Agenda and minutes

To confirm the minutes from the previous meeting

The minutes of the meeting from 1 March 2017 and 21 June 2017 were presented to the Chairman for signature; however, the majority of the Committee had been unable to access these minutes on their tablets, therefore the Committee were unable to agree their contents. As proposed by Cllr Taylor, it was agreed that these minutes would be circulated to the Committee the following day; if no concerns were raised about the accuracy of the minutes by Wednesday 20 September, Cllr Guest would attend The Forum after this date to sign both sets of minutes.

E Glatter also requested that she be added to the circulation list for the minutes. Cllr Guest agreed.

To receive any apologies for absence

Kevin Minier (Dacorum Patients Group) offered his apologies for his absence.  

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. Cllr Guest asked that if any individuals realised any interests during the course of the meeting, to declare it then.

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

None.

West Herts Hospital Trust’s response to the Committee’s questions regarding the CQC inspection report from the previous meeting

Cllr Guest proposed that Action Points become a standing item within the agenda. The Committee agreed.

Cllr Guest introduced the letter from Louise Halfpenny of WHHT (pg 4 of the agenda pack), noting that this was a response to the questions asked of the officers in the previous meeting. She asked if there were any questions regarding this item. E Glatter noted that the document stated that the West Herts Medical Centre was open 24 hours a day; She said that it was not, and that it was instead open from 8am till 8pm. Cllr Guest asked if this was the West Herts Medical Centre, which was distinct from the Urgent Care Centre (UCC). E Glatter confirmed that it was the former.

Cllr Timmis noted that in light of E Glatter’s comments, that the second paragraph of the letter contained errors with regard to access to GP’s out of hours. Cllr Guest re-iterated that the West Herts Medical Centre was in fact open 8am – 8pm, however said that if the public needed a GP, this could be accessed by telephoning 111. H Brown added that if a member of the public were to present at the UCC outside of these hours and their assessment was that they needed to see a GP, there was a mechanism to pass them through to the out of hours GP service. She acknowledged that the letter was not quite accurate in terms of what it described, but said that the ability to see a GP (out of hours) was there.

There was some discussion regarding the out of hours service, with the Committee pressing the outside representative health professionals to clarify the exact hours and process of accessing a GP out of hours. They accepted that the letter did not reflect the exact hours and process, however they said that an out of hours GP was accessible to the public by either contacting 111, or by attending the UCC and being assessed by a nurse as requiring a GP.

Cllr Maddern asked if there was a GP in the West Herts Medical Centre 24 hours. K Magson confirmed that although there was not walk-in access, there was a GP in the building 24 hours a day – however they could be reached in different ways. 

Following a proposal by Cllr W Wyatt-Lowe, it was agreed by H Brown that WHHT would provide a further letter that provides clear clarification of this issue. Cllr Guest thanked her, and asked that it be provided as an action point for the following meeting.

Action Point: H Brown to ensure that WHHT provide a further letter of clarification regarding the process surrounding access to a GP out of hours for meeting of 31 October 2017.

E Glatter requested that waiting times were also added to this item; she said this was because patients could wait a long time for an out of hours GP. K Magson said that this was a separate item within itself. Instead  ...  view the full minutes text for item 34.

Councillors are invited to raise any issues within their Ward.

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 commented that it was good news that the Rothschild House surgery had taken over the new surgery in Tring. This meant that they had a surgery for at least at three years, and hopefully more.

Kathryn Magson, Chief Executive Officer, Herts Valleys CCG, to provide members with presentation.

Cllr Guest introduced K Magson, Chief Executive of HVCCG; she also took the opportunity to thank all the outside Health professionals for attending the Committee.

K Magson began by referring to the documents within the agenda pack (pg 5 – 11) provided to the Committee in advance of the meeting. She noted that this was in response to the Committee request for further information regarding the attendance of the UCC between 10pm – 7am. She noted that this information recorded how attendance varied month to month, as well as the averages attendances per hour. K Magson said that the Committee had requested at the previous meeting that this information be provided for the UCC over the course of the previous three years; she therefore confirmed that this information was contained in the agenda pack in response to this specific action point. 

K Magson went on to outline HVCCG’s strategic plan in relation to the UCC. She confirmed that HVCCG had approved the strategic outline case in July; She said that the Hemel Hempstead site had been prioritised, and that during the summer a piece of work had been commenced looking at how they design UCC’s. She referred to a review, conducted by Sir Bruce Keogh, of UCC’s across the NHS which had completed recently. This review concluded that three types of urgent emergency care that would be delivered by NHS. These were:

·         Hyper acute Stroke Units (very large tertiary centres, delivering specialists services)

·         A&E

·         Urgent Treatment centre (UTC’s)

She said that in the future, UCC’s would cease to exist. HVCCG therefore had a responsibility to resolve this, and commission according to the new national specifications within the next two years. She said they had been developing an urgent care strategy over the summer, specifically trying to develop what an UTC look like over all sites in Herts Valley, with Hemel being the first of these.  She said that this work had been completed, and taken to Commissioning Executive last month, and they were now in the process of engaging with the working group (which was due to meet on 28 September), with a view to ‘bottoming out’ what that specification would look like for Hemel. She said that the development which had been completed would be taken to the working group. K Magson said that the working group consisted of patient representatives and those who had a particular interest over the years, GP’s and Consultants from the Trust. She said that the aim would be to take the outputs from that group back to the Clinical Executive Committee again, and then there would be another discussion, in the form of a public consultation in the coming months. She confirmed that HVCCG had taken the initiative to submit an early adopter bid/expression of interest to become one of the first waves of UTC’s. They considered that this would be an excellent opportunity for the Hemel site. She said that HVCCG were very much at the design stage, whether  ...  view the full minutes text for item 36.

County Councillor C Wyatt-Lowe and Ian MacBeath, Director of Adult Care, HCC, to provide members with presentation.

Cllr Guest introduced County Cllr C Wyatt-Lowe (Executive Member for Adult Care Services) and I MacBeath (Director of Adult Care Services). She also noted that Helen Brown (WHHT) would be able to offer a perspective on this item from the view of a Trust. 

I MacBeath introduced the report; he explained that the terms ‘delayed discharges’ referred to people in hospital that were medically fit to be discharged, but could not go home – he also said that these individuals tended to be mainly older, frail people. I MacBeath went on to explain in detail the contents of the report contained in the agenda pack (specifically points 1-6 at pg 12-13 of the agenda pack), setting out the circumstances that led to delayed discharges.

I MacBeath went on to refer to two graphs set out in pg 14 of the agenda pack. He confirmed that the purpose of these graphs was to show the Committee that delayed discharges in Herts were decreasing, albeit not as quickly as they would like. He highlighted that that NHS England had set a target for Watford hospital that no more than 24 beds of 600+ be occupied by delayed discharges, and confirmed that at the end of August, they had nearly achieved this target with only 26 beds being occupied. I MacBeath confirmed that on the day of the meeting, this figure was 36, however noted that at the end of March 2017, this figure had been 100, and so said that the situation had significantly improved.

I MacBeath went on to highlight the new monies received from the Chancellor (detail set out in full at pg 15 of the agenda pack) of £13million for Hertfordshire in 2017/2018. He confirmed that an investment of £3m in new schemes to reduced delayed discharges (set out in full at point 2–4 of pg 15 of agenda pack). I MacBeath acknowledged there were challenges with money in relation to pay rises for Home Care workers, as it would not be available in year four. Despite this, he said that Herts County had taken the decision to raise care workers wages above the minimum wage.

County Cllr C Wyatt-Lowe endorsed I MacBeath’s presentation as an accurate representation of the situation, and said that the programme of work being undertaken by health partners was fully supported by the County Council. County Cllr C Wyatt-Lowe re-iterated the comments made by I MacBeath about the pay of Home Care workers, and the resulting challenges of recruitment and retention. County Cllr C Wyatt-Lowe said that she was very proud of Herts Care Standard; she confirmed that they were one of the first local authorities to give an enhanced living wage to care workers, as well as one of the very few to pay holiday, travel and training time to care workers. This was because they recognised the value of these individuals. Both I MacBeath and County Cllr C Wyatt-Lowe confirmed that they were happy to take questions on this subject.

At the  ...  view the full minutes text for item 37.

To provide members with an update since last meeting.

K Magson provided the Committee with the regular HVCCG update. She confirmed that a number of public meetings about proposed changes to front line services had taken place over the last months, and that the consultation process was due to conclude on 14 September. She said that there had been a very good response; she added that it had been a Herts wide consultation, with both CCG’s taking part. K Magson confirmed that a joint committee of the CCG’s would make a decision on 12 October. She said that there would be another round of discussion in the New Year (Let’s Talk Two). These meetings/consultations were taking place in the wider context of HVCCG’s requirement to make savings of £45m; she sad that these savings were currently on track, but added a note of caution as they were about to enter winter, and there was little financial resilience She explained that HVCCG was required to make four times as many savings within one years, as previous years. She also added that £30m of savings were also required to be made the following year. K Magson emphasised that this was a difficult process, but they were making progress.

K Magson confirmed she was happy to take any questions; Cllr Timmis wished to note that she had attended one of the consultations and thought it was well advertised, attended and run.

E Glatter had seen the recent WHO alerts, which warned of a particularly strong strain of flu this winter; she asked K Magson for any further advice on avoiding this. As per the national message, K Magson encouraged everyone to have the flu vaccinations, particularly those deemed to be at higher risk. Cllr Guest fully supported this, particularly in her ‘day job’ capacity as a pharmacist. She added that they had begun giving the vaccine that week, and that it was a good idea to have it irrespective of whether you were a high risk group, or not.

Cllr Guest asked K Magson when Let’s Talk Two was due to begin. K Magson confirmed that no timetable had been set as yet, however she considered that it would likely be after Christmas. Cllr Guest asked K Magson to provide an update on this matter in March, within the regular agenda item.

Action Point: K Magson to provide Committee with an update on Let’s Talk Two within ‘HERTS VALLEY COMMISSIONING UPDATE’ agenda item of March 2018.

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

Cllr Guest introduced Cllr W Wyatt-Lowe, the Committee representative on this item. He said that there had not been any recent meetings that he had been able to attend, and due to additional duties of his new role as Vice Chair of County Council, he said that he was unlikely to be attending these meetings. Instead, he would now be attending the ‘Public Health and Prevention’ panel. He confirmed that he would be able to report back on this meeting instead to the Committee. He said that this was a new panel, with newly elected members, including County Cllr Richard Roberts and Cllr Andrew Williams. He confirmed that the next meeting would be on 21 September. Cllr W Wyatt-Lowe proposed changing the name of this item, which was agreed by Cllr Guest.

Cllr W Wyatt-Lowe also said that the Audit Committee at County Council had expressed an interest on doing a ‘deep dive’ into the difficulties with recruiting Home Care workers – this was because it was considered to be an issue presenting significant risk; this would be taking place on 1 December. At the suggestion of Cllr Hicks, Cllr W Wyatt-Lowe confirmed that the panel would ensure that a breakdown of distinct areas (e.g., borough areas, town vs rural) was considered.

Action Point:Cllr W Wyatt-Lowe to report back on outcome of County Council Audit regarding the recruitment of Home Care workers in Hertfordshire in agenda item of December 2017.

Cllr Guest to provide members with an update since the last meeting.

Cllr Guest introduced the item; she confirmed that she was no longer leading on this item following her election to County Council; this would now be lead on by Cllr Birnie for the forthcoming meetings. Both Councillors then updated the committee on the main issue from the previous meeting, which was the ongoing discussion surrounding the closure of the Nascot Lawn facility (Cllr Guest explained that the facility provided respite care for vulnerable children with complex needs, with physical and learning disabilities). This closure was due to the withdrawal of funding by HVCCG; She said it would not be closing immediately, the County Council would be providing funding to ‘plug the gap’ until alternative respite could be found for these children. Cllr Birnie said that funding was being withdrawn by the CCG on the basis that it was not a health provider, and that medical care was being provided elsewhere. Cllr Guest also confirmed that a Topic Group had been set up to scrutinise this, and was currently a work in progress.

Cllr Taylor raised a concern about party proportionality and committee ratio, if Cllr Birnie were to join the committee. Cllr Guest confirmed that she would check this point with the Leader of the Council. She said that it was entirely appropriate that Cllr Birnie attend this committee, given his role as Dacorum’s representative on the County Council Health Scrutiny Committee

OS/041/17       WORK PROGRAMME 2016/17

Cllr Guest asked the members of the committee if they had any items that they wished to add, they should email either her, Cllr Taylor or R Twidle.