Agenda and draft minutes

Apologies were received from Councillor Mattu.

There were no declarations of interest from the Panel.

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

The minutes of the meeting which occurred on the 14^th December 2023 were approved as a true and correct record.

[Members of the Royal Wolverhampton Trust to present to the Panel]

The Directorate Manager Royal Wolverhampton Trust began the presentation (a copy is attached to the signed minutes) which showed an overview of the current waiting times for Gynaecology services across the Royal Wolverhampton Trust (RWT) . She stated that they faced some challenges, attributing some of this to a backlog created by the Covid-19 pandemic. She stated they had outsourced some of their services to Health Harmony to give the RWT further support on tackling the backlogs. She said their backlog had reduced from being over 4500 patients to just under 4000 patients.  Choice of access for Acute Services at New Cross Hospital were summarised as – Monday to Friday (8am – 4pm), out of hours via emergency department, direct access for patients (following telephone referral), they offered emergency surgery.  Outpatient services were primarily at New Cross Hospital, although some were offered at Cannock Chase Hospital. Patients had a choice of a female doctor, although they reported that for some sub-specialities they were not able to provide that option due to a lack of females in the specific role. Initiatives they were currently working through included an endometriosis centre (with a robot for robotic surgery), nurse led triage for suspected cancer patients, expanding ambulatory gynaecology and other examples covered in the slides. They had been working collaboratively with the Black Country Integrated Care System (ICS) with the aim of reducing health inequalities across the Black Country, some examples given were – health hubs within the community, streamlining GP referral guidelines and a workforce review across the ICS. They had collaborated with OneWolverhampton around further education for GPs. The Directorate Manager Royal Wolverhampton Trust also reported on some things they did to support diversity which included: Sign language services, providing hoists for patients, access to the learning disability team, discussions with the transgender community around cervix screening, and providing interpreter services.

A Councillor wanted to know how the RWT gynaecology waiting times compared with the national average waiting times.

The Directorate Manager Royal Wolverhampton Trust stated they were working towards the NHSE National Target to reduce to 78 weeks. Based on patients that attended between January and December last year. When a patient had been seen and had treatment, the list displayed how long they would wait. They discussed with other Trusts within the ICS to compare and work together, as well as reporting to the National NHS their performance.

The Councillor stated that the question had not been answered.

The Clinical Director of Gynaecology replied that within the ICS, they had the longest waiting times compared to other hospitals, she attributed this to a suspension of gynaecology services during the pandemic, with staff sent to support other services. There was also significant illness within the workforce which also added to the delays. Other hospitals did not close their gynaecology services for 2 years, unlike RWT.

The Councillor asked if other Trusts outsourced services, referring to the comment made earlier about outsourcing to Health Harmony, she stated she believed this would  ...  view the full minutes text for item 4.

[Documentation to-follow] [Members of the West Midlands Ambulance Service to present to the Panel]

Strategy and Engagement Officer WMAS began the presentation (a copy is attached to the signed minutes) with a brief overview and summary of his role, he informed the Panel they had begun appointing specialists in maternity care to improve the West Midlands Ambulance Service’s (WMAS) care of pregnant women and that a lot of collaborative work and training had been put into developing staffs expertise in this area. He stated that WMAS served 6 Integrated Care Board (ICB) areas and that they were a partner member of the Black Country ICB. All ICB Chairs and CEOs were invited twice a year to meet with the WMAS Chair and CEO to discuss partnership working. He showed the Panel two comparative graphs of hospital hand over delays looking at West Midlands rates overall across different years and the Black Country rates overall across different years. He said before Covid, lost hours to handover were significantly lower compared to post Covid handover hours. He said that the delays have had an impact on their response times, before Covid they were always meeting their response times across all categories and were the only ambulance trust able to do that. However, post Covid they were no longer able to do this. This contributed to late finishes for colleagues, contributed issues to phone call operatives unable to dispatch ambulances to people in time, and impacted on patients. They had been working with partners to improve pathways with the aim of reducing ambulance call outs. He showed postcode performance ratings, which were mostly in the red and not hitting target. He explained to the Panel that WMAS had expanded their electric vehicles and now had a fleet of them, in aid of the 2030 NHS England goal of zero carbon emitting vehicles. Strategy and Engagement Officer WMAS stated that electric vehicles were far more expensive than fuel powered vehicles, he said this was challenging and that the infrastructural challenges would cause further difficulties. He stated that violence and abuse to staff was a growing issue that in the previous year they had recorded 2000 incidents. He said that as of December 2023, they had recorded 2500 incidents and that the financial year was not over yet. In response they had been exploring different ways to protect staff, which included trialling stab proof vests and body worn cameras; however, staff had a wide range of views on these approaches and consultation was still underway.

The Chair wanted to know how the Trust was aiming to reduce the hand-over delays back to pre-pandemic levels.  The Chair also commented that she would have liked WMAS to include a slide looking at the delay levels of Wolverhampton specifically.

The Strategy and Engagement Officer WMAS stated that he would share this information with the Scrutiny Officer to distribute to the Panel.

The Chair stated that the Health Scrutiny Panel wanted to ensure all NHS organs had a robust freedom to speak up process. She wanted WMAS to reassure the Panel that they  ...  view the full minutes text for item 5.

[The Integrated Care Board & Partners to present to the Panel[

The Wolverhampton Managing Director ICB stated he was reporting to the Panel on oversight and strategy for the Integrated Care Board (ICB) in relation to the Integrated Care System (ICS).

The Director of Partnerships and Transformation ICB stated that the Integrated Care Partnership (ICP) was a statutory committee, a forum of local authorities and the ICB and this partnership was legally obligated to provide a strategy. They had had a series of development sessions held between autumn 2022 and spring 2023. The meetings led to the development of an initial Integrated Care Strategy, published in March 2023. Over the previous 4 months there had been developments, these were: the ICP now had a core membership, the ICP membership and partnership had recently met for the first time and approved its terms of reference, they had regularly been updating health and wellbeing boards on core issues within business plans. The ICP membership included representatives and partners from all relevant organisations within the Black Country, this added to collaborative partnership approaches.

The Chair of Black Country ICB & ICP stated that the ICP was an important part of the overall system. He said the previous system was competitive, with Trusts trying to maximise the number of patients they could take on and those not as competitive lost out on money given to them by the government. This has been changed and now the ICS aimed to get Trusts and partners to work in collaboration. He said that collectively across the Black Country, there were 650,000 people that fell into the most deprived 25% of the national population. He said the Black Country was the second worst in these figures behind Birmingham. He said this was why it was important to change approach, otherwise they would keep getting the same result. He also stated that the aging population added more pressure on the service, as they would be more fragile and vulnerable to health issues, which would cost money and take up bed space. He said a stronger emphasis on prevention was required. He said it was important that place-based partnerships delivered the service and worked together locally and that the ICP would play an important co-ordinating role in this. The strategy the ICP set, the NHS partnership organisations would then need to deliver upon.

The Wolverhampton Managing Director stated that it was a complex system and that this complexity was added to at a Black Country level, given it contained 4 places and 4 hospitals. He said at a place-based level, Wolverhampton was a crucial component and that the smooth working of the health and wellbeing board was vital.

The Wolverhampton Managing Director said the ICB had been responsible for commissioning pharmacy, optometry and dental services, these had previously been commissioned by NHS England at a Midlands level. This team now worked for the ICB through an office in the West Midlands. The ICB also commissioned some specialised services. The ICB hosted the teams responsible for these at their office. They would be  ...  view the full minutes text for item 6.

[Healthwatch Wolverhampton to report to the Panel]

The Manager Healthwatch Wolverhampton reported to the panel that access to GP services remained an issue locally and that this was their third time bringing an item on primary care access to the Panel as requested.  Over the last quarter, 46% of information they had collated involved general practices, with 61% of the information collated being a negative sentiment. The feedback received concerned access to GP appointments, communication pathways and issues, as well as response times. They also looked into the running of Patient Participation Groups (PPGs). She listed some limitations of the research which was listed in the methodology. The Manager of Healthwatch Wolverhampton stated that 65% of respondents preferred to book a GP appointment via the phone as opposed to using website/app bookings, despite knowing that phone bookings could take a considerable length of time. She stated that from her perspective this showed it was important that patients had a choice in the ways they wanted to book appointments, despite a push towards digital from within the NHS.  She said that call times varied in some Primary Care Networks (PCNs) which had worsened, whereas some had improved. In terms of engagement with Healthwatch, some PCNs had significantly improved results: she cited Royal Wolverhampton Trust (RWT) as an example, in December 2022 only 3 of their 8 PCNs would engage with the Healthwatch survey via the phone, whereas for the recent research, all 8 participated. More generally, there had been improvements in signposting across GPs, in particular to pharmacies, which was in line with the GP Recovery plan where pharmacies were set to play a bigger role. She informed that Panel that a number of practices had said they did not know when the last PGG group had been held or that it had been a long time since one had last been held, one PCN said they did not know if they had a PPG. For website booking, the majority of respondents said they found it to be a positive experience. However, 50% of respondents also said they could not book an appointment online via their practice website, with many stating they couldn’t get same day appointments if they used the online service. A barrier to digital inclusion was people aged over 65, most of whom reported they were not able to use the online service and needed to use the phone to book appointments. Healthwatch recommended all practice websites should be updated with guidance to make them clearer to patients how they could access services and book appointments easier, practices to involve patients in how to improve websites, ICB to continue to ensure practices inform patients about PPGs.

The Chair asked if any practices refused to engage with Healthwatch when they called them.

The Manager Healthwatch Wolverhampton that within the Wolverhampton North PCN, 3 practices refused to engage with them, which was also the number that refused to engage in the December 2022 survey, Unity West PCN had one refusal. She stated that overall 6 practices refused  ...  view the full minutes text for item 7.

[Public Health & Wellbeing to present to the Panel]

The Principle Public Health Specialist began the presentation (a copy is attached to the signed minutes) by explaining what tuberculosis (TB) was, what caused it and how it was cured. An infectious disease, caused by bacteria, which was deadly if left untreated and could kill.  Most cases were curable with a 6-month case of anti-biotics, although some cases of TB were becoming drug resistant. She informed the Panel that there was also latent tuberculosis (LTB) where the disease could lie dormant in a person and not show symptoms, until a time when they got ill with something else, it would then develop. The risk of developing TB was much higher in people who had AIDS.  England was a low incident country with a 3 year average of 7.7 cases per 100,000 population but Wolverhampton was much higher than the English average for cases of TB, recorded at 19.9 cases per 100,000 population. However, recently the gap between Wolverhampton instances of TB and the English average was starting to reduce. Everyone was at risk of catching TB, but it was more common in people with weakened immune systems, people who had migrated from countries with high instances of TB and men, who were 4 times more likely than women to catch TB.  Social risk factors for a higher likelihood of TB included those from the 10% most deprived backgrounds, people born outside of the UK (13 times more likely to develop TB), those who abused drugs and alcohol, were homeless and those imprisoned.

The Principle Public Health Specialist stated that whilst Wolverhampton had higher than average rates of TB in the population, its services and outcomes to tackle TB ranked higher than the national average, meaning they were better.

Senior Public Health Specialist gave a LTB patient journey example: a migrant from Afghanistan arrives in the UK is eligible for LTB testing and is invited to a clinic, upon arrival they were tested and if LTB was found in them, treatment began and across several weeks they returned to give blood samples and were monitored until the LTB was no longer detected in their system. For TB cases, they were reviewed by a GP, then referred to the TB team, within one day they were tested, isolated and their family referred to have TB screening, they would then be treated and monitored for several months for TB until they no longer tested positive.

The Principle Public Health Specialist stated that partnership working across the ICS would be essential to tackle TB in Wolverhampton.

The Vice-Chair thanked the Public Health team for their presentation. He stated that he had had developed TB in the past after having LTB unknown in his system and recognised the importance of testing. He wanted assurances that new arrivals to the country had the support needed to ensure they were checked for LTB and given the healthcare needed to stop it developing further.

A Councillor stated that some people, such as foreign students studying in the area  ...  view the full minutes text for item 8.