Agenda item

The Chair advised that action points can be found on pages 4 to 5 of the report and advised that the consultation on the opening hours for the Urgent Care Centre is live at the moment so would be good if we can come up with our thoughts on it so then we can put them to Full Council so Dacorum Borough Council, a community leadership organisation, can take a view on it, asking, has anyone got any thoughts on the opening hours of the Urgent Treatment Centre?

 

Cllr Taylor commented that he would like to outline to the Committee is the following:  It is quite apparent from the feedback that we have received from a number of different sources, not least from people that have attended some of the consultation meetings that we know are going out when Helen was here with her Chief Executive and six other senior members of the various trust bodies that the feeling in Dacorum is that they want the Urgent Treatment Centre to be a 24/7 provider and with the doctors on call at Hemel Hempstead, not at Watford.  We feel that our residents want to see that Urgent Treatment Centre being a provider of as many of the NHS services as are available to the general public. 

 

There are a number of the Councillors here who attended the confidential conversational meeting that again Helen was ably supported by her Chief Executive and six other senior management representatives as to what they were going to deliver in the road show that they were taking around the area. 

 

Now it’s pretty obvious to me that the feeling of the general public in Dacorum is that they want as much as they can possibly have in a hospital that is providing less and less and less.  I use the example many times in this plea that when I first came to this area in 1982, there were two hospitals and there was, if you want to really massage the figures, there was a third, I think it was called Hill End at that time, which was the mental hospital that served this particular area.  Now in those thirty-six years that I’ve been in Hertfordshire it’s pretty obvious to me that our hospital services have decreased and our population has more or less doubled in those thirty-five, odd, years. 

 

I don’t think it unreasonable, Madam Chairman, and you may like to take this in your own words, as a proposition, but I would feel it appropriate that we, as Dacorum Borough Council put forward a proposition in Full Council that we will champion the Urgent Treatment Centre to provide as much and as many of the services that the NHS can offer at the Urgent Treatment Centre.  I would suggest, Madam Chairman, that if you want to put that forward as a proposition in your own words, I will, if those own words coincide with what I’m thinking of, will be pleased to second it.  We want to be seen to be championing that particular cause. 

 

Cllr W Wyatt-Lowe commented that he would heartily endorse what Cllr Taylor has said.  Talking to residents of Dacorum, the things that they remember include a promise that there would be some sort of urgent service in Hemel to avoid travelling too often at night, which some people find very difficult to do and particularly in these days when ambulance services also are stretched, this becomes very important.  I was hearing today of an example of somebody whose carer summoned an ambulance but then had to wait with the patient for nine hours.  The ambulance didn’t view it as massively urgent because there was somebody there with the other person affected but the carer of course, couldn’t move the person who’d had a fall and just because there was the risk of something being broken.  The carer wasn’t capable of assessing that and needed a paramedic.  So, wholehearted support.

 

Cllr Timmis added that whilst it seems exactly what everybody’s asking and requiring; to have more and better facilities, she asked, what can we do as a Council to support that with resources, that’s what they need, the NHS will turn round and say we have not got the resources, we have to make the best of our resources by centring round different places, like Watford.  So my question is whilst I agree with the sentiment, what can we actually do? Just to say that we support it but to support it with words is not enough.

 

Cllr Taylor responded and advised that he fully accepts what Cllr Timmis is saying, that words and effort are not worth a great deal without some actual input.  What can we do?  I think that the longest march is started by the first step, we have the first step where we agreed as a Council that we would support, or we would campaign for, as much as we could, Madam Chairman, by way of hospital provision.  Now I think we owe it to our residents, to at least show willing, and it may well be that the Hospital Action Group, the Patient Participation Groups, the general public themselves say, well, can you actually do anything and take exactly the view you have, Councillor Timmis, and I don’t think that that challenge is a down side, it is factual.  In reference to Cllr W Wyatt-Lowe’s comments, I have had a case just recently where somebody fell over in their home, it took an hour for the ambulance to get to them, they then went to Watford.  They had to wait for an hour to see somebody and he said why are you in a wheelchair, you haven’t broken your leg, you’ve broken your arm, and had a look at the X-ray and said, nothing I can do about it, you can’t plaster up a shoulder, so I’m going to send you home.  She said well, what can I do, I’m in pain.  Well, what do you want?  Well, I want some pain killers, so they gave her co-codamol and then with her husband had to go back home by taxi.  That turned out to be a lady who subsequently went to a private hospital for an X-ray and the X-ray showed she had broken her arm and shoulder in six different places.  That was some seven days after the actual incident.  It’s a real live case.  We, I think, owe it to our residents to at least be championing the cause for services where, if that had been a trip down to the Urgent Treatment Centre, for an X-ray, hopefully the person who saw the X-ray would have realised it was a six times break as opposed to somebody who was just coming in and had fallen over and hurt her shoulder.  We don’t know.  So, I do wholeheartedly agree Cllr Timmis, with what you’ve said, what can we actually do?  I think if we commit ourselves to doing as much as we can, as a whole Council, regardless of political party, show a united front in trying to do as much as we possibly can for the Urgent Treatment Centre.

 

Cllr Maddern commented that she wholeheartedly supports this and made the point that if we’re going to put out a statement at Full Council, it needs to be in the very strongest possible wording.  We need something that’s hard-hitting, we don’t want anything that’s gentle and fluffy, we need it to be very hard-hitting and say exactly what we think.

 

Cllr England endorsed what Cllr Taylor suggested at the beginning, the idea of a DBC statement on this.  We also all know about the 2009 promise when the A&E was closed, that a twenty-four hour presence would be maintained.  So we all agree.  I would like to propose that DBC recognises the point that Councillor Timmis made, to keep the promise, that we ask the government to promise and we ask for Helen to give them the money to do it.

EGlasser spoke Can I thank you all for your support and I attended the recent public meeting and even I was surprised about the strength of feeling in the room and the anger in the room.  Unfortunately none of you could be there because it was the night of the Council meeting.  There wasn’t only support for the Urgent Treatment Centre but also to my surprise, the medical centre, West Herts Medical Centre.  Why I’m particularly concerned about what’s happening, is that we lost night time UTC a year ago last December, what I didn’t know until very, very recently, not until the Berkhamsted meeting when I asked a question publically, about the fact that we no longer have locally an out of hours GP service either, so what we’ve had is a double whammy, we have nothing at night from eleven to eight in the morning, unless you go to Watford.  That’s what Im particularly concerned about and I would echo what Cllr Maddern has said, in that we’d love to have a very strong statement because if it isn’t very focused, it is, I’m afraid, ignored.  In respect of funding, there is money if certain things weren’t done, there’s a lot of services going out to tender at the moment and those cost money, so I know that Adult Services is up for grabs, it’s a huge contract, Herts Community Trust is running it at the moment and they are having to bid and that’s going to cost them a lot of money and that’s money that’s that’s coming out of the NHS, that could have been perhaps used instead to run community services.  So I think there are ways and means, it’s just how you look at your budget and how you spend it.  Anyway, thank you all for your support

 

Cllr Hicks responded that unfortunately he couldn’t attend either of the local meetings because they clashed with either the Council meeting here or the Council meeting in Tring, but expressed that he wholeheartedly agrees with everything that’s said and living on the periphery of the Borough and the County, feels it even more so.  The services in Tring in the time that I’ve lived there, we’ve lost everything and I would totally and wholeheartedly support a strongly wording to say that we need some services back again.

 

Cllr Timmis raised a question; at the last meeting we discussed the times Urgent Care Centre, there was confusion about the services that were going to be delivered, such as resources on imaging and other endoscopy procedures and so on.  None of these had been decided and that was approx. two or three months ago, and I just wondered if we’ve got any progress?  It’s another thing that people have to travel to Watford and that’s a huge unnecessary amount of time and expense for people when it could be delivered locally.  That’s what we’re doing now with GP hubs, we’re trying to deliver things in one go because it saves money and it delivers a better experience for the patient.  So I wonder whether we have any update on that?

 

The Chair asked HBrown to respond to the comments raised by Cllrs.

 

HBrown responded that there are different things that we’re talking about here; there’s a long term strategy for Hemel and the redevelopment and I think that the questions about MRI, CT, endoscopy very much sit into that kind of discussion and we’re continuing to work on the long term plans for Hemel and the strategic outline case, the target is for that to be completed in May, that will set out our views at the current time of what we think we can deliver there in the long term.  If there are changes to services over and above things that were said in Your Care, Your Future, then we’ve undertaken to have an engagement process around that before we complete the outline business case.  The outline business case is the really critical bit of the long term redevelopment plans.  This is just a very early step in the process.  So, there isn’t a definitive view on that, we continue to work on it and see what we think we can, we think is viable for a long term solution.  So, I’ll set that to one side and we’re happy to come and talk again at a future meeting on that. 

 

In terms of the Urgent Treatment Centre and West Herts Medical Centre consultation, obviously that consultation is being led by the CCG.  It is ultimately a commissioning decision about what they want to commission.  I think you do need to see urgent and GP out of hours inextricably linked, there isn’t enough, whichever way we cut it, there isn’t enough urgent activity overnight to have separate services, all kind of working independently, so whichever way we do it, we need to see how that comes together.  It’s not my job to tell you what you should think.  I’ve got a view about the volumes of activity that are genuinely urgent, overnight, are low, because most things overnight, can either wait till the next day or they’re so urgent that they need to go to an A& E department and even with an Urgent Care Centre at Hemel, you’ll find that people will need to go to A&E, you’ll find problems with ambulances, and you’ll find that with the best will in the world that sometimes commissions don’t give exactly the treatment that you think they should have done whether you pitch up at Hemel or Watford or Luton, so I think that’s the real challenge.  It’s partly money, so we get funded on a per case basis for the Urgent Care Centre at the moment, for every patient that comes, we get paid £100, say (I don’t actually know how much it is) and overnight, the volumes of patients that come if we continue to get paid at that level, don’t cover the cost of running the service, so to that extent, there’s a money issue for the Trust but another provider might be able to do it differently, and GP out of hours might be able to provide differently. 

 

The real issue is the workforce and actually we haven’t got enough, we’ve got a real shortage of GPs and we’ve got a real shortage of nursing staff and they’re not popular shifts, because you’re working in a relatively isolated location, with a relatively small volume of work coming through and in the nicest possible way, most of the work is not clinically very interesting, but occasionally, you get something really, really scary through the door and you’re on your own, so it’s a bit of a bad combination between boring and scary and a bit unsupported. 

 

So those are all the reasons why, we think it’s a decision to be made carefully and it’s not just that we’re being difficult, it’s that it is quite challenging to provide that kind of service overnight at that scale.  Having said which, it’s the CCG’s decision what they want to commission.  If we don’t believe we can provide it, we might ask the CCG to find a different provider, so Herts Urgent Care or another provider and that will come in due course.  The current opening hours are 8am till 10pm; the doors actually close at eleven, but we accept the last patient at ten.  The consultation says either retain those opening hours, extend to midnight, which actually means the doors will close at one, which is particularly difficult from a workforce point of view, because working till one o’clock in the morning and then getting home is a bit of a challenge and probably not ideal, or to attend 24/7. 

 

So I think you should make the resolution that you feel is the right resolution and represents your residents’ views but those are all the things that CCG will be taking into account.  That is what we will be saying in our submission to the commissioners about why we think it’s challenging to open overnight. 

 

Cllr Taylor responded that he appreciates everything said by HBrown, but there are two sides to every coin and that is why it is his opinion that we should embrace as much as we possibly can to obtain as much as we possibly can for our residents in Dacorum.  There will be some hard talking and hence the reason why I haven’t prepared a proposition to put forward to this Committee tonight but I think having spoken with my Chairman, who has been making her notes and adding them to what she has been preparing, we can put together a proposition that yes, we need to fight.  We need to fight for as much as we possibly can, knowing that there is an alternative view and there will be compromise, I accept all that and Councillor Timmis’s report back comment about how are we going to do something without putting money on the table.  I think we’ve got to be able to debate, discuss, compromise but both of us have got to achieve, both sides of us have got to achieve as much as we possibly can for our residents and for your bosses.  So, I don’t detract at all from the strength of the fight that is going to have to be put up but I think the time has come that we should be fighting, now we’re getting to know more and more about what might be from, at worst, and I don’t think this is an exaggeration, EGlasser, at worst, I can see everything in Hemel Hempstead disappearing.  And we become like Tring, you just have GPs in Dacorum. 

 

Cllr Timmis added, with all this proposed housing strategic plan, and therefore a large number of people going to be resident in Hemel Hempstead, isn’t it because we need to put in infrastructure, one part of the infrastructure should be a provision health wise, instead of always looking at the NHS, shouldn’t we be looking at the government, saying they want us to, are expecting us, to build more for residents to be able to live here, and as such they need to support the NHS in order to be able to provide the health services for those people.  This is just a quick thought but I mean, it’s getting pretty desperate when you think that our shrinking health services, whilst we’re expected to provide more and more provisions for more and more people living in the area.

 

The Chair recognised the point being made by Cllr Timmis but commented that it’s really the next stage of the fight.  Currently we’re looking at the Urgent Care provision.  The Chari advised she has drafted a Motion, if anyone’s got any suggestions for improvements, then please come out with them.  The draft Motion I have been putting together whilst we’ve been discussing is “This Council believes that the people of Dacorum deserve the best possible care available locally.  This Council remembers the promise of 24/7 urgent care cover when the Accident and Emergency Department at Hemel Hempstead Hospital was closed in 2009.  This Council supports the Urgent Care Centre at Hemel Hempstead Hospital being open 24 hours a day, seven days a week, with doctors on call in Hemel Hempstead for all that time and urges the NHS to open the Urgent Care Centre 24/7 with doctor cover”.  Any suggestions for how that can be refined, developed and improved? 

 

Cllr Taylor responded with a suggestion that this be an outline. I think we’ve had a lot of input about GP attendance, strong wording, hard hitting, funding.  I think that that being the outline, we could then take that forward over the next, say, seven days.  We can incorporate views from Members, in addition to what we’ve already received this evening, so that we can have a strong worded, hard hitting acknowledgement of the problems that are ahead.

 

The Chair addressed RTwiddle (Member Support Officer) and asked could this skeleton motion that we’ve developed tonight be put to Full council to be fleshed out and amended and developed in the debate at Full Council?  RTwiddle responded that any request would need to be put to the Group Manager of Democratic Services to be able to offer the most accurate advice. 

 

EGlasser commented to advise that the consultation ends on or around 28^th March.

 

The Chair confirmed that the next meeting of Full Council takes place on 18^th April, which is going to be after the end of the consultation, so just to make sure we get this right we will seek advice from the Group Manager of Democratic Services, JDoyle, along with the Senior Lawyer for the Council (MBrookes) I suggest we put forward this skeleton motion now and we get advice on how we progress to put together to go to Full Council.  The Chair invited comments.

 

Cllr Taylor expressed his feeling that is perfectly legitimate because his confirmation has come from MBrookes, so the outline I’ve spoken to him about is that we want to do this and we tonight can’t, I think, agree the final wording.  We’ve had a lot of input already from Councillors around the table and I would suggest that we are able to pursue the drafting of a formal proposition on the information that we have collated this evening

Cllr England commented that he thought that Councillor Timmis put it well, that in order for this statement to actually mean something and be coherent, in financial terms, it would be a very good idea to mention the housing demands, the housing situation, in the draft.

 

The Chair agreed with Cllr England, but added that this is a skeleton motion that we’ve put together, which in consultation with MBrookes, the Legal officer and Jim Doyle, the Group Manager of Democratic Services, that’s got to be fleshed out and put the meat on the bones for something to go to Full Council.  I’ll just read out the draft Motion again.  “This Council believes that the people of Dacorum deserve the best possible care available locally.  This Council remembers the promise of twenty-four/seven urgent care cover when the Accident and Emergency Department at Hemel Hempstead Hospital was closed in 2009.  This Council supports the Urgent Treatment Centre at Hemel Hempstead Hospital being open twenty-four hours a day, seven days a week, with doctors on call in Hemel Hempstead for all that time and urges the NHS to open the Urgent Treatment Centre 24/7 with doctor cover”. 

 

The Chair proposed the motion and asked, is there a seconder?  Cllr Taylor responded that he would second it, subject to the inclusion and the fleshing out of the comments, like growing population, government input, so yes I second it, subject to us adding what we’ve heard from the Councillors tonight.

 

The Chair clarified, what we’ve put together in this discussion has been skeleton, so the fleshing out of national funding, of looking at increased infrastructure needed with increased housing numbers, that will be part of the fleshing out, part of the putting flesh on the bones of this skeleton.

 

The Chair asked for a vote of all those in favour, by the showing hands.

 

Agreed unanimously.

 

Action Point:  Chair & Committee to liaise with MBrookes & JDoyle to flesh out motion and submit to Full Council.

 

Cllr Taylor suggested that HBrown now needs to give her update before she leaves.

 

The Chair responded that she understands that HBrown needs to leave so will change the order of the agenda and move on to your bit and then we’ll come back to the other action points after you’ve had to dash off.

 

HBrown thank the Chair and advised that she is on call form the hospital tonight and its quite busy so she has someone else standing in for her and does not want to abuse that.

 

Moved to Item 7 of the agenda.

 

Returned to action points update following departure of HBrown.

 

The Chair referred to the action point for Iain MacBeath to send a copy of the report ‘outline delay transfer to care due to social care and the patient’s home area’, and asked, is that what we’ve seen tonight?

 

RTwiddle confirmed yes, as page 4.

 

The Chair noted that the committee requested an update from KMagson from the CCG to on ‘Let’s Talk Two’ within the CCG item, but note that KMagson is not at the meeting, so the item will need to be pushed back.

 

RTwiddle responded to advise the Chair that DEvans responded on 15^th February to advise that the HVCCG had not developed its Let’s Talk Two programme yes, so they are unable to provide an update on that at the moment. 

 

The Chair confirmed the Lets Talk Two item should be carried forward until the programme has been developed.

 

Action Point: Lets Talk Two update to be placed in future items, pending confirmation from HVCCG that the programme has been developed and an update available.

 

The Chair referred to the final action point, which is for HBrown to give a presentation on Flexicare/wrap around housing at a future Committee date.  It’s been added to the work programme, so we’re looking at the September meeting for that.