Agenda and draft minutes

To confirm the minutes from the previous meeting

The minutes of the previous meeting were agreed by members.

To receive any apologies for absence

Apologies for absence were received from Councillor Guest and Councillor Johnson.

Councillor Anderson substituted on behalf of Councillor Guest and Councillor Silwal substituted on behalf of Councillor Johnson.

Councillor Bhinder chaired the meeting in absence of Councillor Guest.

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

Steve Day registered to speak and the question is included in the minutes under Item 7.

A verbal update will be given at the meeting

Jim McManus gave a presentation on the current Covid-19 situation in Hertfordshire.

Councillor Bhinder said he had concerns that there are still some people who are not wearing masks in shops and supermarkets and when it is mentioned to the staff, they say they cannot enforce it.

J McManus said that the department is reminding retailers of the need for shoppers to wear masks. There is a group of trading standards and environmental health officers who are visiting shopping centres and retail premises to put up displays to remind people to wear masks, offer free masks and remind people that they can enforce mask wearing. If people refuse to wear a mask and they are not exempt from wearing one, they can be issued with a fixed penalty notice and if they continue to breach the rules, the penalty can be increased and it can eventually become a criminal offence. J McManus said he felt the vast majority of people are complying with mask wearing across Hertfordshire and we need to continue to share that message.

Councillor Silwal said he was concerned about children returning to school and asked if there were any plans to test children in schools.

J McManus said the Hertfordshire school plan is good and every school has been provided with guidance on how to open safely alongside cleaning and social distancing rules. We are not doing blanket testing as this is not necessary and would not generate effective results – you could test someone over two days and could have a negative result one day and a positive one the next. We will test when there is a need to. The emphasis in schools is working on measures to prevent the spread, self-isolate those with positive cases and contact pupils and staff through contract tracing. We are more worried about the 18-30 year olds who may think Covid-19 is over and may be spreading it.

Councillor Beauchamp referred to promoting and advertising in Dacorum and asked whether the Communications team at DBC had been approached to put a slide up on the screen in the town centre.

E Walker said the Communications team are working closely with colleagues at HCC and Public Health to push out the message and the screen in the town centre is being looked at.

Councillor Symington referred to the charts in the presentation that showed cases under 17 per 100,000. She asked if there was a point at which a local lockdown would be implemented.

J McManus said the team are trying to stop figures getting to an area of intervention and are handling it at a local level, we do not want bars and restaurants to close and cause disruption to the public’s lives. Measures to prevent the spread are simple; wash your hands frequently, wear a face covering, keep socially distanced and only socialise with those in your bubble. We do not want cases to exceed 30 cases per 100,000 although the level for a local lockdown is  ...  view the full minutes text for item 5.

A verbal update will be given at the meeting

J McManus updated the committee and thanked staff at Dacorum for the work they had done. Like almost every part of the country, there were significant issues in care homes with covid-19 outbreaks earlier in the year. A dedicated care home cell was set up alongside a PPE helpline to provide care homes with advice. Training guidance and a range of materials have been provided to care homes and work on that continues. There are currently no outbreaks of Covid-19 in any care homes in Dacorum. The current issue to work on is how to restart visits to care homes but keeping the virus out particularly as we head towards winter. Hertfordshire have departed from the national guidance and have been stricter on allowing people to be admitted to a care home – currently, if they have tested positive but are asymptomatic they must go into a specific isolation facility until they test negative and beds have been commissioned to do this. A lot of resources and staff have been provided and a mental health programme has been introduced for staff working in care homes with has been funded by Public Health. There is a considerable amount of work to do before winter and ensure that visiting is able to resume as this is important to residents, especially those with dementia. Also need a focus on ramping up the flu vaccination programme as do not want a flu and covid-19 pandemic at the same time.

Councillor Tindall said he had spoken to the Director of Adult Care Services and was assured that the county council had made a separate provision of PPE to avoid the issue of a shortage seen at the beginning of the pandemic.

J McManus said the county council have taken PPE into their own hands and some aspects of testing. There were national problems with PPE at the start of the pandemic and the county council are looking at stockpiling it. We have been looking at winter planning and have asked every care home to review their infection control. Public Health have paid for two additional members of staff to go into the central care home team and two additional infection control nurses. We do not want to see any significant outbreaks in care homes in Hertfordshire and are taking a restrictive approach and this has the support of members.

A verbal update will be provided at the meeting

Helen Brown gave a presentation to the committee.

Councillor Beauchamp referred to the first slide of the presentation which showed a picture of the Watford site and raised concerns that this gave the impression that the only option being looked at was Watford.

H Brown said the preferred option in 2018 was the redevelopment of the Watford site and the slide shows what this might have looked like. The expectation from the Strategic Outline Case to Outline Business Case is that the preferred option is carried forward to the OBC. The change in the amount of money available is larger than expected so there is more time to review the long list to a short list. The picture used is a stock image and does not mean that other sites are not being included. The preferred option in 2019 was development of the Hemel and St Albans sites.

E Glatter asked where the long list was distributed.

H Brown said the long list follows a slightly different process using the green book and options generator and it has been shared. It looks at different dimensions of options and looked at where to prioritise investment and which site to be delivered from. It displays a list of 9 or 10 indicative options including the redevelopment of emergency care at Watford and a green field hospital site.

E Glatter asked if the clinical group knew what the SRG are doing and vice versa.

H Brown said the clinical group met over the same time period as the SRG and information is shared. Most of the clinical staff are more interested in discussing what services are going to be delivered and where, the new service models and planning for future growth. They are less interested about where the hospital will be.

E Glatter agreed with the earlier comments from Councillor Beauchamp.

Councillor Maddern asked where the new buildings at Watford would go.

H Brown said a short list or preferred option has not been confirmed yet but the buildings will be in the existing car park and down to the new road.

Councillor Maddern said this was in the middle of a flood plain.

H Brown said a flooding risk hadn’t been identified in the studies undertaken. She said she would go back and discuss with Riverwell Partners. Clearly, whether the site is used for a hospital or new housing, it must have a detailed assessment.

Councillor Maddern referred to the time frame of the build and was curious to know how it was possible to build that quickly and made reference to a new hospital being built in Brighton.

H Brown said we are operating in a different context to Brighton. The funding and approval process is faster in the context of HIT1 and the nature of the site and project is different. Part of the government programme looks to use modern methods of construction and the nature of a hospital contains repeatable rooms and a standardised design which lends itself well  ...  view the full minutes text for item 7.

A verbal update will be provided at the meeting

D Evans provided an update to the committee. An integrated care system application was submitted at the beginning of the year and approved by NHS England on 1^st May 2020. A single executive lead and joint accountable for the three CCGs (West Herts Valley, East and North Herts and West Essex CCG) has been appointed as Dr Jane Halpin. The senior team is currently being established and the idea is that all three CCGs will merge into one in the future.

Covid-19 has provided an opportunity to learn from and we have looked at areas and decided whether to adopt, adapt or abandon. What has worked well, take away individual pressures, the discharge and assess model has been successful and been able to move people out of our hospitals quickly. There have been challenges in care homes but they have been supported by the team.

T Fernandes ran through the changes that had been made within GP practices such as telephone triage appointments, sending in pictures of concerning moles or marks and physiotherapists providing exercises.

Councillor Symington asked there are reports in Berkhamsted area of underused capacity at GP surgeries. Can you quantify the extent of the under used capacity?

T Fernandes said earlier on in the pandemic there was definitely under used capacity because people didn’t want to go to the surgery. In Hemel Hempstead, now seeing a huge surge in activity. There may have been times when under used but things are now returning to normal. Some people may be putting off going to the doctors as they may think it will be a long time before they can get an operation. We are getting less minor ailments, personally have seen very few children with temperatures. There have been shifts in the way people seek help and different prioritisation, may feel they don’t need to see a doctor.

Councillor Symington said from her own perception there seems to be a difficulty for people to get face to face appointments and being seen by a doctor. She asked what role the CCG have in helping issuing clear instructions to clinical providers about how to move out of this situation.

T Fernandes said there is some professional responsibly involved that GPs should be ensuring they are adequately trained and webinars from training consultants have been provided on telephone appointments.

K Minier asked how doctors where managing referral lists.

T Fernandes said if someone was due a follow up appointment, this is being dealt with by the Trust to make sure these appointments are made. People who have developed problems during covid-19 and couldn’t be referred, some practices have kept their own lists and they are being contacted to see if they still need to be assessed. People waiting for surgery and may be in pain, this is difficult one as surgery capacity has been hugely decreased. At the moment, urgent and cancer surgery has been taking place at private hospitals and consultants have been working hard to make systems  ...  view the full minutes text for item 8.

An update to be provided at the meeting

Councillor Bhinder said he would circulate the update notes to the committee.

None

To suggest items for discussion at the meeting on 9^th December 2020

E Glatter asked the committee for their support in the fight to get proper hospital facilities for Hemel Hempstead.

Councillor Bhinder said he took this on board and the Health committee is cross party and we are all in agreement.

Councillor Maddern said it would be interesting to look at the prescribing statistics over the covid-19 pandemic.

K Minier said that the South West Herts MP was not getting involved in this campaign and said he was waiting for the judicial review to be completed. He asked if the borough councillors in this constituency could approach the MP.