Agenda and minutes

[To receive any apologies for absence]. 

On the STP item apologies for absence were received from the Black Country Partnership NHS Foundation Trust. 

There were no declarations of interest. 

[To approve the minutes of the previous meeting as a correct record.]

The minutes of the meeting held on 7 November 2019 were approved as a correct record. 

[To consider any matters arising from the minutes].

The Chair of Healthwatch referred to the section in the minutes relating to homelessness.  The Director for Public Health responded that he was intending to arrange a meeting with Healthwatch to clarify all the issues raised during the last meeting. 

The Chair of Healthwatch referred to the 18 weeks wait after an initial assessment for the Access to Psychological Services.  She believed this was too long for a person to wait, who wished to access the service.  The Director for Strategy and Transformation agreed that it was too long for a person to be kept waiting and added that they were working with the provider in reviewing the target.

The Chair of Healthwatch commented that she was pleased to have received the data from Dr Odum relating to the waiting times for the results of cancer scans.  The two areas of most concern related to the results for gynaecology and lungs.  She asked the Chief Executive of the Royal Wolverhampton Trust to comment on whether there were any plans to improve these two areas.  The Chief Executive of the Royal Wolverhampton Trust responded that the waiting times for lung cancer results had really started to improve.  They had not improved to the same extent in gynaecology, he was however hoping to appoint 3 new Consultants in this area. 

A Member of the Panel commented that during a man’s lifetime, more than half would be diagnosed with late prostate cancer.   It would overtake breast cancer as the most diagnosed cancer in the country.  The Chief Executive of the Trust acknowledged the Member’s comments and added that if there was going to be a national or local campaign on prostate cancer, the service had to be ready for the additional people reporting with symptoms.           

The Local Healthwatch Manager noted that cancer screening was on the work programme for the next meeting of the Panel.  She wanted to ensure that Healthwatch’s work on cervical cancer screening could be captured as part of the item.  Adding to the discussion, The Director for Public Health stated that cancer screening was a key priority contained within the Public Health Annual Report. 

[To receive a report on the Accident and Emergency Department at New Cross Hospital].  [Report is marked to Follow]. 

In attendance for this specific item from the Royal Wolverhampton NHS Trust will be:-

Andy Morgan – ED Consultant and Divisional Director Division 2

Bev Morgan – Head of Nursing Division 2

Tim Powell – Deputy Chief Operating Officer Division 2

The Chair and Vice-Chair of the Health Scrutiny Panel had submitted the following questions to the Royal Wolverhampton Trust in advance of the meeting:-

1.     Can you explain the processes of the Hospital for declaring a level four and the response this initiates? In addition, how many occasions have you declared a level 4 in the last 12 months and for how long did the status stay at level 4. 

2.     Can you explain what steps the hospital are taking to improve the experience of mental health patients attending A&E?

3.     What are you and your colleagues most proud of in the A&E Department?

4.     What is staff morale like?

5.     Do the staff in A&E take appropriate breaks? 

6.     How does the Hospital work with the Ambulance Trust?

7.     Have the Security arrangements had to be enhanced in recent years and what are the associated costs?

8.     Are there any campaigns planned on the appropriate use of A&E?

9.     AFC Band 2 – HCA and AFC Band 5 - Have the most vacancies, how are you coping with this shortage and how is the recruitment process going?

10. Do you think patients receive enough privacy and dignity in A&E, where could things be improved?

11. Can you tell us more about the administration of notes, are they all scanned on the system and is there a back log?

12. What are your priorities to improve A&E moving forward?

The Chief Executive of the Royal Wolverhampton Trust extended an invitation to all Health Scrutiny Panel Members to visit the Accident and Emergency Department at some point in the future.  He was also happy to host the Scrutiny Panel at the hospital for an official meeting of the Panel as well.  He referred to the slides which had been circulated with the agenda.  Daily attendances at Accident and Emergency were up by over 100.  Ambulance daily attendance had risen to 180 in 2019 compared to 158 in 2018.  Recently there had been over 200 ambulances attending on any one day.  It was not the high number over 24 hours that was his major concern, it was more problematic when there was a rush of ambulances in a small-time frame, such as 17 in 30 minutes.  It would take over two hours to clear this amount of ambulances in such a short time frame. 

The Chief Executive of the Royal Wolverhampton Trust remarked that regionally the Trust was ranked third for the percentage of people meeting the 4-hour target.  He understood that the Secretary of State for Health was considering removing the four-hour target.  He was personally not in favour of removing the target as he saw it as a good way of helping to ensure the systems flowed.  Sometimes it was clinically correct to miss the four-hour target, for instance if it meant keeping a person in the department for six hours, who could then go back home.  He therefore thought the four-hour target should  ...  view the full minutes text for item 5.

[To receive an update presentation on the STP (Sustainability and Transformation Partnership).  Steven Marshall (Director of Strategy and Transformation CCG) will give the initial update and then there will be a wider discussion with Health Partners and the Panel]. 

The Chair and Vice-Chair of the Health Scrutiny Panel had submitted the following questions in advance to the Deputy Chief Accountable Officer of the STP, Mr Steven Marshall. 

1)    Who do you see the STP as being accountable to?

2)    Where does the Chair and Lead Officer get their support from?

3)    How do you see the STP evolving into an ICS (Integrated Care System)?

4)    What Governance arrangements do you foresee for the future ICS?

5)    What role do you see for Local Government in the ICS?

6)    The CCG in Wolverhampton has been rated as outstanding in the last four years.  This is partly due to excellent finances.  How do we ensure that Wolverhampton does not suffer financially in the future, with money being allocated in other areas at the expense of Wolverhampton?

7)    How can we ensure that the future ICS will not make some health services worse in Wolverhampton?

8)    Will the meetings of the future ICS Board meet in public?

9)    Where do you see the future leaders of the ICS originating from?

10) How far should the ICS take on responsibility for quality and financial performance as opposed to planning and implementing the transformation of care?

11) What are your views on legislating for ICS’s?

In relation to question 1, the Deputy Chief Accountable Officer of the STP responded that the STP was not a statutory body, it was just a mechanism which brought a group of statutory bodies together for a common planning and organisation consideration.  The STP did not have any legal authority, each organisation within the STP had their own accountability structures.

The Deputy Chief Accountable Officer, in response to question 2 remarked that the Chair and Lead Officer had a small Project Management Office, housed at the Science Park.   There were currently discussions taking place about how it might need to change following the evolution of the STP. 

With reference to question 3, the Deputy Chief Accountable Officer responded that fundamentally an integrated care system was about devolving decision making authority, as to where funding should be spent, to a more localised footprint.  In order for the STP to evolve into the ICS there were a series of hurdles which needed to be crossed during the financial year 2020-2021, in order to demonstrate to the regulators of the NHS that it had the mechanisms in place to become self-regulating.  Once it had achieved this the ICS would then decide how it would run the Black Country ICS.  The ICS also had to be made up of Local Authorities and the voluntary sector.   

With reference to the Governance arrangements of the ICS (question 4), the Deputy Chief Accountable Officer commented that a paper had been presented to the STP Board in November 2019 which proposed a move to recognise the importance of place.  Each place, including Wolverhampton, had been asked to establish an ICP (Integrated Care Partnership) Board.  This was a work in progress and discussions were ongoing.  The Voluntary Council,  ...  view the full minutes text for item 6.

[To consider the Health Scrutiny Work Programme]. 

Resolved: That the Health Scrutiny Work Programme be agreed.

The Meeting closed at 3:10pm.