage and streaming arrangements but yes, people walk in, they get an initial assessment by a Triage Nurse and if their needs can be met by a GP or a nurse, they get streamed to Minors.  If they need to see a consultant or a specialist they go through to Majors.  We’ve had lots of people come and look at our A&E model including Pauline Phillips, who’s the national emergency care lead and the Chief Executive at Luton and Dunstable and she has confirmed that she thinks our model is good and that we’ve got good arrangements in place for patients who prevent the flow of complexity needs.  Actually at Watford, it’s less of an issue than it is for many other areas in Hertfordshire.  We don’t have such a high proportion of public care attendances as other A&E departments do. 

Cllr Timmis further queried; do you have an emergency ward, so that patients whose decision has not been made, at least don’t necessarily go up at all aren’t being held up?

HBrown responded to advise that there is a whole range of alternatives, so yes, because, there are lots of different decisions that get made for patients who come through emergency care, sometimes you can go home, with ongoing care with your GP or outpatient follow up.  Sometimes it’s you definitely need to go through for an admission  ...  view the full minutes text for item 7.

Collaborative presentation between WHHT, HVCCG and HCC

The Chair advised that delayed transfers of care is the term that the health world use these days for what the media call bed blocking.  I personally think bed blocking is an unfortunate term because it’s not the poor patient’s choice or fault they’re stuck in hospital. It’s because there’s things happening preventing them going home when they’re fit to.  The chair asked HBrown to say where West Herts Hospitals Trust is at from the health world’s point of view?

HBrown advised that EGlasser is looking at the information that Ian circulated, the Herts County Council overview, HBrown added that she herself is not an expert in delayed discharge, and says that particularly because the devil is in the detail and the rules are quite esoteric and complicated about how people get counted, so unless you’re really immersed in it, it’s easy to lose track.  Patients’ journeys through hospitals vary and actually it is a relatively small number of patients who need formal ongoing care following discharge, either from social care or from health.  Delayed discharges generally relate to patients who require an ongoing package of care, either health or social care but they are only counted after a particular number of days and after a particular number of steps and processes have been triggered, so they only present a small bit of the picture.

HBrown referred to and guided Members through data in an information provided in a pack she has put together.

The Chair thanked HBrown and firstly extended a welcome to Committee to Cllr Howard, advising that as she is attending as a non-member of the Committee, she will not be able to take part in any votes, but advised she is more than welcome to ask questions.

The Chair continued that, as has already been mentioned, there is a disparity of delayed transfers between East and North Herts, The Lister Hospital in Stevenage and the West Herts Hospitals Trust in Watford.  Basically there’s a far lower percentage of delayed discharges at The Lister than there are at Watford and the County Council’s Health Scrutiny Committee is going to be having a topic group that’s going to be looking at the reasons for that in April or May this year.  County is carrying out scrutiny on it.

KMinierasked if it was possible to see wards sometimes open up at Hemel to take up some of the excess, to alleviate some of the problems at Watford to actually have these people that are delayed for whatever reason, as long as it’s not a clinical reason.

HBrown responded that Herts Community Trust have got two wards at Hemel that provide post-acute care.  We would love to, HCT increase the number of beds that they were able to provide, the funding wasn’t available so if David was here, I’d be looking at David, but the CCG wasn’t able to make funding available to enable the Community Trust to do that.  From our point of view our biggest challenge currently  ...  view the full minutes text for item 8.

Cllr Taylor suggested this item be carried forward to the next meeting.

Cllr W Wyatt-Lowe gave a verbal update and advised that the biggest problems as far as the County Council are concerned is staff retention.  Upcoming at this month’s meeting is staff retention throughout the Council because it’s the recruitment of care workers that is probably the most difficult at the moment, so that will be covered extensively.  If anybody has any stories or bits of information that would help I would happily raise them at Audit, I do intend to make sure that the problems of recruiting care workers in particular parts of the country are thoroughly explored and we look into what we can do about it.  Today I have been to a neighbouring care provider where things look a lot better.  What they have done to improve matters is to reduce or develop their own training courses, they’ve got all the relevant certifications, they’re teaching right up to Level 4 Leadership and Management, all within their own staff.  It’s become the training and the opportunities for self-development are very pleasing indeed.  That has come after the County increased the minimum rates for care workers by 71p a few months.  They’re not particularly understaffed but this particular care provider doesn’t operate in Dacorum.  I’d love to get the same figures or details from Care By Us but they will come out at this Audit meeting because part of what we’ve been doing is going to different care providers and we will talk about it at the next meeting. 

Another area that seems to be worth following up, which is improving; messaging so that anything in the discharge process gets sent, any event, gets sent to all interested parties, whether they be voluntary sector, Age UK, whether it be CCGs, Doctors or care providers, care homes, I suggested that they need to invest in a proper messaging system.  There’s one thing I’m afraid I do need to say, though.  After the last meeting at which I produced a sheet of notes that I was going to read out because the meeting had gone on very late, I was told that this set of papers when I did it in proper English as opposed to notes, would be published on our Website as part of the records of this meeting and nothing seems to have happened.  Is that because I’m missing it?

RTwiddle responded to advise that it is in the appendices of the minute of the last meeting and has been published.

Action Point: Cllr W Wyatt-Lowe to circulate HCC Public Health meeting notes to Committee members (meeting taking place 8 March).

The Chair asked if Cllr Birnie had submitted his apologies for the meeting.  RTwiddle confirmed that nothing has been received.

Cllr Timmis, noting that Cllr Birnie is not present, made some observations about the report; , that this Health and Wellbeing Board, does this have anything to do with the Health and Wellbeing building being set up in Hemel Hempstead, although it’s a separate thing, it’s not anything to do with the Health and Wellbeing Board, that’s my first question.  The second thing is looking at this Item 2 on this report, it seems to me extraordinary, and extraordinary mess, if you don’t mind me saying of the fact that the STPs, another acronym which has not been written out, which assume is the Strategic Transformation Programme.

The Chair confirmed that it was, but it now stands for Strategic Transformation Partnership, it’s from a plan to a partnership.

Cllr Timmis commented that this is yet again, another NHS type changing everything, which costs more money, changing headings etc, but this, it says here in Item d, that the establishment of STP, in 2015 has rather complicated the issue but who has responsibility for certain items.  I find it extraordinary because they’re doubling up or overlapping, if you like, it appears and that again will cause more money and more waste of money, I should say, when you’ve got overlapping of the Health and Wellbeing Board and the STPs and it says that Hertfordshire Board has found it difficult to find a role in the STP, because the strategy is largely driven by the NHS and timescales are set nationally.  It’s not together, properly organised thinking.  This, you could roll out into a lot of what’s happening with the Discharge of Care and the fact that you’ve got all sorts of different bodies all working on different levels.  I find this really disheartening.  It says here “the division of responsibility between the elected body and the CCG to fund integrated provision in these straitened times has led to demarcation disputes in Hertfordshire”, which we’re already aware of, which again seems a pity that we’re spending time doing that rather than actually looking at care for patients.  It says here “one very useful function of the Hertfordshire Board has been the gathering of statistics to underpin its planning”.  It then goes on to say a bit further down “The statistics concerned are presumably considered appropriate for each of these life stages but, as a result, are not, unfortunately, always comparable.”  That doesn’t sound very useful.  Another drawback is that at the end of the reporting period some of the statistics will necessarily be out of date.”  So, it seems this is a report, rather than actually saying what’s going to be done about it?  Because it does seem to me that it’s not working.  An Appendix actually came with the second report but I won’t say any more.  I just feel this is a little worrying.

The Chair suggested Cllr  ...  view the full minutes text for item 11.

The Chair referred to the June meeting, which includes the Marlowes Health and Wellbeing Centre, hopefully after we’ve visited it.  We’ve got an update on Gossoms End.  There’ll be the standing CCG item, so Rebecca can you make sure that Member Support do liaise with the CCG because it’s been a pity they haven’t been here to discuss things with. 

Action Point: RTwiddle to ensure CCG representation at future meetings.

KMinier referred to new carer’s strategy and new upgrade coming out for ECCN with TCCGs and you might like to see that or have someone talk through.  The Chair asked for Carer’s Strategy to be added, with either Iain MacBeath or Cllr C Wyatt-Lowe to speak to the Committee on that.

Action Point: RTwiddle to arrange for Iain MacBeath or Cllr C Wyatt-Lowe to attend meeting to discuss Carers Strategy.

EGlasser advised that the Hemel Hempstead Hospital SOC is going to be coming out, it was going to be April but now it sounds like it’s May.  It will be going to CCG Board in May.  You might to look at the report when it does come out.

Cllr Maddern added that the SOCis a hugely important item and our next meeting’s not until June and that’s coming out in May.  I would like to propose that we have an extra meeting sooner than the June Meeting to discuss the SOC.

EGlasser added the issue is that w do not know when in May, or if it will be May, that it will come out.

The Chair requested that Cllr Maddern liaise with the CCG as to when it’s coming out and then just before or just after it comes out then perhaps we could have another meeting and and get David Evans here so he can discuss it with us.

Action Point: Cllr Maddern to liaise with CCG and advise Member Support, copying The Chair & Cllr Taylor, as to when the SOC is due to come out so a meeting can be planned.

Before closing the meeting, the Chair thanked RTwiddle on behalf of the committee for all her hard work, as this will be her last meeting prior to leaving Dacorum.  The Chair expressed that the Committee are sorry to see her go and wish her well for the future.

The date of the next meeting is on 4 September 2018.