Apologies for absence had been received from Councillor Mandy Tromans and Councillor Pam Redford (Warwick District Council).

None.

An update was provided on the South Warwickshire Community Hospital Review. Following further discussion at the Chair and spokesperson meeting it was confirmed that this review was not considered to be a major service reconfiguration. This review would be kept under consideration bu the committee.

The Chair outlined the agenda content, urging brevity in both presentations and questioning, also reminding of the additional documents circulated ahead of the meeting.

To receive the Minutes of the meetings held on 10 and 16 February 2022.

The minutes of the meetings held on 10 and 16 February 2022 were approved as true records and signed by the Chair.

Carolyn Pickering made a statement and submitted questions concerning the Coventry and Warwickshire Integrated Care System and public accountability. A copy of the submission is attached to the Minutes.  Councillor Margaret Bell, Portfolio Holder for Adult Social Care and Health responded. A copy of the response is also attached to the minutes.

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.

None.

This report summarises the performance of the organisation at the Quarter 3 position, 1 April 2021 to 31 December 2021.

The Council Plan quarter 3 performance progress report for the period 1April to 31 December 2021 was considered and approved by Cabinet at its meeting on 17 February 2022. A tailored report was submitted relevant to the remit of the Committee. It provided an overview of progress of the key elements of the Council Plan, specifically in relation to performance against Key Business Measures (KBMs), strategic risks and workforce management. A separate financial monitoring report for the period covering both the revenue and capital budgets, risk management and delivery of the savings plan was also provided. Comprehensive performance reporting was available through the Power BI platform.

Councillor Drew sought further information about the number of people who could have remained at home with support rather than going into a care or nursing home. This would be researched to provide an indication to members.

Resolved

That the Committee notes progress on the delivery of the Council Plan 2020 - 2025 for the period.

Dental services was added to the committee’s work programme on 16 February. NHS England & Improvement will provide an update to the Committee.

Terry Chikurunhe, Senior Commissioning Manager for NHS England and Improvement (NHSE&I) provided a verbal update to the committee covering the following areas:

• The change in commissioning arrangements, moving from NHSE&I to the new Integrated Care System (ICS).
• Key messages to address public confusion of dental services and the difference in patient lists when compared to GP doctors. Contractually, dentists provided treatment and then retained responsibility for that patient for two years afterwards, unless the patient had periodic ‘check ups’. 
• The challenges for dentists throughout the Covid pandemic, the loss of services other than some urgent dental care.
• Dentists continued to receive NHS funding throughout this period, providing they maintained services at a level set nationally. NHSE&I had a contractual monitoring role. 
• Oral health promotion and work with the new ICS for Coventry and Warwickshire.
• There were 65 dental practices within Warwickshire and five specialist orthodontic practices for children. South Warwickshire Foundation Trust provided secondary care for patients in the County, with George Eliot Hospital providing community dental services. Specialist and complex procedures were undertaken at the Birmingham dental hospital and children’s hospital. 
• Dental services in Warwickshire performed well when compared to other areas of the Midlands region. However, there were some areas of the County with significant challenges for dental access, with Nuneaton and Rugby referenced. There were challenges in attracting dentists and nurses to work in rural areas. Reference to the work to promote NHS dentist services to practitioners. There were workforce challenges and some dentists chose to treat patients privately, even if the same premises were used for NHS services.
• The planned strategic review of dental services. This would be based on population growth and tackling inequalities in current services.
• Prior to the pandemic, 50 percent of the population accessed NHS dental services, with the other half either using private services or not having access to a dentist.
• The pandemic impacted significantly on access to dentists, mainly due to infection control. Data was provided for Warwickshire. In December 2021, dental access was just below 44% of pre-pandemic service levels. Now the lower threshold for services was 62% of normal service levels, with one in 10 dental practices not achieving this level currently. 
• Oral health improvement. Targeted work was taking place in Nuneaton, Bedworth and Rugby to address high incidences of children with tooth decay. A joint approach was taking place to encourage children through programmes like ‘brushing for life’ where education and toothbrush/paste were supplied. Reference also to training for care home staff so they could look after their residents. A move to more integrated services.
• Fluoridation of water supplies. This was not preferred by all but was beneficial in preventing tooth decay.

A lengthy debate followed with the following contributions and themes:

• The Chair requested that a written summary of the data be provided.
• Further discussion about dental registration and the contractual obligations. After two years of initial treatment, a dentist was not contractually obliged to keep the patient registered. This was not widely  ...  view the full minutes text for item 6.

The Committee received an update from WMAS on 17 November 2021. This item will provide an update on performance.

The Committee received an update from WMAS on 17 November 2021. Pippa Wall, Head of Strategic Planning for WMAS provided an update on performance data since that meeting, through a presentation covering the following areas:

• Incidents, transport and conveyance rates year on year.
• Coventry and Warwickshire hospital handover delays of over fifteen minutes – the total hours by month.
• Operational demand and handover delays.
• Hospital handover delays of over fifteen minutes and cohorting vs operational performance. A series of charts showing the position for priority categories 1,2 and 3.
• Two further slides were provided showing handover delays for University Hospitals Coventry and Warwickshire (UHCW) and for Warwick Hospital. A similar slide for George Eliot Hospital would be circulated.

The Committee was invited to submit questions and comments, with the following points raised:

• Difficulty in reading and interpreting the slides. It was noted that these had been circulated ahead of the meeting.
• The slides showed a concerning position. It was interesting to note that during the peak of the pandemic services were coping but performance had worsened over the last year. The causes were questioned.  Pippa Wall agreed that it was a bad position and was difficult for front line staff assisting patients. People were waiting longer for WMAS to arrive, and the situation was unprecedented. An outline was given of contributing factors, including Covid, the recovery work of NHS impacting on other services and people presenting with more acute conditions. There was staff fatigue and sickness, some people were leaving the services and reference to ongoing recruitment as well as continued infection control measures. Ambulance delays at hospitals were also mentioned.
• The data for the most serious (category 1) calls was considered shocking and the trends showed the position was worsening. It was hoped the position would improve. Details were provided of the escalation processes to raise these concerns and the dynamic response approach to address concerns where possible. This situation required a holistic system response as hospitals were similarly facing many challenges.
• The open and honest approach was appreciated.
• Chris Bain of HWW agreed this was a system issue for the ICS. He spoke about separating attendance at the Accident and Emergency (A&E) departments from resultant admissions. There was more chance to influence why people attended A&E and avoid unnecessary attendance. The impact on patients was not covered and should be. Delays could be linked to readmission rates, lengths of stay and impacts on discharge. Chris asked how the situation would be recovered and by who. He was not clear if there were any system plans in place for recovery.
• Pippa Wall agreed on the points about patient impact. WMAS was a data rich organisation and could make more use of this data to give an integrated picture and insightful messages. An increasing number of complaints were being received. She spoke about the monitoring of performance data around impact for patients who were critically ill. This could be researched to provide an answer to the questions raised.  ...  view the full minutes text for item 7(1)

West Midlands Ambulance Service has invited the Committee to consider and comment upon its annual Quality Account.

A copy of the WMAS draft Quality Account for 2021-22 had been circulated and the Committee was invited to submit questions and comments.  Pippa Wall took members through the document, which was accompanied by a presentation of the key areas:

• Update on 2021/22 priorities for:
  • Cardiac arrest management
  • Maternity care
  • Reduction in the volume of patient harm incidents
  • Learning from patient feedback
• Priorities for 2022/23 for:
  • Integrated urgent and emergency care clinical governance
  • Maternity
  • Mental health
  • Utilisation of alternative pathways including urgent community response
• Taking action on last year’s comments
• The recent engagement exercise on the draft quality account

The following points were raised, with responses provided as indicated:

• The report made reference to the Commonwealth Games and the 400 frontline staff being deployed to work on the games. There were strong concerns that ‘business as usual’ would not be maintained. Data was sought on what proportion of WMAS staff this involved.  Pippa Wall gave an undertaking to provide this information including  why 400 staff were required and what the expected impact would be, together with the cover arrangements. It did sound a significant number and she outlined the reasons for this, including the scale of events, multiple locations and the length of cover needed each day. WMAS would be challenged if it didn’t provide resources. The Chair also asked who was funding the service to the Commonwealth Games. A formal response would be provided.
• A series of questions and points were submitted about the incomplete nature of the QA document, with a number of examples quoted. The member felt it would have been better to defer this item until the full report was available. 
• Reference to the accompanying presentation. Earlier in the meeting there was discussion about the serious challenges in providing a responsive service for patients, which had not been included in the presentation. WMAS had attended the Committee in November to provide a performance update and at that time described the situation as a crisis. Again, the report made no reference to this, focussing on other areas, such as safeguarding and body cameras. For the public the key issue was a responsive service.
• Pippa Wall responded reminding of the statutory nature of this report which had to be approved and published by June. There was a duty to seek comments from a range of stakeholders and a number of timing constraints with availability of information, such things as avoiding council elections and the requirements for sign-off before publication. The Chair added that this was a draft report. She agreed with the points made about the key issue for patients being a responsive service and questioned the value of producing such QA reports instead of addressing the current service challenges. Pippa Wall confirmed that large sections of the report were mandated. Most people would be concerned about response times, whilst others had raised staff wellbeing and safety.

• Chris Bain noted that all service providers were required to produce these QA documents and he questioned what added value they  ...  view the full minutes text for item 7(2)

To consider the organisational plan of University Hospitals Coventry and Warwickshire, which is included in the document pack.

The Chair advised that Justine Richards, Chief Strategy Officer had needed to leave the meeting due to its long duration and other commitments. Endeavours would be made to rearrange consideration of the UHCW organisational plan. It was suggested that members comments could be collated, considered by the Chair and submitted to UHCW as there may not be the opportunity to revisit this item at the next meeting in June. Otherwise, a retrospective look at the document may also be useful in providing feedback to UHCW. Another view was to seek a brief face to face meeting ahead of an existing meeting, or possibly to arrange a meeting via MS Teams.

A councillor considered that if reports could not be provided in full that they should be deferred to a future meeting. The Chair reminded of the timing constraints around the Quality Account (QA) document discussed under the previous item. The member reiterated that it could not be considered fully as it was incomplete. Paul Spencer provided background on the detailed consideration given to the QAs previously through task and finish groups  working with each provider trust and the two Healthwatch organisations for Coventry and Warwickshire. The QA documents were now circulated and any member feedback was collated and submitted to the Trust.

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

The Committee reviewed its work programme. A suggestion for a further update to be scheduled from West Midlands Ambulance Service. The Chair noted that this would now be pursued through the Health and Wellbeing Board. Further statistical information would be circulated to members in due course. Councillor Bell confirmed she would report back. It was particularly challenging as this was a regional service provider, but this matter would be pursued.

Resolved

That the Committee notes the work programme as submitted.