Agenda item

Herts Valleys Clinical Commissioning Group & West Hertfordshire Strategic Review of Health update

Helen Brown and David Evans to provide an update since the last meeting, including a further update on the Hemel UCC (following presentation of 13 September 2017). 


H Brown and D Evans confirmed that the item would be a combined update; this was because of the amount of interplay and overplay between the work of both stakeholders.


H Brown confirmed that the presentation would focus on the following matters:

       Hemel Hempstead and Dacorum Project Group – Strategic Outline Case (SOC) for redevelopment of Hemel Hempstead General Hospital (HHGH). (H Brown)

       Main acute redevelopment strategic outline case (E Moors & F Banks)

       Urgent Care Strategy, opening hours for Hemel UTC and West Herts Medical Centre contract (I Armitage & D Evans)


H Brown, E Moors & F Banks provided the Committee with a detailed presentation based on the information set out in pg 2 – 7 of the presentation slides  (Appendix A). D Evans also gave the perspective on slide 7 of presentation from the HVCCG’s point of view.


Cllr Taylor asked H Brown and D Evans for clarification regarding the presentation pack, in particular, what they would like DBC to do with this information; did they wanted the packs handed back, or were they content for it to be shared with the public? H Brown said that while she was not unhappy for it to be shared, it should be made clear that this was very much a ‘work in progress” and so should be treated in this spirit. Cllr Guest re-iterated this point to K Minier, saying that he should treat this document as such when sharing with the other members of DHAG. She also noted that this document should be recorded as ‘draft’ within the minutes.


Cllr Birnie observed that the proposals sounded very useful, particular the cross-working between specialisms and sites; however he thought that the IT would need to be improved in order to facilitate this. E Moors agreed, saying that the way the Trust wished to deliver care in the future was very reliant on it. She said that technology had significantly moved on, and was able to support care in the community. Cllr Birnie re-iterated his point, saying that IT would need to support Specialist with emails, accessing patient records, etc.


Cllr Birnie also noted the comments about specialism on different sites; he asked whether investment in one site could leave others under-resourced.  Cllr Birnie cited the example of the MRI scanner being moved from HHGH to St Albans City Hospital (SACH). F Banks accepted that this may be a possibility, but emphasised that that in the case of the MRI scanner, it would be located where it was most needed for diagnosis. H Brown added that MRI was expensive equipment, that was difficult to staff. It could not be sustained on three sites, and was absolutely necessary to be placed at SACH, in order to support the planned surgical model for the cancer services. However, H Brown added that a local MRI would still be available to Dacorum residents (albeit not a same day service), through different routes. She emphasised the need to think of HHGH and SACH as complimentary services. F Banks added that this model would mean that SACH would be a consultant-led site, delivering excellent service to the area.


Cllr Hicks clarified that ‘maternity services’ referred to midwife appointments and support, rather than delivery/labour wards. He also asked for further clarification regarding the flexi care housing; he asked if it would be temporary accommodation. D Evans said that it would not be temporary; instead it would be for individuals requiring extra care. Cllr Hicks asked about where this fitted in relation to the removal of step-down beds following their removal at Gossoms End, and future removal at HHGH. D Evans that this was also being taken into consideration within the planning for flexi care. There was a discussion on how this plan could look, however D Evans emphasised that this was a plan still in the process of being developed.  Finally, Cllr Hicks noted that a huge amount of housing was currently being built in Dacorum, as well as Aylesbury; given that a significant number of Dacorum’s residents accessed healthcare provided by Bucks, he questioned the impact of the new housing and residents on the healthcare services. He asked what forward planning had taken place. H Brown confirmed that strategic planning took into account predications for both growth in population and housing.


Cllr Maddern noted the proposal to develop SACH into a cancer specialist site; she observed that it was building on what had developed for the breast clinic, and described this as a “fantastic” facility. She wanted to clarify that the proposal was for the biopsy and diagnosis to take place on the same day. F Banks confirmed this, and said this was the standard being aimed for. Cllr Maddern praised this as a model.


Cllr Maddern also asked when a decision about the new hospital on a greenfield site was due to be made. H Brown was unable to confirm this. She said this was being debated at national level. She said that West Herts was recognised as a priority.


Cllr Birnie asked where the post-operative cancer care would take place. F Banks confirmed this was still being developed. Cllr Birnie also asked the impact of the Trust’s finances, given he understood that its accumulated deficit was approximately £100million, upon this project. H Brown acknowledged it was a very challenging environment; she also highlighted that all Healthcare providers were managing deficits. However, she said, there needed to be investment within the infrastructure, otherwise it would be almost impossible to reduce one’s deficit.


Cllr England asked if the stakeholders recognised that Dacorum had the largest population as an identifiable area, and would continue grow over the coming years. H Brown acknowledged that the Trust served a significant population, along with Three Rivers and Watford, however also highlighted that there were two other hospitals, Luton & Dunstable and Stoke Mandeville nearby. This meant it was not as simple as developing a hospital in Dacorum because of its population. Cllr England said while he understood the proposals, he was concerned that residents would not feel they had a ‘proper’ hospital. H Brown highlighted that HHGH would provide local services, urgent care and diagnostics, as well as a special focus on long term conditions. She also emphasised that the respiratory services, which were previously located in Harefield and provided specialist care, were now located at HHGH. F Banks added that this was an opportunity to provide top quality integrated care to West Herts residents. He believed there was a need to focus on West Herts, rather than Dacorum, St Albans, etc.


Cllr Birnie asked that the flexi care proposal be added to a future work programme. Cllr Guest agreed. H Brown suggested that this item be added to the March 2018 committee meeting, (if the plans had been developed by this time) as it would fit in with I MacBeath’s item regarding delayed transfers. Cllr Guest suggested that H Brown liaise with I MacBeath and R Twidle about developing this item.


Action Point: H Brown to provide a presentation on flexi care/wrap around housing at a future Committee meeting.


H Brown also said that she would welcome a view from the Committee on the Strategic Outline Case. She said that it was hoped to be approved in April 2018, it should be available at the next Committee meeting following this. Cllr Guest asked H Brown to liaise with R Twidle as to when this could be brought to the Committee.


Cllr Taylor also took the opportunity to again offer his sincere thanks to all of the stakeholders for attending the Committee, and presenting their plans to their Committee. He emphasised how meaningful it was for DBC representatives to engage so readily and easily with the Health professionals. He said that the Committee would welcome any plans that they wishes to bring and discuss with the Committee. Cllr Guest echoed these comments.


Cllr England asked about the current situation regarding the greenfield site/new hospital proposal; there was a subsequent discussion with H Brown about the various possibilities regarding the site as well as the time scales of the decision. Cllr Guest asked that when WHHT receive notice from NHS improvements with regard to the greenfield site/new hospital proposal, that H Brown inform the Committee, via R Twidle. H Brown agreed.


I Armitage & D Evans then provided the Committee with a further presentation based on the information set out in pg 8 – 16 of the presentation slides (Appendix A).


Cllr Birnie said that this proposal appeared to be relying heavily on 111. He also noted that between the closure of the overnight service and the implementation of the proposals contained in the SOC, it would be nearly two years. 


Cllr Hicks said that although the proposals looked impressive, there was a certain amount of trust to be regained in the ‘111’ service following various negative press. He also asked about people on Dacorum’s boundaries; how would they be treated by the service? D Evans said patients may be booked (via 111) into a GP’s surgery for urgent care, rather than travelling to HHGH. H Brown said that ‘111’ had access to a national directory; this enabled them to book patients into a range of urgent care options. 


Cllr England highlighted that HHGH was very accessible by public transport; he was concerned that by removing this as an overnight option, patients without access to transport may be unable to access some of the urgent care options. H Brown noted Cllr England’s comments, however highlighted the significant costs involved in keeping HHGH open overnight, which would inevitably be at the cost of other services. She also said that realistically, if patients needed to be seen in the middle of the night, this would indicate a need to be treated by A&E. D Evans further commented on this point that it was his role as HVCCG commissioner is to spend the resource in the best, most effective way to achieve the best outcomes to the population. He said one of the purpose of consulting was to make clear in an open and transparent way, the consequences of spending, and explain that one service may then be at the cost of another.


Following questions by Cllr Birnie and Cllr Hicks about the process surrounding how a ‘111’ call would be identified as a ‘999’ emergency, H Brown confirmed that there was a clear protocol with calls to ‘111’ and ‘999’. They were assessed very early on if the caller needed to be escalated/de-escalated to the other service.


Cllr Guest invited any further questions; when none were forthcoming, she thanked the stakeholders for attending.