Agenda and draft minutes

To confirm the minutes from the previous meeting

The minutes of the previous meeting from 20 June 2018 were agreed by the Members present and signed off.

To receive any apologies for absence

No apologies for absence were submitted. It was noted that there were three people absent.

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]

There were no declarations of interest

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 Actions points from the previous meeting were reviewed and agreed, outstanding action points are listed below along with the actions points added from the meeting held on 4 September 2018.

Verbal update

David Evans provided the following Update to the Committee Members (the slides attached as Appendix 1 refer);

Questions from the floor followed.

Cllr Taylor asked if David knew where the meeting was going to be held? David said that he did not know at this time and it was agreed that the details of the venue would be forwarded to Sharon Burr when available.

Cllr Birnie felt that there appeared to be a disparity on the slide regarding the four partners, talking about Luton and Dunstable and then on the next one talking about Herts and Essex. David replied that he thinks that is t on the diabetes pathway – and the reason that the hospital is on there is because even if you live in Hertfordshire you would possibly use that hospital.

Cllr Guest requested at this point that questions were saved until the end of the presentation, unless there is something that needs to be clarified now.

Cllr England enquired whether the campaign included Dacorum Digest as that may be a good thing to pick up.  David replied that he didn’t know the specific places they would be promoting it, but said that if the Councillor felt that it has a good reach then they may use it as anywhere we can connect closer to our communities is good.  There will also be a local campaign on the back of the national one.

Cllr Birnie asked where the figure of 65% for GP access came from?  David explained that this related to extending bookable appointments to 7 days a week which increases the normal finish at 18.30 through until 20.00 so you have a service that is ‘8 til 8’ at 7 days a week, and the target is for 100 percent of our patch to be covered offering that service by November.

Cllr Birnie asked about muscular skeletal services and would that treatment take place within GP surgeries? David confirmed that the treatment can take place in a variety of settings, some of it will be in practises where there has been space allocated, some will be in places that have been rented, some will be on the phone, some will be through video conferencing as well, depending on the type of physiotherapy or intervention it will depend on where they go or how they are seen, tailoring the response to the individual.

Cllr Birnie questioned the figure of 85% percent for A&E with a target of 95%, and David explained that this was for the percentage of people being seen within four hours. 

Cllr England asked for more information regarding Connect Health and David told him that   Connect Health are a private organisation that have been running for around 8 years with contracts in north London and other areas around London.  Feedback is positive.  Cllr England asked who was doing that before and was told that it was West Herts Hospital Trust.

Cllr Hicks said that David used a phrase which really annoyed him when  ...  view the full minutes text for item 28.

Ian Armitage gave a verbal update;

‘At the urgent treatment centre in Hemel Hempstead  we have new patient testing in place and there are just two outstanding, waiting for sign off from the clinical trust as there have to be clinical protocols in place to make sure the equipment is safe to use in another environment.  We are also developing multi- disciplinary teams at the urgent treatment centres, so job specifications have been put in place for a pharmacist and it has been agreed that the community navigator team who currently work closely with GPs will be based at the urgent treatment centre. They are considering the potential for an Emergency Care Practitioner car, they have one car at the moment that goes to care homes and helps with preventing people going to hospital by dealing with whatever circumstances they find at the home, and feel that by having one based in the urgent treatment centre there could be potential for offering a similar service to people in their own homes.  There has been quite a steep increase in activity since April this year, from hovering around 75 attendances at the UTC per day, by the end of July that had risen to 95 – so quite a considerable increase.  If you then look at the comparison with the attendance for the same period at A&E while there was a slight rise and month on month variation, what you do see is the significant difference between the rise in the UTC attendance, so you can draw the conclusion that there is activity that would otherwise of gone to A&E being driven towards the UTC’.

The workforce review:  ‘Currently looking at whether we can extend the working hours at the UTC until 12 o’clock, a commitment was given during a public exercise where we said as part of this consultation we will look to see whether we can do this and are currently looking at data around GP availability, the graphs that I am showing tell that there is not a significant increase in clinician time or in clinical staff, we have done a survey of GP’s to see if anyone is expressing an interest in working extra hours.  Once we have all the information we have to put together a board paper for November where we will provide an update on those findings and there will be a board decision as to whether or not we actually do move to opening hours of 12 o’clock or whether, in fact, we remain the same.  At the moment it doesn’t seem to be the activity that would indicate the need to do that but more importantly, we haven’t had a tremendous feedback from the survey that we have done of the GP’s of people interested, and what we do need to keep in mind at all times is the safety of patients, we don’t want to offer a service which then has to be closed intermittently because we can’t staff  ...  view the full minutes text for item 29.

Sue Fogden gave a verbal update;

‘The CCG does not have any access to capital which needs to be put into context first. GP premises are funded and regulated by NHS England and the CCG has accepted the delegation of that function.  NHS launched a fund programme called Estates Technology Transformation Fund ETTF and that comes with a set of regulations about how much money you can spend and how you spend it.  What happened with Gossoms End and a number of national projects is the rules needed to change to meet the new ways of working  the agenda and we have been waiting two years for those regulations to change and to be published and we are still waiting. CCG had a number of meetings with the national team to try and look at how this could work and we could unblock some of these things and initially it looked positive in July whilst the new rules hadn’t come out we are working behind the scenes to find ways of unblocking it.  There was a consultation regarding Gossoms End in September 2016 that completed about not supporting the intermediate beds and that was the decision from that consultation, which left a huge void.  We already have one GP working there at Gossoms End Surgery and we still have three other surgeries in Berkhamsted and all four practises got together to think about how they could work together as we are looking at workforce issues as well as capital issues and how we can offer some resilience to those practises in terms of workforce and GP’s.  Those talks meant that one practise decided not to partake which was their decision to make, so we were left with two town centre plus the surgery that is already based at Gossoms End.  The CCG supported a project through this fund to relocate two of the town centre practises to the void area at Gossoms End following the closure of the beds.  We haven’t got the revised rules issued so we are still tied in that respect so we have tried to find ways around this and we have looked to see if we can apply exceptionality status to some of these projects and we have met with the council and various other developers to look at how we could alternatively fund those projects.  So with Gossoms End we think we have found a way with NHS England through exceptionality, we have funded a paper to be written by a specialist on business cases to try and get this exceptionality passed, and we are on track to get this to NHS England within the next two weeks.’

Cllr Taylor said  Due to the retirement of current GP’s in Berkhamsted the CCG highlighted an issue with the provision of GP premises in Gossoms End,the complexity of health funding makes it difficult for Health Bodies to find the investment required to resolve the problem – consequently the CCG has approached the Council to see if  ...  view the full minutes text for item 30.

To provide an update on the new premises at 41 The Marlowes and agree a date for a visit.

The Health in Dacorum Committee requested a visit to the new Marlowes Health and Wellbeing Centre and after discussions with Mark Graver from the Hertfordshire Community NHS Trust, he has proposed some dates for members of the committee to visit. The dates are as follows:

·         Thursday 13^th September 2018                      2.00 – 5.00 p.m.

·         Friday 14^th September 2018                           2.00 – 5.00 p.m.

·         Wednesday 19^th September 2018                  2.00 – 5.00 p.m.

Date were circulated to committee members, responses received to date suggest that any of the above dates are suitable.

The Committee are therefore requested to finalise a preferred date at the meeting.

Mark Graver introduced Diane Brent the Associate Director for Estates for both the Community and Mental Health Trust and John Lavelle a Senior Operational Manager for the Mental Health Trust responsible some of the services in the building. (Presentation as slides in Appendix 2 attached);

Cllr Birnie asked if the catchment area for the centre was only Dacorum and it was confirmed that it was.

Cllr Birnie went on to ask if this was all non-residential and do we have a need in this borough for in-patient care for young people. 

It was explained that there is a provision for this just outside Radlett for the whole county and this is unique to Hertfordshire.

Cllr Taylor asked if audiology had been transferred to the new centre and Diane explained that it remains in the General Hospital, together with St Peter’s Ward and some speech and language services.

Cllr Guest explained that there are two parts to the adult care services item the first one is the report that she had submitted to the committee and Cllr Guest invited questions.

There were no questions.

Cllr Birnie confirmed that there was nothing to report.

Cllr Guest asked whether any of the members had been approached with issues from other councillors.

Cllr Birnie explained that he has had enquiries regarding a new hospital group based in Leverstock Green who he thought had employed a consultant to draw up a feasibility study.  After some discussion it was unclear as to whether this was the case and it was agreed that Cllrs Birnie and England would look into this and if it was felt it should go ahead they would request that SB put it on the agenda.

Action point:  Cllr Birnie and England to look into whether there was a valid case for a speaker to attend from the new hospital group. 

Waiting times for Urgent Care and 111

Gossoms End

Step Down care as a separate item