Agenda and minutes

Adult Social Care & Health Overview & Scrutiny Committee - Monday, 13th January, 2020 2.00 pm

Venue: Committee Room 2, Shire Hall. View directions

Contact: Paul Spencer - Senior Democratic Services Officer  Senior Democratic Services Officer


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Councillor John Cooke, replaced by Councillor Dave Reilly and Councillor Tracy Sheppard, Nuneaton and Bedworth Borough Council.


Disclosures of Pecuniary and Non-Pecuniary Interests

Members are required to register their disclosable pecuniary interests within 28 days of their election of appointment to the Council. A member attending a meeting where a matter arises in which s/he has a disclosable pecuniary interest must (unless s/he has a dispensation):


·         Declare the interest if s/he has not already registered it

·         Not participate in any discussion or vote

·         Must leave the meeting room until the matter has been dealt with

·         Give written notice of any unregistered interest to the Monitoring Officer within 28 days of the meeting Non-pecuniary interests must still be declared in accordance with the Code of Conduct. These should be declared at the commencement of the meeting.

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Chair’s Announcements

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The Chair referred to the joint health overview and scrutiny committee (JHOSC) which had considered maternity services delivered from the Horton General Hospital in Banbury and made representations to the Secretary of State for Health. A response was still awaited to these representations.


Public Speaking

Any member of the public who is resident or working in Warwickshire, or who is in receipt of services from the Council, may speak at the meeting for up to three minutes on any matter within the remit of the Committee. This can be in the form of a statement or a question.  If you wish to speak please notify Paul Spencer in writing at least two working days before the meeting.  You should give your name and address and the subject upon which you wish to speak. Full details of the public speaking scheme are set out in the Council’s Standing Orders.


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Question from Professor Anna Pollert

Professor Pollert made a statement opposing the proposed merger of the three CCGs across Warwickshire and Coventry, stating it would lead to a loss of public accountability of health and social care commissioning. The Chair replied that the Committee had not yet had the opportunity to discuss this matter, but would look into it.


Question from Mr Dennis McWilliams

Mr McWilliams urged this Committee and the Coventry and Warwickshire JHOSC for a lay public participation involvement member to be on the Implementation Board for the stroke project and for the County Council to lobby Stagecoach to retain the existing services they proposed to cut between Stratford, Warwick, Leamington and Coventry. The Chair replied that he would need to discuss this with Councillor Clifford from Coventry City Council as this was a matter for the JHOSC. With regard to bus services, this lay within the remit of another of the County Council OSCs. He would speak to the appropriate committee chair and it may be helpful if Mr McWilliams provided some further information to help with the investigation of this matter.


Copies of both questions are appended to the Minutes at Appendix A and B respectively.



Questions to the Portfolio Holder

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

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Councillor Margaret Bell raised an issue with regard to the lack of awareness of some out of hours services delivered though the primary care network, using an example to illustrate this. The telephone ‘111’ service had had referred a patient to the local acute hospital, when there was a GP practice providing out of hours services closer to the patient. The Portfolio Holder agreed to look into this matter, which may also need to be referred to the Health and Wellbeing Board. Adrian Stokes, Warwickshire North and Coventry & Rugby CCGs also offered to pursue this.


Developing Stroke Services in Coventry and Warwickshire - Public Consultation pdf icon PDF 149 KB

At its meeting on 14 October 2019, the Joint Coventry and Warwickshire Health OSC (JHOSC) gave initial consideration to this review. This Committee is asked to comment on the stroke review proposals, in order that members’ views are submitted to the next JHOSC meeting on 22 January 2020.


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The Coventry and Warwickshire Joint Health Overview and Scrutiny Committee (CWJHOSC) had given initial consideration to the stroke services review at its meeting on 14 October 2019. It had agreed that the proposals be reviewed by each council’s OSC, before their respective findings were considered at a further CWJHOSC meeting scheduled for 22 January 2020.


This item was introduced by Adrian Stokes, who took members through the key sections of the report. The aim was to improve stroke services. Comparisons of the performance and outcomes of current services against best practice showed that better health outcomes and more effective and efficient services could be achieved. There was unwarranted variation and inequity in the range of services available. Options for the future delivery of stroke care had been co-produced and appraised through a process involving extensive professional, patient and public engagement.


The resultant pre-consultation business case (PCBC) described the process and outputs in detail, proposing the implementation of a new service configuration, which was outlined in the report. The preferred pathway and delivery model would create services that met best practice for stroke care. The report stated the public and patient engagement to help inform and shape the proposed pathway over the last four years and the clinical engagement undertaken. It was acknowledged that it was unusual for only one option to be proposed, but the reasons for this were also reported.


Details were provided of the assurance process completed through NHS England in 2019 and the provisional assurance granted, subject to minor amendments. These amendments had been completed, and the resulting consultation document signed off by local CCGs in preparation for consultation.


The consultation document had been circulated and it went live on 9 October 2019. The announcement of the General Election meant that public events due to be held in November and December had to be postponed but they had been rescheduled. The financial aspects were reported and this proposal represented an investment of nearly £3.1 million into the Coventry and Warwickshire health system.


The Chair invited Councillor Joe Clifford, Chair of Coventry City Council’s Health Overview and Scrutiny Board to give a summary of the key issues raised when it had considered the stroke review proposals. Councillor Clifford confirmed the following areas had been discussed:


·         The benefits of the revised stroke pathway

·         The impact for WMAS in meeting the service requirements

·         Staff recruitment and retention

·         The financial benefits from reductions in social care costs

·         The requirements for public transport to ensure visitors were able to visit patients, especially when they were in rehabilitation centres


Overall, the Coventry Board viewed that the proposals were safe for the patients who were the main priority; visitor issues were not as important. The Chair thanked Councillor Clifford for this input.


Questions and comments were invited, with responses provided as indicated:


·         Clarification was provided on the time spent in the Hyper Acute Stroke Unit (HASU), the discharge to home arrangements and arranging packages of care at home. It was expected that stroke patients  ...  view the full minutes text for item 4.


Performance Monitoring - Clinical Commissioning Groups (CCGs)

The Committee agreed in September to hold a special meeting to monitor CCG performance.


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The Committee received an update on performance across the three CCGs at its September meeting. It was agreed that a further meeting be held and a more detailed report on performance provided, at which appropriate executives of the CCGs would attend to present and take questions from the Committee. Performance monitoring reports were submitted by South Warwickshire CCG and a joint report on behalf of Coventry & Rugby and Warwickshire North CCGs.


The report from South Warwickshire was presented by Alison Cartwright, who provided an introduction on the duties of the CCG, how it managed performance and held service providers to account. Performance was reported on a monthly basis through a governance process, which was outlined in the report. The current performance was appended highlighting areas of concern. It was noted that where applicable, the CCG served contract performance notices and monitored remedial action plans.


A corresponding report had been provided on behalf of Coventry & Rugby and Warwickshire North CCGs. This report provided information on the performance monitoring and consisted of three sections:


·         Overview of governance, key performance summary, priorities for action across the three CCGs and how as joint working further develops ensuring the role of ‘Place’ maintains local visibility of performance;

·         Copies of the performance report taken to the CCGs most recent public governing body meeting;

·         A glossary containing descriptions of the key performance targets that were monitored routinely, how they were calculated and what targets CCGs was expected to deliver.

 The following questions and comments were submitted with responses provided as indicated:


  • A number of stakeholders had raised concerns about public involvement in CCGs in the future and it was asked that these concerns be noted.
  • An unannounced Care Quality Commission (CQC) inspection had taken place at the George Eliot Hospital in December. There were a number of concerns raised, especially in regard to the A&E department. It was asked when the Committee would see the CQC report and associated action plan. This was noted and a response would be provided on when the report would be available.
  • There were concerns about the data for Warwickshire North CCG relating to the George Eliot Hospital A&E department. This could be applicable to a number of other departments, but was highlighted by the indicator on twelve-hour trolley waits before patients were transferred to a ward. This was an indicator of insufficient bed numbers. It was acknowledged that some people occupying acute hospital beds could be treated more appropriately elsewhere, but there was a risk for patients due to this lack of capacity. There were many contributors to the demands faced by the A&E department and waiting times, not least an 8% increase in patients presenting. Members were referred to the glossary which provided key targets in regard to trolley waits.
  • A comment was made that service performance for many key indicators reflected the national position. Service performance for  mental health services was a cause for particular concern. Similarly for dementia, there was a need for a single  ...  view the full minutes text for item 5.


05a CR-WN CCG Performance Report pdf icon PDF 286 KB

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05b South Warwickshire CCG Performance Report pdf icon PDF 129 KB

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Any Urgent Items

Agreed by the Chair. 

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The Chair made an announcement that in future where public questions were received which did not relate to the Committee, they would be forwarded to the appropriate committee or body.