Agenda and minutes

Apologies for absence had been received from Councillor Richard Baxter-Payne (Nuneaton and Bedworth Borough Council) and Councillor Sandra Smith (North Warwickshire Borough Council)

Councillor Holland declared an interest as a governor of South Warwickshire Foundation Trust. Councillor Barker, although not a member of the committee, declared an interest as a governor of South Warwickshire Foundation Trust and a member of the League of Friends for Ellen Badger Hospital.

None.

To receive the Minutes of the meeting held on 17 November 2021.

The minutes of the meeting held on 17 November 2021 were approved as a true record. As a matter arising it was noted that a response was still awaited to the question raised to West Midlands Ambulance Service regarding first responders. This would be pursued.

Mr John Dinnie spoke to a circulated submission which is attached at Appendix A to the Minutes. This provided a position statement on behalf of Shipston-on-Stour Town Council in regard to the Ellen Badger Community Hospital and the review being undertaken by SWFT.

Up to 30 minutes of the meeting is available for members of the Committee to put questions to the Portfolio Holder: Councillor Margaret Bell (Adult Social Care and Health) on any matters relevant to the remit of this Committee.

Councillor John Holland submitted a question to Councillor Margaret Bell, Portfolio Holder for Adult Social Care and Health. He sought an update on the following motion approved at Council in December: “This Council requests that an invite be sent to the Chief Executive of the West Midlands Ambulance Service (WMAS) in order to consider how the ambulance service can be strengthened for the residents of Warwickshire and to agree an action plan”.

Councillor Bell responded that she had requested to raise this matter at the next meeting of the Blue Light Collaboration Board on 9^th March. Councillor Holland thanked her for the reply, reminding that WMAS was the only emergency service not based on the county’s area and the need to maintain a focus on this matter. The chair agreed an ongoing dialogue was needed with WMAS.

Members of the Committee are invited to give notice of questions to NHS commissioners and service providers at least 10 working days before each meeting. A list of the questions and issues raised will be provided to members.

A question had been received from Councillor Mills concerning nursing. As this question had not been received in time to enable the preparation of a response at the meeting, it had been referred to the CCG for a written response, which would be circulated in due course.

Dr Shade Agboola, Director of Public Health will provide a presentation to the Committee on menopause services in Warwickshire.

The Committee received a presentation from Dr Shade Agboola, Director of Public Health. The presentation covered the following areas:

•        Background/context outlining the request from the Committee’s Chair

•        There is a lack of visibility of the services provided. What services are provided across Warwickshire and are the services equitable across the whole County, or do they vary for each ‘place’?

•        What are the access arrangements? Are services provided at times convenient for women who work?

•        Anecdotal feedback from a constituent told by her GP that she would not receive treatment until one year from her last menstrual cycle. When should services be available and how easy is it for women to get a referral? Does this vary for each GP/ area?

•        There is an education piece. Schools educate on puberty and many aspects of the reproductive cycle. Should this include reference to the menopause?

•        Are there triage arrangements to other services where required, such as CWPT for psychological impacts of the menopause?

•        What roles do Public Health provide in regard to menopause services?

•        Why important

•        The menopause is caused by a change in the balance of the body's sex hormones, which occurs as women get older

•        It’s a natural part of aging in women

•        It happens when the ovaries stop producing as much of the hormone oestrogen and no longer release an egg each month

•        Menopausal symptoms can begin months or even years before periods stop and last around 4 years after last period, although some women experience them for much longer

•        Symptoms

•        Most women will experience menopausal symptoms. Some of these can be quite severe and have a significant impact on everyday activities

•        Common symptoms

•        When to see a GP

•        Troubling symptoms or symptoms of menopause before 45 years of age

•        Can confirm if menopausal based on symptoms, but a blood test to measure hormone levels may be carried out in women under 45

•        Treatments

•        hormone replacement therapy (HRT) – tablets, skin patches, gels and implants that relieve menopausal symptoms by replacing oestrogen

•        vaginal oestrogen creams, lubricants or moisturisers for vaginal dryness

•        cognitive behavioural therapy

•        eating a healthy, balanced diet and exercising regularly

•        Referral to menopause specialist if symptoms do not improve after trying treatment or if unable to take HRT

•        What’s available in Warwickshire?

•        Menopause specialists

•        The British Menopause Society is a specialist society associated with the Royal College of Obstetricians and Gynaecologists https://thebms.org.uk/

•        British Menopause Society specialists are health care professionals that have been awarded additional qualifications.

•        All BMS specialists are encouraged to become menopause trainers

•        An online directory that provides a list of menopause specialists across the country

•        Menopause specialists in Warwickshire

•        There are two specialists listed in the online directory available at https://thebms.org.uk/find-a-menopause-specialist/

•        They are both private providers

•        There is no NHS provision in the County

•        There are a number of  ...  view the full minutes text for item 5.

This report provides the Committee with an overview of the purpose, scope and progress of South Warwickshire Foundation Trust’s Community Hospital inpatient review. It presents findings of the initial engagement as well as the future plan and indicative timeline for the review.

Katie Herbert introduced this item on behalf of South Warwickshire Foundation Trust (SWFT), to provide an overview of the purpose, scope and progress of its community hospital inpatient review. It presented findings of the initial patient, carer, stakeholder, and staff engagement as well as the future plan and indicative timeline for the review. There was a requirement to consult on substantial developments or variations in the provision of health services.

Sam Owen Head of Nursing for out of hospital at SWFT then took members through the detail of the report which covered the following areas:

Community Hospital Inpatient Provision

Background was provided on community hospitals and the facilities in the south of Warwickshire. Ellen Badger Hospital in Shipston on Stour had 16 inpatient beds and the Nicol Unit at Stratford Hospital had 19 inpatient beds. The bedded offer at the community hospitals was broadly split into two areas providing for acute discharge and admission prevention beds. There was currently no provision in the north of Warwickshire Rugby areas. Within those areas, patients’ needs were met via a mix of primary care, community and acute provision. 

The review of Discharge to Assess services

A system wide strategic review of discharge to assess (D2A) services was agreed by all local system partners in 2019. The report outlined this review which was now moving into its implementation phase. Recommendations within the review were to move towards a simplified, clear and fit for purpose D2A offer. Community hospitals formed part of that offer within south Warwickshire. A table within the report provided a breakdown of the different pathways available to patients at the point of discharge, including community hospital inpatient beds, which should account for no more than 4% of all discharges from acute hospital within the over 65’s population.

Hospital Discharge Policy 2020

This was one of the central policy drivers for the D2A review, setting out the responsibilities of service providers. The report included an outline of the original guidance, the ambitions within the hospital discharge policy and its supporting guidance. This approach to ‘Home First’ stated that ‘every effort should be made to follow home first principles, allowing people to recover, re-able, rehabilitate or die in their own home’.

The case for change

The community hospital review took place within the context of wider changes within both health and social care, the Integrated Care System (ICS), the development of out of hospital services, the wider availability of D2A services and the prevalence of preventative programmes. Community health/out of hospital services had developed and were able to support much higher levels of patient need with a focus on admission prevention and supported discharge. Therefore, community hospital provision should be reviewed within the context of this enhanced and broader community offer. Some patients went to community hospitals to die, but there were inpatient and outpatient hospice facilities available. A multi-agency audit of patients using the community hospital inpatient facilities was undertaken in the spring of 2021 and the findings were reported.

Current  ...  view the full minutes text for item 6.

To review the Committee’s work programme for 2021/22.

The Committee reviewed its work programme. The following additional items were proposed:

• Dental services, suggested for the April agenda.
• Integrated Care System – an item at the end of 2022 to see how the new arrangements are embedding.
• An update from West Midlands Ambulance Service suggested for the April Committee.
• A workforce update on the success of the recruitment drive for additional carers. This could include aspects on the consistency and quality of training. It was suggested that members be signposted to the report to the January HWBB in the first instance.
• Delayed transfers of care. This was no longer an indicator which was monitored. An offer to provide information on the current indicators that were monitored through the Better Care Fund reports. A suggestion to look at this broadly to understand the reasons for delayed discharge, irrespective of whether this was due to an NHS or social care issue and how to reduce such delays. Members needed to understand the system and processes from ‘end to end’ to enable a holistic approach. A suggestion that the report include readmission rates too.
• A request for a presentation on Social Care.

It was suggested that the issues raised above be discussed further at the next meeting of the Chair and spokespeople.

Resolved

That the Committee notes its work programme and that the issues outlined above be discussed further at the next meeting between the Chair and Spokespeople.