Agenda and minutes

Health Scrutiny Panel
Thursday, 7th November, 2019 1.30 pm

Venue: Committee Room 3 - Civic Centre, St Peter's Square, Wolverhampton WV1 1SH

Contact: Martin Stevens  Tel: 01902 550947 or Email: martin.stevens@wolverhampton.gov.uk

Items
No. Item

1.

Apologies

Minutes:

An apology for absence was received from Panel Member, Cllr Bhupinder Gakhal.

 

David Loughton, Chief Executive of the Royal Wolverhampton NHS Trust and Professor Steve Field, Chairman of the Royal Wolverhampton NHS Trust sent their apologies to the Panel.   

2.

Declarations of Interest

Minutes:

There were no declarations of interest. 

3.

Minutes of previous meeting pdf icon PDF 300 KB

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

 

Minutes:

The minutes from the meeting held on 12 September 2019 were confirmed as a correct record. 

4.

Matters Arising

[To consider any matters arising from the minutes.]

 

Minutes:

The Chair took the opportunity to thank most sincerely the CCG Clinical Accountable Officer, Dr Helen Hibbs MBE for her public service to the CCG.  She would be stepping down from the role at the end of November.  She did however intend to continue in her role at the Black Country and West Birmingham Sustainability Transformation Partnership, until April of next year.   The STP was on the workplan for the first meeting in the New Year and so he hoped the Panel could thank her in person.  He sought the Panel’s approval to send a letter on behalf of the Health Scrutiny Panel thanking her for her contribution to Wolverhampton CCG.  Members of the Panel paid tribute to the work of Dr Hibbs. 

 

The Chair commented that he was very pleased how the last Health Scrutiny Panel had gone at Linden House, where the first part of the meeting had been on the Tettenhall Wood Road GP Surgery consultation.  The Panel had received a wide range of evidence from interested parties and he felt the matter had been handled appropriately by the Health Scrutiny Panel.  It had been a good example of Local Government Scrutiny out in the heart of the community. 

 

The Chair stated that earlier in the day he had been formally notified of the formal decision of the Primary Care Commissioning Committee.  At the meeting a paper had been presented by the Tettenhall Medical Practice withdrawing their previous application to close their branch surgery, but asking to reduce the number of clinical sessions provided from 7 to 4.  The committee had considered the proposals and took views from local residents.  They agreed to support the proposals as set out in the paper having considered all the options, the outcome of the consultation and the equality impact assessment. 

 

The surgery was currently open for three and a half days a week.  From January 2020, this would reduce to two half days and one full day.  More appointments would be offered at the main site in Lower Green to ensure the same number of appointments were available to patients.  Local patients who were unable to travel to Lower Green surgery would be offered pre-bookable appointments a month in advance and a number of ‘on the day’ appointments would also be ring fenced for patients local to Wood Road.  Meanwhile, the CCG would be supporting the practice to explore other models for the future including using alternative clinicians. 

 

A Member of the Panel commented that it was good and bad news.  It was clearly good news that the surgery was being saved but bad news that there would be a reduction in service hours at the Tettenhall Wood Road surgery.  They hoped that the hours would be increased again in the future should circumstances allow. 

 

A Member of the Panel commented that they thought the wrong approach had been taken.  They believed it was a recruitment issue, which needed to be solved.  The overall overhead costs would increase on the  ...  view the full minutes text for item 4.

5.

Draft Budget and Medium Term Financial Strategy 2020-2021 to 2023-2024 - Health Scrutiny Panel pdf icon PDF 268 KB

[To consider a report on the Draft Budget and Medium Term Financial Strategy 2020-2021 to 2023-2024]. 

Additional documents:

Minutes:

The Finance Business Partner presented a report on the Draft Budget and Medium Term Financial Strategy 2020-2021 to 2023-2024.  He commented that there weren’t any specific saving proposals which fell within the remit of the Panel.  They were seeking feedback on the budget relevant to the remit of the Panel and how it was aligned to the priorities of the Council.  In addition they were asking for feedback on the Draft Budget and Medium Term Financial Strategy 2020-2021 to 2023-2024, including budget proposals that were relevant to the remit of the Panel.  In October 2019, Cabinet had been informed that after taking into account projected changes to corporate resources and emerging pressures, the projected remaining budget deficit for 2020-2021 would be in the region of £3.9 million, rising to £20 million over the medium term period to 2023-2024. 

 

The Finance Business Partner stated that the report also made reference to the Medium Term Financial Strategy including provision for a real terms increase to the Public Health Grant budget in 2020-2021.  This had been announced by the Government in the Spending Round 2019 to ensure local authorities could continue to provide prevention and Public Health interventions.

 

The Director for Public Health remarked that the £20 million grant from Government to Public Health did come with some mandatory requirements, which included having to provide the Healthy Child Programme, Sexual Health Services and NHS Health checks.  Despite the Public Health Grant being reduced year on year, it was refreshing to be able to list the successes detailed in paragraph 5.3 of the report.  This had included increasing the number of health checks offered to the eligible population.  The City had moved from one of the lowest performing areas to top quartile within the year. 

 

The Director for Public Health commented that the number of rough sleepers had reduced, which was pleasingly in contrast to the national trend.  Substance misuse treatment had significantly improved meaning recovery rates were better with more people finding employment.  They had moved from a treatment to recovery focus.  The performance of the Healthy Child Programme was at its best since Public Health had transferred to the Council in 2013.  He believed the most important check to be at 2 -2.5 years old as this was to try and ensure every child was ready for school.  Performance was currently at 72.6%.  They were working closely in partnership with the Royal Wolverhampton NHS Trust on the Healthy Child Programme.  Public Health also provided the drug and alcohol services for the City, which was not a mandatory requirement, but a requirement locally. 

 

The Chair referred to the budget risks in appendix 1 to the report detailed on pages 26 and 27 of the agenda pack.  As some of the risks were out of the authority’s control, he asked what the Council was doing to mitigate them.  He noted that four items were currently listed as red risks.  The Financial Business Partner commented that the fact that the risks had been identified enabled  ...  view the full minutes text for item 5.

6.

Public Health Annual Report 2018-19 pdf icon PDF 287 KB

[To consider the Public Health Annual Report 2018-19]. 

Additional documents:

Minutes:

The Director for Public Health presented the Public Health Annual Report 2018-2019.  He had a statutory duty to deliver an Annual report.  He stressed it was important to get the basics right in life to ensure people remained in good health this included good housing and living in a good community.  The Annual report included a section at the back of the report on individual ward profiles.  He was particularly pleased with the work Public Health had completed in partnership with health partners on health checks.  Organisation had been the key to success in both the increased uptake of health checks and flu vaccinations. 

 

A Member of the Panel commented that she felt the ultimate strapline from the report was that if you wanted to live longer it was important not to be poor.  They stressed the importance of living in good quality housing and the value of the enforcement work the Council carried out in private sector housing.  They believed the enforcement team had halved in strength in recent years. 

 

The Panel discussed the ward profiles and the differences in life expectancy. Comments were made about breaking the cycle of deprivation within families.  A Panel Member asked about the amount of alcohol related hospital admissions in Wolverhampton and what action could be taken to bring the level down.  The Director for Public Health responded that alcohol abuse was a key problem for the City to address.  It was important to promote sensible drinking practices and have an effective intervention service.  The Wolverhampton alcohol intervention services were well respected nationally. 

 

A Panel Member asked about the homeless figures for Wolverhampton.  The Director for Public Health offered to write to her with the formal definitions of rough sleeping and homelessness as they were different.

 

The Chair remarked that it was most concerning that nearly a third of local children aged 0-15 years old were living in poverty (31.3%).  He asked what definition of poverty Public Health were using in the report and what they were trying to do to change the situation.  The Consultant in Public Health responded that Public Health were using a well-established national indicator for child poverty in their report.  Nationally there was a database of all the families in receipt of child tax credits.  A child was deemed to be living in poverty if they lived in a household in receipt of child tax credits and the household was receiving income support or job seeker supporter, or if they were living in a family receiving child tax credit and were deemed to be in the bottom 60%. Wolverhampton did not compare well to the rest of the country and that was largely down to the deprivation rate in Wolverhampton.  The child poverty figure in Wolverhampton was similar to Dudley, Sandwell and Walsall.  The only way to improve the figure was to increase the employment rate and improve household incomes. Jobs, skills, strong and stable homes and opportunity were key.

 

The Chair asked what the contributing factors  ...  view the full minutes text for item 6.

7.

Wolverhampton CCG Annual Report 2018-19 pdf icon PDF 1 MB

[To consider the Wolverhampton CCG Annual Report 2018-19].

Additional documents:

Minutes:

The Chair read out an initial statement which praised the CCG for receiving an outstanding rating in July 2018 and also this year.  It had also been a great achievement for the CCG to receive the Clinical Commissioning Award for 2018.  He was very pleased to see the increased uptake in health checks.  He was also pleased to see the CCG using innovative technology in primary care to improve services which included being one of the first areas to implement online triage and GP online video consultation.  He also welcomed the extended GP opening hours. 

 

The Chair had submitted a number of questions on behalf of the Health Scrutiny Panel in advance of the meeting.  The questions and written answers provided were as follows: -

 

Mental Health

 

1)    The report makes reference to you working to minimise your Out of Area Placements in Mental Health.  What steps are being taken to ensure we have enough beds in Wolverhampton to avoid out of area adult placements and how many more do you think would be sufficient for now and in the future?  Crucially it also refers to this not being able to be zero, as you have no female Psychiatric Intensive Care Unit in the Black Country (p.18). 

 

CCG Written Response :-

In this contracting round we are working with BCPFT and DWMHPT to increase the beds we purchase locally – if possible by as many as 8 – from April 1st 2020 (this will involve reducing the access of BSOL CCG to BC&WB STP wide bed stock) we are working with BCPFT to develop an STP wide female PIC Ward – we expect to have this by April 2021.

 

Across both our business intelligence teams (i.e. provider and commissioner) we are working with data to understand the increase in activity and what community models are required to prevent admission and relapse and ensure access to evidence based community care in line with NICE and the constitutional and transformational standards of the NHS Plan.

 

We have raised concerns with PH alcohol and substance misuse commissioners regarding the impact of high levels drug use in Wolverhampton upon mental ill health and have requested a public health comms campaign.

 

We have agreed a service model for primary and secondary mental health and a service specification is in draft.  Additional investment is available however recruitment to required workforce is likely to be an on-going risk for at least 2-3 years while we work with HHE to grow the required workforce and trainees.  

We i.e. the CCG have set a sum aside to invest in promoting emotional health and well-being to mitigate against the impact of Public Health and Social Care cuts in these services and to mitigate against the impact of very high levels unemployment deprivation and substance misuse in Wolverhampton.  We have also identified sums of money for Sec 117 MHA care packages – again to mitigate against social care financial pressures.

 

 

2)    Can you inform us about how the new  ...  view the full minutes text for item 7.

8.

GP Appointment Waiting Times pdf icon PDF 648 KB

[To consider a report from Wolverhampton CCG on GP Appointment Waiting Times]. 

Minutes:

The Wolverhampton CCG Primary Care Transformation Manager presented a report on GP appointment waiting times.  There were two forms of data available,  National data was collected by NHS Digital and local data was collected for Primary Care Networks Hub access through a Local Enhanced Service.  The waiting time statistics for Wolverhampton were similar to other areas in the STP (Sustainability and Transformation Partnership).  They were also comparable to regional and national statistics.  There were no performance targets for waiting times for either core services or hub appointments.  The contractual requirements for Extended Access Hubs were that both pre-bookable and on the day appointments needed to be available. 

 

The CCG Primary Care Transformation Manager commented that all practices had same day provision with different models of managing demand.  Practices had reported that the majority of their appointments were available on an urgent basis in order to manage patient expectations.  All practices had systems in place to manage demand and flow of patients, by releasing appointments at different times. 

 

A Panel Member asked how the CCG informed patients that out of hours appointments were available.  The CCG Primary Care Transformation Manager responded that there had been a bus and metro advertising campaign, in addition to radio advertising.  The STP were undertaking some communication work and developing this with the local community. 

9.

GP Communication Report - Healthwatch pdf icon PDF 292 KB

[To consider the GP Communication report produced by Healthwatch]. 

Additional documents:

Minutes:

The Healthwatch Manager introduced the GP Communication report.   Healthwatch Wolverhampton had carried out a short survey to gain an understanding of the communication that was taking place across Wolverhampton from the GP’s to the patients.  There had been over 500 responses.  73% of patients had indicated that they did not receive any communication from their practice.  The communication that was received by 27% was mainly around appointment and prescription reminders.  Healthwatch had been informed that communication was shared through the Patient Participation Groups.  However, when Healthwatch asked the public the question, 76% were not aware of PPGs but 51% would be interested in attending one at their practice.  She understood there had been some changes since the survey had been completed and shared with health partners. 

 

Resolved: That the Health Scrutiny Panel notes the report and thanks Healthwatch for its compilation. 

10.

Healthwatch Wolverhampton Annual Report 2018-19 pdf icon PDF 191 KB

[To consider the Healthwatch Annual Report 2018-19]. 

Additional documents:

Minutes:

The Healthwatch Manager introduced the Healthwatch Annual Report 2018-19.

 

The Chair asked how Healthwatch promoted to the general public their ability to inform Healthwatch of issues they had been experiencing.  The Healthwatch Manager responded that they used a variety of different methods.  They tried to get out into the community, which had included having a take over shop in the Wulfrun Centre.  They would be happy to hold something in the Civic Centre should the appropriate approval be given. 

 

The Chair commented that he had read in the Annual Report that Healthwatch had identified interpreter services at Patient Participation Groups as an area requiring improvement.  The Panel would be reviewing Patient Participation Groups as an item next year. 

 

The Chair asked the Trust and the CCG to comment on the statement in the Section in the Annual Report entitled, “Spotlight on Mental Health.”  The relevant section he read out as follows: -

 

“Due to the times that GP’s and mental health services can be accessed; people are often forced to go to the Emergency Department with challenging behaviour because of their mental health condition, they are often treated by security in the same way that someone who is causing a problem.  This often makes the situation worse and has a negative impact on the mental health of the person.”

 

The Director for Strategy and Transformation of the CCG responded that it was clearly a failure of the system if someone was going to A&E in crisis for a mental health condition.  The key was to try and ensure that this did not happen, but whilst this was an admirable ambition, it was inevitable that there would be some cases of people going to A&E in a mental health crisis.  It was important that they be treated with dignity. 

 

The Medical Director of the Royal Wolverhampton Health Trust responded that it was difficult for security staff to sometimes to be able to distinguish between someone in a mental health crisis and someone intent to cause a difficulty.  Someone in an acute mental health crisis could have very challenging behaviour and A&E was clearly not a suitable place for them.  Security staff were trained to deal with various situations and did their best to try and manage them.  Sometimes the perception of how a person felt they had been dealt with could differ to the security staff.

 

The Director for Adult Services commented that it was not a unique local challenge as it was a national problem.  There was a general discussion about the matter. 

 

Resolved: That the Health Scrutiny Panel formally note the Healthwatch Annual Report 2018-2019 and that Healthwatch be thanked for its excellent content. 

 

 

11.

Development of the Medical Examiner Role and on site Registrar pdf icon PDF 332 KB

[To consider a report on the Development of the Medical Examiner Role and on site Registrar].

Minutes:

The Medical Director from the Royal Wolverhampton NHS Trust introduced a report on the development of the Medical Examiner Role and on-site Registrar.  He stated that the introduction of the Medical Examiner Role was very welcome and was at least ten years too late.  There had been discussions about introducing the role since the Shipman Inquiry.   Earlier this year the Trust had opened up a Bereavement Centre in a vacant area of the Urgent and Emergency Care Centre.  The Centre was staffed by administrative officers, medical examiners, a bereavement nurse and a City Council Registrar.

 

The Lead Medical Examiner stated that there were 8 consultants classed as Medical Examiners.  The process was an independent one and they discussed the care of the deceased with the medical team and the family of the deceased.  They were able to refer matters to the Coroner.  They completed checks to ensure that the Medical Certificate of Cause of Death was correctly completed.  This helped to prevent delays when a family took the certificate to the Registrar to register the death.  They were aiming to scrutinise 97% of all cases.  The feedback they had received from families had largely been of an informal nature and the most common reaction was to say that they couldn’t speak highly of the care received. 

 

Panel Members praised the introduction of the new Bereavement Centre and thanked the Medical Examiners for their work. 

12.

Health Scrutiny Work Programme pdf icon PDF 282 KB

[To consider the Health Scrutiny Work Programme]. 

Minutes:

The Scrutiny Officer reported that the Chair and Vice-Chair of the Panel had met Officers from Public Health the previous day and it had been recommended to defer the item on cancer screening to the March 2020 meeting.  Members of the Panel agreed to make the change to the work plan. 

 

Resolved: That the Health Scrutiny Work Programme be agreed. 

 

 

The meeting closed at 4:05pm.