Agenda and draft minutes

To confirm the minutes from the previous meeting

Cllr Bhinder opened the meeting by raising the minutes of the last meeting.

There was disagreement over the characterisation of Helen’s undertaking to consider the desktop exercise, with some members deeming the 2 sentences on the topic overly brief. SDay offered his transcript of the meeting, noting that his request for the official recording was rejected due to cost constraints. LHalfpenny relayed that Helen felt the minutes were an accurate reflection and offered to circulate Helen’s letter detailing her rationale to not proceed with the desktop exercise.

Cllr Bhinder and a number of other committee members also felt the minutes accurately reflected the meeting, noting that there had been several reviews of the recording as requested at the Full Council meeting, However Cllr Bhinder did not ratify them in light of the considerable debate.

To receive any apologies for absence

Apologies were received from Cllr Durrant and Cllr Guest,

Cllr Adeleke was substituting.

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

Members of the public are reminded to keep their microphones and cameras muted throughout the meeting until they are invited to speak on their specific agenda item(s).

There were members of the public present.

Philip Aylett and Steve Day will be showing a presentation and giving feedback on a recent meeting with the Health Secretary. 

For committee members to discuss issues in their wards

Cllr Maddern noted complaints from elderly residents who had subpar experiences at the General Hospital, being in A&E for many hours and not offered a drink of water or anything to eat. LHalfpenny asked Cllr Maddern to send the details with the patients’ permission LHalfpenny relayed the starring system and explained food and drink were sometimes prohibited in case patients needed surgery later. LHalfpenny updated them on 400 attendances in A&E, which was very high. Cllr Maddern queried LHalfpenny’s prohibition of food and drink, as she understood water could be given up to 2 hours’ before an operation.

Cllr Bhinder noted an incident, which he would report at the next meeting. There were no other issues reported

Presented by Louise Halfpenny WHHT

Update on latest national New Hospital Programme timeline and local hospital redevelopment plans.

Presentation to be shared at the meeting

LHalfpenny shared a presentation highlighting their plans for the 3 sites.

·         Hemel Hempstead Hospital plans showed planned medical care and combined appointments to raise diagnostic quality and bring in new equipment at St Albans and to retain the Urgent Care Service.

·         St Albans City Hospital was the site for planned surgical care. This clear separation of emergency and planned surgery enabled them to continue with non-complex surgery during the pandemic. They wished to grow the complexity and bolt on additional services such as a Cancer Centre and upgrade diagnostics. They would offer Urgent Care.

·         Watford General Hospital was the centre for Emergency and Specialist Care. They would triple the emergency department, equipment up to date.

·         There were plans for Maternity Services at Watford and implementation of single occupancy rooms from early labour to postpartum care instead of moving patients.

·         They wished to demolish the main building.

Cllr Beauchamp raised the Care Commission Quality Report’s reference to the service not always controlling infection risk, patients who were not always visibly clean, and there was a build-up of grime and mould in the building. He noted this was not addressed in West Herts Hospital Trust’s response. LHalfpenny disagreed this referred to a serious hygiene problem and had discussions with the Director of Environment and concluded it was staining versus mould. She explained the press statement responded to what they felt were the most serious issues.

Cllr Maddern queried whether most surgery was done at St Albans as Mike van der Watt said 80% of surgery was done at Watford. Cllr Bhinder upheld Cllr Maddern’s request for details.

KMinier suggested pushing Hemel Hospital and St Albans City Hospital plans forward, including the one-stop diagnosis for diabetes, instead of doing them after. LHalfpenny confirmed they would propose this.

EGlatter referred to a note in previous minutes that they would hear within several weeks how much money was available from the Treasury for the rebuild. LHalfpenny stated they had been expecting to hear the money was for the preparation, which they heard December 23^rd, rather than the money for the development. EGlatter was unsure what was going on at Hemel Hempstead. LHalfpenny offered a detailed list of services and assured there was nothing new at Hemel Hempstead.

• The 6 options showed the varying degrees of new build. They wished to pursue an option with the most new build possible.
• These options would be presented to the Trust Board in May, and the Board would recommend a third option for the 3 sites. They had ruled out a new hospital on a new site. Once the Board approved recommended preferred options, they would finalise their Outline Business Case with detailed final designs and delivery plans including timescales. 2022 would hopefully see the OBC submitted to the New Hospital Programme, and Treasury, who would make a funding decision. Barriers included demands for higher degree of standardisation, and national plans on percentage of rooms of single occupancy.
• They would move forward from funding to construction starting in  ...  view the full minutes text for item 6.

·         CAMHS update – Presented by Joella Scott

·         Primary Healthcare Update – Presented by Michelle Campbell

·         Integrated Care System – Presented by David Evans

·         Population Health Management in the Primary Care Networks – Presented by Charlotte Mullins

CAMHS (Child and Adolescent Mental Health Services)

DEvans introduced JScott Foster, Programme Manager for CAMHS Redesign and Implementation, who presented an update on CAMHS.

·         CAMHS had seen a huge rise in demand in the past 6-8 months, pressuring the service delivery. Responses had to be sustainable.

·         More young people presented in a state of crisis than at an earlier stage. They invested significant money for a 24/7 crisis support offer, in both acute hospitals, and 8am-8pm Crisis in the Community. If a young person presented at risk at a placement breakdown, or a family breakdown, Social Care would attend such an assessment. If a young person presented with challenging behaviour, the Positive Autism service would attend the assessment.

·         Residential strategies looked across Health and Social Care to create a better system, increase therapeutic support, better training for social care staff, and more mental health training.

·         Developing to recognise trigger points for crisis and up-skilling was taking place.

·         They were seeing unprecedented demand on Eating Disorder Services, nationwide, in all ages. The amount of young people presenting with eating disorder concerns had grown 127%.

·         They were looking at Early Help Eating Disorders services for parents and a home treatment team to support young people within the family to instil change and grow better outcomes.

·         A positive from Covid was how they responded digitally, and understanding they could deliver services at scale to young people, recognising they did not want to create digital poverty. Large numbers of young people did not have access to digital platforms, although many young people preferred digital services. Having a robust hybrid offer was moving forward. Digital advice and guidance was being developed to increase relevancy and self-help in a digital environment.

KMinier reported low percentages of young people who preferred digital to face-to-face and asked what they were doing in schools regards mental health. JScott did not have a percentage breakdown of digital versus face-to-face. She relayed many young people disliked being on camera initially, and concerns from young people whose home environments were not private enough for a conversation. She noted that professionals understood the importance of hybrid models.

Jane requested that acronyms were explained in parenthesis for public presentations. Jane praised the team’s work, and enquired about prevention. JScott relayed she worked closely with Public Health who owned preventative information, and detailed safe navigation of social media, body positivity, and Just Talk, for preventative information. JScott confirmed prevention was a CAMHS priority and all agencies recognised their role in prevention.

Cllr Bhinder was pleased to hear the team effort.

• Improved access was an ask in the long-term NHS Plan, with plans for digital access into the mental health system. With Early Help, there was huge demand on CAMHS to prevent needs escalating. They invested significant money including preventative support, digital support, therapies, and counselling. With place-based support, they were looking to work with primary care to offer a better support suite. Nationally, they were rolling out mental health programmes in schools so young people  ...  view the full minutes text for item 7.

Presentations from:

Steve Day – Herts Valleys Hospital

Philip Aylett – New Hospital Campaign

Philip Aylett – New Hospital Campaign

PAylett opened the meeting by providing an overview of the New Hospital Campaign’s role, noting that they emerged from the Dacorum Health Action Group and provide expertise in a wide variety of areas including project management, building, civil engineering and public spending. The campaign takes an independent approach and is in place to challenge the Trust, with the largest hurdle being that the Trust appears to have made its mind up regarding keeping all clear new sites off the shortlist.  The campaign wishes to have an unbiased appraisal of all potential sites for acute redevelopment, including clear new sites.

PAylett next looked to the Trust’s current plan for Watford, stating that it will be a 16-17 storey development of 3 large towers, though are likely to be shorter given that high buildings are already a political issue in Watford. 

PAylett noted the letter from Christine Allen, CEO of West Herts Hospital Trust, dated 29th December, and suggested it contained a number of misleading statements, including the links between WHHT and Royal Free London.  Cllr Bhinder noted that Christine Allen was not present at the meeting and clarified that the comments being made were a perspective of the letter. It was noted that LHalfpenny was still on the call, who commented she would not be arguing the point and was seeing the points for the first time.  PAylett confirmed that the information could be made available to LHalfpenny if required.

PAylett provided an overview of what the Health Secretary had said in their meeting on 7^th February, noting that he had stated it was a monumental task and that the Trust have made their decision.  PAylett confirmed that the Secretary of State had listened and that there were no senior civil servants present, which he described as highly unusual and suggested that he was keeping an open mind.  PAylett continued that they made a case for a new hospital on a clear new site as it is felt it is a good environment for care, that good access by road and public transport can be provided, efficient buildings can be designed for an efficient operational campus, and construction will be faster as there is less disruption.  PAylett referred to Princess Alexandra Trust in Harlow who calculated that building their hospital on a clear new site would be 2 years faster than in a crowded town centre.

PAylett noted the key arguments against the acute development in Watford.  Polls suggest that the ideas for building at Watford are not liked by the public.  It was also noted that the Trust had not followed Treasury rules as it was admitted at meetings that officials had not done an objective assessment on the speed of the build.  The acute programme development was described as subjective and high level, which PAylett described as inadequate for this sort of visit.  PAylett went on to note the disruption for patients and staff at Watford during the process, stating that the  ...  view the full minutes text for item 8.

Cllr Beauchamp advised that the committee had elected to not meet in December due to the ongoing pandemic and the meeting had therefore been rescheduled to take place on 14^th March.  It was confirmed that a report would therefore be provided at the next meeting.

Cllr Bhinder noted that Cllr Guest wasn’t present to give the report. MSells noted that the report was attached to the agenda and that any questions could be submitted after the meeting.

Cllr Bhinder noted a previous suggestion from Cllr Maddern that the committee meet more regularly as it was felt that every 3 months was not sufficient.  Cllr Bhinder confirmed that officers had looked into holding meetings every 2 months but that this was unsuccessful due to constraints such as school holidays and suggested that a steering group instead be set up to meet on an ad hoc basis to address individual items and ensure the right items are being brought to the committee.  MSells added that a number of officers are interested in the meeting and that the steering group would be an opportunity for offices to provide information on other items in the borough. 

Cllr Maddern asked for further clarity on the difference between the committee and steering group.  It was noted that the steering committee could meet on an ad hoc basis to discuss specific subjects before being reported back to the committee.  Cllr Beauchamp explained that the steering group could be a much smaller group of people and would not require a formal agenda.  Cllr Bhinder added that it would also be an opportunity to discuss items that would otherwise be discussed as part of the work programme agenda point. 

Cllr Allen asked what would happen with the recording of the meeting and when it would be accessible.  Cllr Bhinder asked that this be left with him as an action to look into. 

SDay requested a copy of the meeting.  Cllr Bhinder noted the request.

EGlatter commented that Christine Allen’s letter would be a good item for the steering group to look into.  Cllr Bhinder agreed, noting that they could look at the letter and any potential response.

Cllr Allen suggested, in the interests of even-handedness, that they hear from the Trust on their submission to the Health Secretary.  Cllr Bhinder requested that this be added as an action point for the next meeting.  LHalfpenny commented that if they are asked to submit anything to the Health Secretary then they would be prepared to share this and that this may be in the public domain ahead of the next meeting.  LHalfpenny confirmed that she would inform MSells if anything was available ahead of the next committee meeting.