Venue: Training Room, Ground Floor, Civic Centre, St Peter's Square, Wolverhampton WV1 1SH
Contact: Earl Piggott-Smith Tel: 01902 551251 or Email: firstname.lastname@example.org
Apologies for absence were received from Councillors Mattu and Page.
Declarations of Interest
There were no declarations of interest.
[To approve the minutes of the previous meeting as a correct record.]
Neeraj Maholtra to be added as attending the meeting.
[To consider any matters arising from the minutes.]
Agenda Item 8: Wolverhampton Integrated End of Life Care Strategy
David Watts, Director of Adult Services, updated the panel on progress of the pilot to introduce red bag in care homes.
Agenda Item 9: Walsall Clinical Commissioning Group
The Scrutiny Officer updated the panel on progress of comments made about changes to hospitals stroke services and shared a copy of the response from Walsall CCG to the issues highlighted. The panel agreed to monitor the progress of plans to reconfigure stroke services. The panel commented on a discussion where a reference was made about consultation and whether it was genuine as changes were already being made now. The panel agreed to note the comment.
[To consider the draft budget and medium term financial strategy for 2018/19 to 2019/20 and to provide feedback for the Scrutiny Board to consider]
Finance Business Partner (People), introduced the draft budget report 2018-2019. The panel members comments would be consolidated with comments from other panels and presented to Scrutiny Board to agree a final draft response that would be presented to Cabinet.
The Finance Business Partner (People) invited panel members to also comment on the approach to the budget consultation process. The Finance Business Partner (People) outlined the plans to identify £14.8 million of budget reductions and income generation to address the projected deficit in 2018-2019. The Finance Business Partner (People) added that a series of
public meetings were arranged to explain the budget proposals and to invite comments. The members of the public also had the opportunity to submit comments online.
The Finance Business Partner (People) explained that there were no new savings proposals that fell within the remit of the Health Scrutiny Panel detailed in the draft budget report. The Finance Business Partner (People) briefed the panel on the planned reduction in the public health grant for 2018-2019 and that further reductions in the grant were expected. The public
health grant is currently awarded as a ring-fenced payment from the Department of Health. The Finance Business Partner (People) explained that an overspend of £376,000 for Public Health for 2017-2018 was predicted at quarter on in order to address the recurrent budget pressures and review was being undertaken across Public Health including a restructure and
commissioned services. A report will be presented to Cabinet on 29 November 2017 on findings of a review of commissioned services delivered by Public Health with recommendations for new priorities for the service.
Director of Public Health, outlined plans for restructuring of the public health service and the vision for promoting the development of a public health focused organisation in the future. The Director of Public Health commented on the contribution of the policies and financial resources of other Council departments in contributing towards improving public and well-being and the
change in the role of a restructured service from funding a number of traditional services, such as stop smoking, to looking at the factors that impact on the health of the local population and which encourage healthier life choices.
The panel requested that it would be useful to have information about quality of life, measures such as breastfeeding rates, to provide evidence to be able to assess the impact of the policies.
The Director of Public Health explained that there was a public health outcome framework and agreed to present the information to a future meeting for panel. The Director of Public Health explained that the new approach was focused on achieving lasting behaviour change and improving current health measures.
The panel queried the plans to achieve a balanced budget for public health service, given the overspend and the use of £1.7million reserves. The Finance Business Partner (People) explained that a financial recovery plan for quarter one has been developed to bring the budget back into balance. The panel were advised that public health service would not ... view the full minutes text for item 5.
[John Denley, Director of Public, to give presentation on the role of local authorities in public health, current and future challenges and proposals for developing a new service model.]
John Denley, Director of Public, gave a presentation which outlined a new approach to role of public health. The approach is based on the view that improving public health and meeting statutory priorities is the responsibility of the whole organisation and not the small specialist public health service. The Director of Public Health listed the factors that influenced the health of a population and stated that health service provision only makes a small contribution – lifestyle factors e.g. smoking, diet and socio-economic factors, e.g. employment, income had much greater impact on the health of a population.
The Director of Public Health commented on the slow progress in reducing differences in life expectancy at a ward level and argued that the role of the service must be to support all three council directorates to deliver the statutory public health responsibilities of the authority.
The Director of Public Health commented on evidence which challenged the effectiveness of services typically offered by public health service such as smoking cessation where the focus was not on addressing the causes of the behaviour but on designing services to meet the need. The Director of Public Health added that the new approach will mean reducing the delivery of services and focus on making changes at the population level.
The Director of Public Health commented on proposed changes to the commissioning of services and create services that people can user to use and build community resilience and move away from the delivery of services. The role of public health in the future will be to influence the work of other agencies such as hospital and Wolverhampton CCG in achieving the priorities detailed in the corporate plan.
The panel discussed the issue of drugs and alcohol preventative services and the implications for other agencies such as GPs if public health service reduces its provision. The was concern expressed that the proposals need to be discussed with other partners as the changes are likely to affect areas differently if funding for stop-smoking services is stopped. The panel discussed the high number of fast food outlets concentrated in certain parts of the city and the challenge for the Council in wanting to reduce the number empty shops and the impact of such premises on health. The panel discussed the important role of planning control on the public realm.
The panel queried the risks of the approach in reducing the provision of support services at a time of high demand. The Director of Public Health responded that the issue of fast food outlets and there is a need for the Council to consider the balance between creating a business environment and promoting better health. The Director of Public Health discussed the evidence about the factors that support behaviour change and the importance of raising aspirations to persuade people reduce levels of smoking and drinking. The Director of Public Health commented on the importance of raising the aspiration of young people in order improve future life chances.
The panel accepted the need ... view the full minutes text for item 6.
Debra Hickman – Deputy Chief Nurse, The Royal Wolverhampton NHS Trust (RWHT), presented an update on progress against priorities detailed in the Quality Accounts 2017/18 report.
The Deputy Chief Nurse advised the panel that the hospital had a recent visit from the Care Quality Commission who inspected the Urgent Care Centre, receiving a ‘good’ rating.
Jeremy Vanes, Chair (RWHT) advised the panel that the hospital agreed to be filmed for the tv series Junior Doctors. The hospital has no editorial control over filming but considered there were real benefits to being involved in the programme. The Chair advised the panel that progress is being made to recruit two non- executive directors.
The Deputy Chief Nurse advised the panel that the priorities for the hospital have remained the same for two years. The issue of staffing levels is a significant priority but progress was being made. The hospital has placed significant attention on recruiting and retaining staff with the required skills and experience. The action plans linked to the priorities are regularly audited. The Deputy Chief Nurse made the comments about progress against priorities.
Priority 1: Nurse staffing levels
The Deputy Chief Nurse commented that reducing the number of nursing vacancies remains a challenge for the hospital. The hospital arranged a series of overseas trips in the past to find nurses but have not done so recently given national changes to requirements for registration. The hospital wants to continue to encourage local recruitment and have adopted different approaches to finding replacement staff.
The Deputy Chief Nurse commented that the issue of Brexit cannot be evidenced as impacting on recruitment for the hospital. However, there is evidence of European recruits leaving the hospital to pursue opportunities further south of the country. The Deputy Chief Nurse reported that the hospital has made significant impact on improving attendance at work following a review of the approach to managing sickness.
Priority 2: Safer Care
The Deputy Chief Nurse advised the panel that 95% is the national target benchmark for ‘harm free’ care. This is a point prevalence measure identifying prevalence of pressure injuries, falls, medication and infections associated with urinary catheters at a given point in time. The panel were advised of work that is being done nationally to reduce the number of patient falls. The Deputy Chief Nurse advised the panel of the work done to identify high risk patients and provide the right interventions to support patients; however this is a challenge at night time when less staff are available to observe patients at risk of falls.
The panel queried the reasons for the high number of reported medication incidents. The Chair explained that the procedures for prescribing medicines are clear but are not followed and the challenge for the hospital is understanding the reasons for this. The Deputy Chief Nurse commented on a move to electronic prescribing as way forward for reducing the number of incidents. In addition, work is being done to identify ‘hot spot’ areas across the hospital where more ... view the full minutes text for item 7.