Agenda and draft minutes

Councillor Cape (Nuneaton and Bedworth Borough Council), Councillor Mills, Councillor Mrs Redford (Warwick District Council) and Councillor Rolfe (replaced by Councillor Fradgley). An apology from Councillor Shenton who joined the meeting late and from Councillor Falp (due to present the GP Services review). Apologies had been received from the following Officers: Shade Agboola and Becky Hale (WCC) and Rose Uwins (C&WICB).

None.

None.

To receive the Minutes of the committee meeting held on 16 November 2022.

The Minutes of the committee meeting held on 16 November 2022 were approved as a true record and signed by the Chair. Councillor Mrs Humphreys asked for an update on the additional customer service data relating to complaints from older people in the north of the county. This had been circulated and would be reissued to the member.

None.

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.

None.

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.

It was noted that Councillor Mrs Humphreys had submitted questions but had agreed that these be covered as part of the presentation on system pressures.

The Overview and Scrutiny Committee will receive a joint presentation from the Integrated Care Board and the County Council on system pressures in Warwickshire.

The Committee received a joint presentation on system pressures in Warwickshire from Rachael Danter of the Coventry and Warwickshire Integrated Care Board (C&WICB) and Pete Sidgwick for the County Council.

The presentation covered the following areas:

• System pressures – some key facts
• Accident and emergency attendances
• Activity to support the system
• Number of occupied beds for all discharged adult patients in hospital for over seven days
• Supported discharges facilitated by Warwickshire Social Care. Slides provided this data for the period April 2022 - January 2023 by week, site and site & pathway.
• Discharge to Assess activity  
• Home based therapy
• Reablement
• Domiciliary Care
• Hospital Discharge Fund

Questions and comments were invited with responses provided as indicated:

·   Several members recorded their thanks for the presentation.

·   Councillor Holland noted the data provided on the low numbers of people awaiting care packages to be able to leave hospital, which showed this was an efficient service. The data on discharges he received as a hospital governor showed this to be a major concern for the Trust.  He asked what could be done to align the figures to give a common understanding.

·   Pete Sidgwick replied that operationally there was a good understanding. The challenges may relate to NHS England metric requirements around medical fitness for discharge. He had discussed the same issue with the Portfolio Holder, Councillor Bell. In broad terms the data reported by hospital trusts and the County Council were similar. Another contributor was where patients lived. Some patients at George Eliot Hospital lived in neighbouring areas and were included on social care data for Leicestershire or Coventry.

·   Reference was made to the Discharge Integration Frontrunner Initiative. This sought to streamline acute hospital discharges, the ask being to discharge patients within 24 hours of when they were deemed to be medically fit to do so. This could be very challenging both from a commissioning and operational perspective and an outline was given of the many facets which needed to be considered. That said, there was always room to improve.

·   Rachael Danter spoke about perceptions and what was actually required to enable patients to return safely to their place of residence.  Sometimes acute services may feel the process took longer than necessary, especially when those trusts were under pressure. The frontrunner initiative provided the way forward and whilst its target was challenging, it was believed it could be achieved.

·   Councillor Holland sought more information about NHS continuing care and onward treatment for people in their home, referring to recent announcements from the Secretary of State for Health and Social Care. This should assist earlier hospital discharge and an example was given for elective surgery procedures which may only require patients to be in hospital for a single day. He asked if there were perceived problems with delivering such care at home for both the NHS and Social Care.

·   In response, Officers advised this was known as ‘virtual wards’ with continued treatment in the home. Social Care was precluded from providing healthcare. However, when it  ...  view the full minutes text for item 5.

For the Committee to consider the review report from the GP Services Task and Finish Group.

On behalf of Councillor Falp, Chair of the Task and Finish Group (TFG), Paul Spencer, Senior Democratic Services Officer introduced this item.

The County Council had approved a motion that the Adult Social Care and Health Overview and Scrutiny Committee (OSC) review and make recommendations about the provision of health centres within Warwickshire. To undertake this review, the OSC appointed a member TFG. An outline was given of the process undertaken by the TFG. It considered written evidence and held discussions with expert contributors from the NHS. Contributions were also provided by Healthwatch Warwickshire and a co-opted representative from a district council. The review included a comprehensive presentation from the then Coventry and Warwickshire Clinical Commissioning Group and a GP doctor who also represented the Local Medical Committee. The review report had been submitted. The TFG made a series of recommendations for the Coventry and Warwickshire Integrated Care System (ICS) and for those within the remit of individual agencies. The recommendations and the rationale for each of those recommendations were set out in the covering report and the appended review report, which also provided the supporting information.

Members reviewed the report and appendix, raising the following points:

• Chris Bain said this was a comprehensive report. There were some things which could not be influenced such as the shortage of GPs. There was more interest in looking at those things which the system could begin to tackle, such as the effectiveness of primary care networks (PCNs) in supporting practices, ensuring the patient voice was heard and lived experiences captured in PCNs. There was mixed experience of this and how well patient participation groups were working. This was another area where patient expectations clashed with capacity creating a tension. Demands on general practice were increasing. One contributor was people delaying going to their GP and their condition worsening as a result. He was concerned about the emergence of a primary care provider collaborative as part of the ICS. Healthwatch had not been involved in the development of that collaborative and he wondered where the patient voice and lived experience was being reflected in that collaborative.
• Councillor Shenton sought more information about the NHS endeavours to recruit another 556 full time equivalent roles into primary care. He asked if these staff were an increase, or to replace others and what the net effect was. Additionally, more information was sought about what the equivalent roles would be. This would be researched with NHS colleagues. There were also plans to revisit primary care as part of the committee’s future work programme. 
• On GP recruitment, Chris Bain added that doctors were less willing to become practice partners than being a part time GP. This created a further problem of securing senior GPs, to manage practices and replacing those who were nearing retirement age.
• Councillor Bell took this point speaking of the opportunity for employed GPs rather than the current private businesses. Personally, she would like to see the acute trusts become involved in establishing such practices  ...  view the full minutes text for item 6.

For the Committee to review and update its 2022-23 work programme.

The Committee discussed its work programme. Paul Spencer reported that the next task and finish review would focus on Menopause Services. The Committee was asked to consider the size of the group, the terms of reference for the review, indicating any areas which should be included within the scope and to appoint a chair for this review. Members wishing to be involved in the TFG were asked to contact Democratic Services. He added that the Council did provide a lot of information and support for its staff, which could be a useful resource for background information.

Discussion took place on the following areas:

• The Chair gave a personal reflection and spoke of the absence of commissioned menopause services within Warwickshire. She would not take an active role in this review as chair of the commissioning scrutiny committee. The Chair reminded of the briefing provided by the Director of Public Health. She suggested the scope include research of the services provided in neighbouring geographic areas including Coventry and also in councils of similar size/demography. This benchmarking would provide useful evidence.
• Councillor Holland suggested that group leaders be invited to make nominations to the TFG.
• Councillor O’Donnell thanked the Chair for taking forward this much needed piece of work, speaking about the health gender inequality aspects and she looked forward to the findings from the TFG.
• Councillor Humphries used an example to show the impacts from menopause causing fatigue and the need for holistic social worker support to be provided in that case connected to an adoption process.
• The Chair added that the focus of the review should be on the services available to Warwickshire residents from both the Council and the NHS. People were presenting with symptoms that were menopause related, linked to hormonal imbalance, including stress, anxiety or being tearful, which may be diagnosed as other conditions.
• Councillor Drew asked what the council would be able to influence with its findings from this review process. The Chair responded that once established, the TFG would discuss the scope of the review and outcomes it wanted to achieve. The TFG would consider the recommendations to be made and who those recommendations were for. It would not be used as a forum purely for discussion or complaint, but would need to be constructive and give value, with good and demonstrable outcomes, which could be implemented, to effect some change.
• Councillor Bell expected that the ICB, which was responsible for health pathways would be involved in this review and be asked about the pathways for menopause services. The Chair agreed that the ICB should be part of the conversation, firstly to understand what services were provided, to assess if there is a disconnect and options to bridge any gaps.

Paul Spencer provided a summation of the key suggestions made to progress this review. He offered support to any members wishing to learn more about the work of the TFG, then explaining the importance of the scoping of the review, having a tight focus and  ...  view the full minutes text for item 7.