Agenda and minutes

Nominations were sought for Chair of the Health In Dacorum Committee for 2017/18. Having been proposed (Councillor W Wyatt-Lowe) and duly seconded (Cllr Maddern) it was

Resolved;

That Councillor Guest is elected Chair of the Health In Dacorum Committee for 2017/18.

Nominations were sought for Vice-Chair of the Health In Dacorum Committee for 2017/18 and The HCC Health Scrutiny Representative. Having been proposed (Cllr Guest) and duly seconded (Cllr Timmis) then (Cllr Guest and Cllr W Wyatt-Lowe) respectively it was

Resolved

1. That Councillor Taylor is elected Vice-Chair of the Health In Dacorum Committee for 2017/18.

2. The Councillor Maddern is elected the committee’s substitute representative on HCC Health Scrutiny.

To confirm the minutes from the previous meeting

The minutes of the meeting on 1 March 2017 were not available for signing and will be presented and signed at the next meeting.

To receive any apologies for absence

Apologies for absence were received on behalf of Councillor Taylor and Tony 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]

None.

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

The Committee observed a minute silence in respect to those who lost their lives, survived or were affected by the terrible events surrounding the recent fire at Grenfell Tower in London.

Rachael Corser and Esther Moors, Deputy Directors from WHHT, to provide members with presentation.

Rachel Courtan (RC) Esther Moors (EM), Deputy Directors West Hertfordshire Hospitals NHS Trust; presented a series of slides updating the committee on the current position. The slides covered areas such as

·         How the services did in the inspection

·         What the inspectors saw

·         Minor Injuries / Caring

·         Safety of patients

·         Hospital Management

·         Responsiveness

·         Simpson Ward

·         Key Findings and proposed responses

The headlines were:

•       West Hertfordshire Hospitals NHS Trust has moved from ‘inadequate’ to ‘requires improvement’ and has seen a leap in the number of services graded as ‘good’

•       The number of services rated ‘good’ is almost double that in 2015 and the number rated ‘inadequate’ has more than halved

•       There are 40 individual quality ratings of ‘good’ from the 2016 inspection, compared to 25 in 2015

•       The number of services rated ‘inadequate’ is less than half that of the previous year, was 31, now 15

•       The CQC inspection in September 2016 involved around 50 inspectors who visited all three of the trust’s sites

•       They interviewed frontline staff and the leadership team, spoke to patients and relatives and took soundings from key stakeholders

•       Before, during and after the inspection, inspectors considered nearly 1,000 documents; policies; patient notes; medical records and additional information in relation to specific questions.

•       The staff are doing amazing things!

Councillor Birnie questioned the title Urgent Care Centre (UCC) as he had examples of patients turned away because they did not have an appointment. RC admitted this may have occurred however the UCC is not an appointment based service. Councillor Maddern also called into question the ‘established’ status of the UCC as it is only open 10.00 pm – she contended that it will not be established until it is open for 24 hrs as originally promised.

This prompted a discussion on communicating to the general public that the current closing of the UCC at 10.00pm is not a temporary measure and has no end date in view.

There then followed a short discussion on bed allocation.

RC went through the operation of the A rated ‘Stroke service’. The move towards early discharge and recovery at home was considered. Marion Dunstone (MD), Director of Operations, Hertfordshire Community NHS Trust advised that this is an evidence based approach; it will free up beds and decrease the need for hospital stays.

RC and EM advised the committee that through the Quality Improvement Plan they have identified and addressed areas which were rated as inadequate or requiring improvement. They are embedding changes and will continue to monitor the impact through audit and governance.  They will make further changes as required. The team aims to continue to develop and grow to support changes.

Cllr Maddern asked if any services had gone down in the ratings. She was informed that Medical Care Services needed improvement and Children Services went down from ‘outstanding’ to ‘good’. K Minier asked when the report will be finally released – RC and EM agreed to bring the results to the December  ...  view the full minutes text for item 22.

Marion Dunstone, Director of Operations, Hertfordshire Community NHS gave an update on the operation of the Community Health Centre now based at 41 Marlowes, Hemel Hempstead. The centre provides physical and mental health services, the majority of which will be for the local area. She requested support from the Borough Council to increase the parking around the centre or its full potential will not be realised.

She is concerned that there is not enough parking for the staff that have to come and go with equipment and material they cannot carry a long way to a car. She agreed to provide numbers of staff and required parking places. She added that the current parking is prioritised for the users of the building.

She went on to describe how the building is set up with different access for each different service and category of user/patient; and the safety features designed in to ensure safe care all round.

KM sought and was given staffing figure estimates.

Cllr Guest suggested a further update in Feb/march 2018 and that in the meantime a tour should be arranged for those members of the committee who would like to see around the new facility.

Cllr Timmis advised the committee that Rothschild House Surgery in Tring have now taken on the running of the Markyate surgery. However they still desperately require new replacement premises. The committee considered some of the options suggested and the issues involved. J Doe, Assistant Dir. Planning at Dacorum has been assisting on landholding issues.

Cllr W Wyatt-Lowe to provide members with an update since the last meeting.

The council’s representative on the board, Cllr W Wyatt-Lowe began with praise for the Street Triage team/initiative. The team attempt to diagnose at the scene what care a sufferer requires. This prevents patients being taken straight to the mental health unit where they may block spaces while they a re-directed to more appropriate health care.

Cllr Wyatt-Lowe went on to highlight the work done to produce the Children’s’ Commissioning priorities and suggested that all members read the resulting report and he will provide a link to their website.

He then went on to highlight the work of the Public Health Committee which is now focusing on public poor health prevention and earlier intervention. The aim is to repeat the good work done by and the successes of achieved through Children’s Care and apply this to the area of Public Care. The aim is to focus the voluntary effort in Herts into the public health issues that matter/exist. It was suggested that HCC Councillor Richard Roberts be invited to attend the committee to update them on the work being done. Dr Fernandes welcomed the move to an emphasis on prevention rather than concentrating solely on treatment.

The committee then discussed the issue of delayed discharges with (KM); reconciling their perceptions with the different stats being bandied around and how this matter is being addressed at the moment. KM provided her figures which are the most up to date. She informed the committee of the work being done and the drastic reductions in delays made recently. Her target is to have the number halved by November 2017.

Resolved:

1.    That HCC Councillor Richard Roberts be invited to address a future meeting.

2.    That Kathryn Magson, NHS Herts Valleys CCG Chief Executive Officer provide the committee with an update on the work being done to address delayed discharges.

David Evans to provide members with a verbal update since the last meeting held on 1 March 2017.

David Evans (DE), NHS Herts Valleys CCG Programme Director gave the committee an update on the current financial position.

One of the issues he wants to deal with is the amount being spent on the expensive provision of prescribed medicines that can be purchased more cheaply by the patient directly ‘over the counter’ in pharmacies/shops. DE and KM suggested that the communication of the benefit of this type of approach to the general public could be a role for local authorities. Members of the committee made suggestions for addressing the issue – small ‘tuck shop’ style booths in hospitals/surgeries; messages on the videos frequently displayed in surgeries, etc.

DE suggested that there are a variety of matters / challenges that could form part of the programme ‘healthy future- let’s talk’ in an effort to communicate with the general public on how to address funding issues. Matters such as vasectomy and female sterilisation; IVF; Hearing Aids; Smoking; BMI; respite and provision of short breaks; overnight care; etc could all form part of a debate on the costs of health care provision.

Cllr Timmis asked about plans for the Berkhamsted and Tring areas and DE went through some of the plans for health provision in these areas.

Cllr England suggested that the Health authority does not have a good record on communication and cited the lack of publicity surrounding the reduction of opening hours for the UCC. He again pressed the Health professionals on a date for the UCC going back to 24hr opening. KM responded that the UCC reduction is due to a reduction in the workforce to support it and that position has not changed. She added that monitoring has shown that overnight use of the facility is tiny. She drew attention to the more ‘nurse led’ model for urgent response, which is backed on his website by the MP.

E glatter asked if the health professionals could provide statistics on the use of the UCC for the past three years and was informed that this is possible. The committee requested that they see these statistics as well.

Resolved:

That Kathryn Magson, NHS Herts Valleys CCG Chief Executive Officer provide the committee with statistics for overnight use of the UCC for the past three years.

Cllr J Birnie to provide members with an update since last meeting. Cllr F Guest to provide report.

The committee considered the report from Cllr Guest on recent developments involving HCC Health Scrutiny. The committee sought and were given an update on the new model for the UCC and the commissioning of an Advanced Nurse Practitioner model to provide this service.

Cllr Guest left it to the committee to ‘draw their own conclusions’ regarding the provision of some form of health care from Gossoms End. KM sought to reassure the committee that funding was being sought for some form of use for the building and she is working with J Doe on a plan for development of the site.

Resolved.

That the proposals for Gossoms End form an item on the agenda for a future meeting of this committee.

To agree items for work programme for the remaining 2017/2018.

The work programme for the committee was considered.

It was suggested that the following be included in future agenda:

·         Inclusion of a report on the new premises at 41 Marlowes. Date: TBC

·         Inclusion of a report on the results of the CQC Inspection report  - Dec 2017

·         Regular updates on the Hemel UCC and figures for overnight use of the facility (Sept 2017)

·         Gossoms End update – TBC

·         Invite to HCC Cllr Richard Roberts to address the committee on ‘prevention and working with the ‘third’ sector - TBC

The date of the next meeting is on 13 September 2017.