Apologies for absence were received from Mrs P Mullock.  Mr P Wynn substituted for her.

Members are reminded that they must not participate in the discussion or voting on any matter in which they have a Disclosable Pecuniary Interest and should leave the room prior to the commencement of the debate.

Members were reminded that they must not participate in the discussion or voting on any matter in which they had a Disclosable Pecuniary Interest and should leave the room prior to the commencement of the debate. 

To confirm the minutes of the meeting held on 15 September 2014 as a correct record.

The minutes of the meeting held on 15 September 2014 were confirmed as a correct record.

To receive any questions, statements or petitions of which members of the public have given notice.  Deadline for notification is Tuesday 21 October 2014 at 4.00 pm.

Five questions were received from Members of the Public.  Three were taken under this agenda heading and two which related directly to agenda items were taken at the appropriate time.

Peter Gillard – Monitoring Private Providers of NHS Service

Mr Gillard’s question asked what steps the Scrutiny Committee would take to ensure adequate level of patient safety and quality by private providers.  He referred to recent press coverage of private companies delivering ophthalmology services.  (a full copy of his question and the response provided is attached to the signed minutes)

The response from the Chairman referred to the:  recently extended scope of Scrutiny Committees to cover all providers of health services, commissioned by NHS England, CCGs or Local Authorities; working with Healthwatch to get an impression of services overall and the Committee’s ability to question commissioners and providers regarding patterns and trends.  Healthwatch Shropshire had not received any comments to date related to the two private firms mentioned in the press report.

By way of a supplementary question, Mr Gillard said that a problem in one part of the country might indicate a systemic problem which should warrant a look by the Scrutiny Committee.  The Chairman reported that he was a Member of the Healthwatch Intelligence Committee and action would be taken where necessary.

Dr Julie Davies, Shropshire CCG, added that the companies in question were sub contracted by Shrewsbury and Telford Hospitals NHS Trust (SATH) and subject to regular monitoring for clinical quality as all providers were.   

Gill George – Paediatric Care in the Community

Ms George had submitted a question asking if the Committee had considered the implications for community services of the consolidation of Women’s and Children’s acute services, and whether the Committee believed there was currently adequate provision in the community, particularly within the community paediatric nursing team – to adequately support children with long-term health needs. 

The written response provided details of the Assurance Panel established as part of the process for considering the merits of changing the women and children’s services within the county.  The local CCGs would be reviewing the new service model and community services across the county as part of Future Fit. 

By way of a supplementary question, Ms George referred to there being only 10 whole time equivalent community paediatric nurses and said she did not believe they had the resources to properly do their job.  Children’s nurses could be a lifeline and she felt it would be appropriate to look at the level of provision. 

Gill George - SaTH Recruitment and Retention

Ms George had submitted a question in relation to SaTH Recruitment and Retention, drawing attention to the results of the 2013 Staff Survey. 

The response from the Chairman highlighted action taken by the Joint Health Overview and Scrutiny Committee related to low morale and difficulty recruiting.  The Joint Chairs had in the last week made a submission to the Care Quality Commission (CQC) to inform its current inspection of SATH. This had included comments around low  ...  view the full minutes text for item 29.

To receive any questions of which Members of the Council have given notice.  Deadline for notification is Tuesday 21 October 2014 at 10.00 am.

Member questions had been submitted by Mr M Bennett and Mr C Mellings, both relating to the performance of the West Midlands Ambulance Service.  It was agreed to take these at the appropriate point on the agenda. 

Dr Julie Davies, Shropshire CCG, will provide a presentation on Ambulance Performance which was recently delivered to the CCG Board (copy attached).

Barry McKinnon, Regional Manager, West Midlands Ambulance Service, will address questions on September 2014 performance figures (copy attached)

Gail Fortes-Mayer, Regional Commissioner, will also be present for this item.

The Chairman had invited Dr Julie Davies, Director of Strategy and Service Re-Design, Shropshire Clinical Commissioning Group, to the meeting to give the presentation to the Committee on Ambulance Performance which she had made to the CCG Governing Body meeting on 24 September 2014.  (A copy of the presentation is attached to the signed minutes).

She explained that the current performance levels for Ambulance performance standards within Shropshire CCG fell short of the national standards and in response to concerns around this she had been asked to consider what investment would be required to provide Shropshire with the same standard of service as received in urban areas.  A number of external agencies had reported on this issue and suggested that rural counties should expect a lower level of ambulance performance than urban areas, due to the geographical difficulties and lower activity numbers. 

In partnership with Shropshire Clinical Commissioning Group, West Midlands Ambulance Service had agreed to look at this issue and model some scenarios based on three questions asked by the CCG:

·       What resources would be required by the WMAS within Shropshire to achieve all performance standards within every postcode sector?

·       What resources would be required by the WMAs within Shropshire to attain all the performance standards for the CCG as a whole 

·       What is the level of performance that can be expected within the Shropshire CCG with the level of resource currently available?

Dr Davies reported that addressing questions 1 and 2 would require massive increases in staff, facilitated posts, ambulance and rapid response vehicle fleet in different proportions for both questions.  This was completely unaffordable within current resources and there was not a workforce available to recruit from in such large numbers. 

The best performance that could be achieved within current resources was outlined.  Members of the Committee agreed that it would be useful to benchmark this against similar rural locations. Dr Davies reported that equivalent data had been requested from NHS England but was proving difficult to obtain.  Some preliminary benchmarking information had been obtained from Lancashire and Cumbria.  The Committee asked for sight of benchmarking information as it was received by the CCG. 

The presentation also covered the assumptions made in answering the questions, the extent of current CFR coverage, and listed the actions being taken to improve performance. 

In response to questions, Dr Davies referred to cross border issues which were putting pressure on the West Midlands Ambulance Service.  These included lengthy delays to transferring patients at Wrexham Maelor Hospital, in some cases leading ambulances having to travel from Wrexham Maelor to Royal Shrewsbury Hospital.  She confirmed that the CCG was actively seeking a meeting with Wrexham hospital.  The reduction of minor injuries facilities at Chirk which had also resulted in a significant increase in Welsh patients using the Minor Injuries Unit at Oswestry.

She confirmed that there were monthly meetings between WMAS, the CCG and patient representatives which covered any clinical incidents or NHS to NHS concerns.   

From the 1 November 2014 there would  ...  view the full minutes text for item 31.

Paul Tulley, Chief Operating Officer, Shropshire CCG and Gail Fortes-Mayer, Regional Commissioner, will provide a briefing on plans to re-procure the NHS 111 service.

Emma Pyrah, Commissioning and Redesign Programme Lead for Unscheduled Care,       Shropshire CCG outlined proposals for reprocurement of NHS 111 Service ( a copy of the report is attached to the signed minutes).

Referring to the Public Question submitted by Healthwatch, Vanessa Barrett, Healthwatch Representative, commented that the 111 number was not well known in Shropshire, and that there was lots of confidence around Shropdoc.  Healthwatch were keen to obtain assurance that there would be no dimunition of access to Shropdoc with any re-procurement of 111.

Emma Pyrah explained how the 111 number had worked in parallel with Shropdoc after the 111 service had failed. There would be a recommendation to the CCG Board in November to retain the parallel numbers.   

The Chairman asked if on contacting Shropdoc as opposed to 111, whether local doctors were more informed with regard to local services.  The Committee heard that the 111 call handler had access to the same pathway as the ambulance service and there were clinicians available.  If the pathway involved out of hours it would be passed on to Shropdoc as appropriate.  It was confirmed that the directory of services that had been made available to NHS Direct was still in operation at 111 Centres and CCGs were being encouraged to use this.

In response to a question it was confirmed that the CCG paid for 111 and Shropdoc and that the Joint Project Board were recommending that both be maintained and the outcome of Future Fit would influence services in the future.

The location of the 111 call handler was raised and whether they would have appropriate local knowledge.  A member felt that resources should be concentrated on Shropshire and this comment was noted.

The Healthwatch representative commented that Shropdoc was purely for out of hours whereas 111 was essential for all other times. The Regional Commissioner explained that the 111 journey was now implemented on the ED desk, so if it was triaged to A&E it could be re-triaged which meant that 50% had been diverted from A&E to other services. 

Questions were asked about how patients living adjacent to borders would be triaged and also about telephony, in cases where people had Welsh telephone codes.  These issues were addressed through the design of the Directory of Services. Members were encouraged to phone the 111 test line and feedback on experiences. 

It was agreed that a visit to the Ambulance Service and 111 in Dudley would be useful for the Committee early in the new year.

Mrs Pyrah and Mrs Fortes-Mayer were thanked for attending for this item. 

The Chairman reminded the Committee that the Shropdoc telephone number was 08444 068888

The meeting finished at 11.55 am.