Apologies for absence had been received from
Councillor Mandy Tromans and Councillor Pam Redford (Warwick
Disclosures of Pecuniary and Non-Pecuniary Interests
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 Chair outlined the agenda content, urging
brevity in both presentations and questioning, also reminding of
the additional documents circulated ahead of the meeting.
Minutes of previous meetings PDF 526 KB
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
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
Questions to Portfolio Holders
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.
Questions to the NHS
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.
Quarter 3 Council Plan 2020-2025 Quarterly Progress Report (April 2021 to December 2021) PDF 965 KB
This report summarises the performance of the
organisation at the Quarter 3 position, 1 April 2021 to 31 December
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
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.
That the Committee notes
progress on the delivery of the Council Plan 2020 - 2025 for the
Update on NHS Dental Services
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
- 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
- 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
- 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
- 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
- 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.
West Midlands Ambulance Service (WMAS)
WMAS - Performance Update
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
- Incidents, transport and conveyance rates year on
- Coventry and Warwickshire hospital handover delays
of over fifteen minutes – the total hours by
- Operational demand and handover
- 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
- 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)
WMAS - Quality Account PDF 3 MB
West Midlands Ambulance Service has invited
the Committee to consider and comment upon its annual Quality
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
- Learning from patient feedback
- Priorities for 2022/23 for:
- Integrated urgent and emergency care
- Mental health
- Utilisation of alternative pathways
including urgent community response
- Taking action on last year’s
- 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
- 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
- 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.
More than a Hospital – University Hospitals Coventry and Warwickshire (UHCW) Organisational Plan PDF 18 MB
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.
Work Programme PDF 212 KB
To review the Committee’s work programme
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.
That the Committee notes the work programme as