Agenda and minutes

To confirm the minutes from the previous meeting

The minutes of the meeting on 7 November and 7 December 2016 were confirmed by the members present and then signed by the chairman.

To receive any apologies for absence

Apologies for absence were received on behalf of Councillor Brown, B Harris, R Trigger, and T Gallagher.

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]

Councillor Guest declared a personal interest due to the fact that she is a practicing Community Pharmacist for another Health Authority.

All of the matters arising were included in the agenda and formed part of the discussion during the meeting.

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

None.

Councillors are invited to raise any issues from within their Ward

Councillor Hicks again raised the issue of medical care in and around Tring. He is being continually approached by residents concerned about the closure of Tring facilities. He referred to a quote from Herts County Council implying that there is no demand for places in Tring and countered it with the fact that the day centre, a charity run facility is filled immediately, implying the demand exists. In his opinion the number of doctors available in the Tring area is being reduced. He suggested the continuance of the surgery at the other end of the town.

Dr Fernandes, Herts Valleys Clinical Commissioning Group: GP Board Member said he thought that the reduction may be due to the retirement of a GP at short notice. He believes that this may well be an interim measure which will come to an end and the service will be going out to tender again.

The general view was that Cllr Hicks can reassure residents that there is no intention to close the surgery.

Councillor Timmis asked what progress is being made with provision of in-patients beds in Tring and the fact that there are no step down beds in Berkhamsted and Tring.

David Evans (DE), Programme Director - Your Care, Your Future, responded that there is a re-configuration of services underway with an emphasis on moving to a more home based approach. The team supporting this approach started 1 March 2017. This will free more beds in HH.

Cllr Timmis asked for confirmation of who is considering Gossoms end and DE told her that Herts Community Trust are considering the future of Gossoms End. He added that health services are continuing out of Gossoms End but this is unlikely to be step-down beds. Cllr Timmis felt this will not provide for those who need step-down beds and who are not able to be looked after at home. Charles Allen, (CA), Herts Valleys Clinical Commissioning Group added that particularly elderly people do not react well to being in an intuitional bed. Cllr Timmis then asked if there is adequate resources in the community to care for people at home.  DE said the intention could be that the savings on beds should be used to provide the home care and Cllr Timmis retorted that she is sceptical that the provision is there.

Cllr Guest confirmed that the impression being given is that there will be more beds on the Hemel site.

E Glatter (EG) repeated that the impression being given is that there will be extra beds at HH Hospital, Increasing the local bed base. She too expressed scepticism that the Care in the community approach will work as she does not believe we have enough provision for care in the community and she cited the example of District Nurses numbers being reduced.

In relation to the inspection carried out by the Care Quality Commission (CQC) last September West Hertfordshire Hospitals NHS Trust issued the attached Press Release.

The release was accompanied by the following comments:

“The Trust’s overall rating has improved from ‘inadequate’ to ‘requires improvement’. Next stop is ‘good’!

The attached release is quite comprehensive, but here are some key facts:-

·         Two areas made a significant improvement by moving up two ratings from ‘inadequate’ to ‘good’ - maternity & gynaecology and critical care.

·         Inspectors commended the trust’s children’s emergency department, the treatment of patients with hip fractures and the hard work of the trust’s estate team in keeping the hospital’s estate as safe and clean as possible and contributing to low infection rates.

·         Urgent and emergency care at Watford General Hospital was rated ‘inadequate’ for a second year running.

·         We were commended for our low mortality rates and our stroke care.

·         At Hemel Hempstead, there was a mixed picture related to more services (14) being reviewed, compared to eight in 2015. The overall rating has moved from ‘requires improvement’ to ‘inadequate’, despite outpatients & diagnostic services improving one rating to ‘good’.

·         Inspectors were concerned by the high number of inpatients who are well enough to leave hospital but are waiting for arrangements to be put into place for their return home or to a nursing or residential care setting. They observed that this limited the flow of patients through the trust.

·         At St Albans City Hospital the overall rating had moved up from ‘inadequate’ to ‘requires improvement’ but for the minor injuries unit the rating was down from ‘good’ to ‘requires improvement’.

·         Inspectors praised progress with recruitment and also noted the percentage of savings made in 2015/16 – these are areas where the trust is bucking the national trend.”

Detailed reports are available from the CQC’s website http://www.cqc.org.uk/

The committee moved on to consider the CQC report at this point which Helen Brown (HB), Director of Strategy & Corporate Services, West Hertfordshire Hospitals NHS Trust led on.

Councillor W Wyatt-Lowe referred to a recent programme put out by the local BBC implying there is no improvement in general in local health services. HB felt that the CQC report on West Herts was balanced and the BBC had been keen to present a negative picture.

Cllr Timmis drew attention to the fact that the inspectors had expressed concern regarding the numbers and length of waiting times - she added that in this case wouldn’t that mean it is not a good idea to cut things like Gossoms end. HB responded that the issues faced are profound and there are issues with flow through the hospital.

In Cllr Timmis’ opinion the current good points of the service are what the Trust are intending to cut - Outpatients and Diagnostics. HB pointed out that the plan is to develop St Albans as the place for complex diagnostics. At the moment the Trust intend to offer over 90 specialities from HH and she went on to list some examples. Cllr Timmis responded that there are ‘good’ facilities At HH Hospital - so why move these to St Albans?

The group then discussed the reasons for ‘bed-blocking’, the impact of maintaining the beds at Gossoms End; a rehabilitation at home approach as opposed to a stay in hospital and the need for acute beds. The health professionals felt that more beds is not the answer.

Cllr Hicks felt that the flaw in this argument is that the problems would simply occur at home. However CA countered that at home patients ‘mobilise’ on their own and are better off, healing faster.

E Glatter challenged that view that we have enough beds as the statistics prove the Trust do not have enough beds compared to the national average. In her opinion there are too many trusts/bodies trying to provide a fragmented service. DE admitted that they are in the middle of initiatives trying to address the problem of too many providers and rationalise the service to avoid fragmentation. He warned that If we buy more beds we will compromise support services - Partnerships are the best way of dealing with the shortages.

Cllr Mahmood advised that the Trust has adopted the wrong approach in attempting to move services to centres of population; he suggested they stop moving facilities around as it is ineffective; they should develop the sites we already have.

Cameron Ward, NHS Herts Valleys Interim Accountable Officer replied that services are moving out of hospitals and into the home - unless it is a specialist service which need to be concentrated in smaller centres. In his opinion this improves services to the patients: he added patients go a little bit further but they get better care.

Dr F added that the level of service needs to be high for some things and that  ...  view the full minutes text for item 7.

To consider the implications of recent changes to the opening hours of the Hemel Hempstead Urgent Care Centre,

HB introduced the item by highlighting the difficulties in finding doctors to work overnight.

CA also questioned the effectiveness of providing a service overnight where they could be dealing with one patient an hour.  He quoted Prof Keith Willit’s suggestion that one should deploy resources to the patient instead of having it sitting in a building. It was confirmed that the current opening times are 8.00 - 22.00.

Cllr Maddern reminded those present that assurance had been given that this was a temporary measure and she feels that as the service is reducing now they misled the public.

HB said this is one interpretation but it was always a temporary decision until a review was conducted. CA reinforced this view that the temporary move was to allow for consultation on the issues of a scarce workforce; return on investment; and the small number of patients.

K Minier said the public is unclear of what is provided at HH Hospital so they go to Watford.

HB felt this is being considered as they are mapping if HH residents are going to Watford when they could use HH and they are examining the need of the locality.

EG considered this to be ‘more bad news on bad news’. She felt HH Hospital was supposed to provide 80% of the needs of Hemel Hempstead but that it was set up and maintained badly so it would fail. The option of a nurse led service is a further downgrading towards closure.

Cllr Taylor went on to outline the involvement of the MP. He then went on to compare the poor HH service with his recent experience of the Luton & Dunstable Hospital. He was Impressed with how the system works there and put the difference down to the fact that they spent the money on improving the service - good example of how and acute centre can work. He agreed that this thing needed to be looked at strategically and the UCC was never set up and resourced properly.

Cllr Mahmood returned to the work of Prof Willit who advocates meeting your urgent care needs as close to home as possible. However in his opinion, in the case of HH Hosp, the approach here is the classic method used to run a service down - create a problem - then shut it. He expressed his disillusion and disappointment with the outcome.

HB and CCG would continue to update the committee on the various models being considered for out of hours service.

EG sought confirmation on the time and extent of the consultation and was assured she would be kept informed.

West Herts Hospitals Trust - Acute Transformation - Strategic Outline Case

An opportunity for the committee to discuss the document and then formulate a response.

The item was introduced by HB who summarised some of the issues and conclusions that form parts of the discussions, particularly on options for future provision of hospital care in West Herts. She outlined the recommendation that this would predominately be provided from the current Watford and St Albans sites with continued UCC provision at Hemel Hempstead. She pointed out that the recommendations will require formal ‘commissioning’ support.

The was a fair degree of opposition to this approach expressed by those on the committee who feel HH is not adequately provided for in the new proposals and some who felt that the HH Hospital site is being ‘run down’ to help finance the review’s proposals.

K Minier advanced alternative proposals that disputed the costs being put forward by the health professionals and claimed that the plans for the development the Watford site and the timescale for the regeneration of the Princess Alexandra wing are untenable.

DE felt that the alternatives did not compare like with like. He advised that the review team are carrying out a rigorous check and challenge process to check the figures. Their aim was not a large scale development but an effort to ‘build smaller - build cheaper’.

Cllr Taylor drew attention to the SOC on the top of page 2 which shows that the Hemel site was left out of the scope of the SOC and consequently discarded and disregarded. The only option considered was for the HH site to be pared back and developed as a local health facility. DE felt this might be viewed more positively as an opportunity for land sale and redevelopment in partnership with the local Council He has a project group working on the SOC looking at options for Hemel and believes they can create something exciting and innovative.

Cllr Mahmood replied that Dacorum people are not well served by the options on offer and believe that any benefit from the sale of the Hemel site will be used elsewhere.

HB was anxious to reassure the group that any finance from a sale will be used on health education and housing in Dacorum.

EG circulated the key points from the Hemel Action Group paper on the subject which included views mainly opposed and opposite to what the SOC contains. These included the view that it would take four years to build on a greenfield site as opposed to the 10 years redevelopment at Watford. She advised that the Trust will encounter problems during the development and cause unhelpful and unnecessary disruption to the patients. The Greenfied site should be included in the outline business case OBC. Redevelopment of the Watford site is a short term inefficient approach.

Cllr Maddern reported that her impression of the debate at the Herts Scrutiny Group was that in an ideal world they would have supported a greenfield site but went 15-2 for the development of the Watford site. She felt that Herts scrutiny Group rejected the greenfield site on financial grounds and if  ...  view the full minutes text for item 9.

To provide Members with an update since the last meeting held on Wednesday 7 December 2016.

DE informed the committee of various ‘Health Needs Events’ being held to help identify the needs of Herts residents and as part of the Prevention agenda. The results will help inform the Locality based plans.

This is linked to the financial position with a view to identifying how best to spend the £750m in social care funds in consultation with the public. There is a role here for the local Authorities involved.

KM suggested that £750m is not enough to meet the needs of the communities involved. The result will be that if there is not enough money in the system then the Trust will make cuts to fit into this budget.

DE went on to identify a range of initiatives and procedures that may save money as there is definitely going to be some further prioritisation and good health prevention measures can have a significant financial impact.

Councillor W Wyatt-Lowe to provide Members with an update since the last meeting.

Cllr WWL reported on recent developments in the ways Community Infrastructure Levy monies could be used. It is designed to be spent on infrastructure projects and each district is accumulating a pot of funds. The decision at Dacorum is not to start allocation until the funds reach £2m. He contended that some of this fund could be directed towards health matters. The group agreed that any health care projects that would benefit from CIL monies should be identified and considered. Cllr Taylor agreed to circulate the information on the rules surrounding the use of CIL monies.

The committee considered the report from Cllr Guest on the HCC Health Scrutiny Meeting held on 8th November 2016. Cllr Maddern reported that the February 17 meeting to scrutinise the withdrawal of £8.5m in funds resulted in agreement to question the decision and the procedure which led to it.

To agree a work programme for the Health in Dacorum Committee 2017-18

The work programme for the committee was considered.

The committee felt that regular updates on the Strategic Outline Case would be beneficial. This could include any improvement work carried out in response to the improvement plan.

That Herts Community Trust be requested to attend a future meeting with a presentation on their current and future position.

It was suggested that more GPs be invited to attend these meetings.

Home care - someone from HCC to be requested to attend to outline the commissioning of Homecare.

It was suggested that it could be useful for someone from East and North Herts Health Trust attend to detail how they arrange integrated discharge.

The date of the next meeting is on 21 June 2017.