There were no apologies for absence.

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 25 July 2016 as a correct record, attached marked:  3

The minutes of the meeting held on 25 July 2016 were confirmed as a correct record.

To receive any public questions or petitions from the public, notice of which has been given in accordance with Procedure Rule 14.  Deadline for notification is 5.00 pm on Wednesday 21 September 2016.

Mr C Deaves asked a question related to a recent article in the Shropshire Star regarding the financial management of Shropshire CCG and referring to the ‘360 stakeholder survey’ asking if the Committee could have sufficient confidence in the CCG analysis to accept the Disinvestment and Decommissioning Decision Paper and recommendations within it at item 8 of the agenda.  (A full copy of the question and response provided is attached to the signed minutes).

In response, Mr Deaves was informed that Members of the Committee had not yet agreed a considered view of the plans.  The Committee Chair had written to the CCG Accountable Officer to give him an opportunity to inform the Committee of the rationale for its plans. 

Responding to a supplementary question about the powers of the Committee and a suggestion from Mr Deaves that the Committee view the ‘360 assessment survey’ results, the Chairman confirmed that no decisions related to the CCG Paper would be made at the meeting and commented that Senior Managers at the CCG had not been in post very long.  Mr Deaves was also informed that the Committee had the ability to call the CCG to account but not control it.  Shropshire CCG had been placed under formal legal directions by NHS England

To receive any questions of which Members of the Council have given notice.  Deadline for notification is 5.00 pm on Wednesday 21 September 2016. 

Councillor Tracey Huffer had submitted a question related to closures in recent weeks at Ludlow Minor Injuries Unit.  She was thanked for making the Committee aware of the problem and an explanation would be requested from the Community Health Trust about the problem and the actions it is taking to prevent a reoccurrence and ensure there are effective measures to communicate with the local community and stakeholders such as GPs.

Councillor David Turner had submitted a question related to the proposed closure of four Pathway 2 rehabilitation beds at the Lady Forester Nursing Home in Much Wenlock, and asking if the Committee believed that closing the facility was an appropriate way to provide rehabilitation beds and thus reduce bed blocking and whether it was the best way to manage tax payer’s money. He also circulated six letters to members of the Committee written to the CCG Accountable Officer expressing concern about the proposal.

In response to his question, Councillor Turner was informed that a number of concerns regarding the proposals by Shropshire CCG in relation to disinvest or decommission a range of services had been raised.  The Committee would have an initial chance to review the relevant CCG papers at today’s meeting and further information would be sought from the CCG. 

It was agreed to take agenda item 8, Shropshire CCG Decommissioning and Disinvestment, as the next item. 

To consider two reports that were approved by Shropshire CCG Governing Body on 10 August 2016, attached marked:  8

The Chairman referred to the 10 August 2016 Shropshire CCG Governing Body papers circulated with the agenda on Shropshire CCG Decommissioning and Disinvestment (copies attached to the signed minutes).  He reported that he had received a great many letters expressing concerns related to these and had asked for them to be circulated to Members of the Committee for discussion.  He said that whilst the financial challenges of the CCG were accepted, it was felt that some of the changes proposed might have unintended consequences.  Although the CCG Chair had stated that ‘it is clear that the patients’ care comes first’,  it was essential to see that the patient had ample chance to be consulted before a service was changed or taken away and to understand their options. 

He said that this should be done as openly as possible and reiterated that discussions needed to be held with providers of services within Shropshire, including the Community Health Trust, the local authority, private sector and voluntary sector, so that they could analyse the situation and feedback on any unintended consequences that were likely to impact on the local Health and Social Care economy. 

A Member referred to the need for actions to live up to the statements in the Decommissioning and Disinvestment Policy.  She also referred to a step in preparing for disinvestment or decommissioning the service involving assessment of ‘appropriate availability of patient choice’.  She emphasised that patient choice was not often available in a large rural county like Shropshire, especially when it came to rehabilitation beds.  She reported on a major problem finding rehabilitation beds in the part of Shropshire she represented which bordered another county. 

Another Member felt that the terms ‘disinvestment and decommissioning’ were not helpful or meaningful to the public and that clearer engagement was needed by explaining simply that some services were going to close and some would be delivered in a different way.  The Chairman agreed that the Committee would want to know how messages would be conveyed. 

A Member said she had received lots of questions from members of the public, and also people who ran services who did not understand the situation.  She was concerned that the changes could affect some of the most vulnerable people in society who may not have any idea about what was happening.   Other Members expressed concern around the apparent lack of a risk or impact assessment relating to individuals and other organisations, including the Council and that legal action might be a consequence if procedures were not followed correctly. There was no legal definition of the term ‘substantial variation’.

The Chairman said it was important to avoid simple budget shifting to stabilise just one part of an economy.  The Director of Adult Social Care agreed that it was necessary to take into account risk and position of services across the whole economy, and ensure any shortfalls in accuracy and consultation were addressed.   In the interim period before the next meeting, a formal response from Adult Social  ...  view the full minutes text for item 27.

At the meeting on 25 July 2016, it was agreed that West Midlands Ambulance Service, Shropshire CCG and Shrewsbury and Telford Hospital Trust attend the 25 July 2016 meeting of the Committee and present the following information:

·         Update on Performance – Pilot Figures

·         Feedback on co-working with the Fire Service

·         Detailed update on initial impact of Physician Response Unit

·         Update on handover performance

·         Update on High Intensity User Project

·         Data on Community First Responder Coverage in rural areas

The Chairman welcomed the following to the meeting:  Julie Davies – Director of Strategy and Service Redesign, Shropshire CCG, Gail Fortes-Mayer – Lead Commissioner Ambulance Service, Mark Docherty, Director of Clinical Commissioning and Service Development/Executive Nurse, WMAS, Barry McKinnon – Shropshire Area Manager, WMAS, Pippa Wall - Head of Strategic Planning, WMAS, and Sara Biffen – Deputy Chief Officer, SATH.

Mr Docherty gave a presentation explaining the three categories of response used by WMAS up to 2011 and from 2011 to 2016.   WMAS was now a pilot site for the ambulance Response Programme introduced in June 2016.  He explained that a very target service did not help patients and the new system was designed to separate responses and the time in which the patient received the correct response.  Some measures were still be perfected but it meant a move away from use of percentages to percentiles. The figures for August 2016 showed that Shropshire was in the 75^th percentile which was thought to be a good performance.

Members queried the way the data was set out and what it actually meant.  Mr Docherty explained that 90% of all red calls were responded to in 16 minutes.  Members asked what the longest time was for the remaining 10% and he acknowledged that the remaining 10% in the most rural areas was always the problem.  He explained that the aim was to get to patients with the right response as quickly as possible, and then to the right place, even if a target was missed.  The old system created behaviours which were not helpful. Figures were available broken into postcodes and the Committee requested that this data be made available in future.  

Members were pleased to note that a letter had been written by Dr Davies following the last meeting of the Committee to the Regional WMAS Commissioner encouraging work which would help link response times with outcomes.  The Committee agreed that outcome for the patient was the ultimate measure. 

Mr McKinnon continued the presentation in relation to Community First Responders in Shropshire, and setting out priority recruitment areas.  He confirmed that WMAS was rolling out training to upskill CFRs and this would be offered to all. 

A Member asked if recruitment of CFRs was a high priority and how they were recruited.  The Committee heard that the Community Response Manager made approaches as necessary to Councils.  Members suggested using Shropshire Association of Local Councils for targeting local parish and town councils in recruitment campaigns.  Dr Davies said support from elected Members in recruiting CFRs was always welcome. 

The Chairman referred to a letter he had recently received from the Chief Executive of WMAS in relation to working with the Fire Service.  He asked if this had been progressed.

Mr Docherty explained that one meeting of Chief Officers had been held locally with the Fire and Rescue Service.  Fire Officers would be required to complete the full role, receive training and have to log on as CFRs.  He said that WMAS  ...  view the full minutes text for item 28.

To receive an update from Dr Julie Davies, Director of Strategy and Service Redesign,

Shropshire Clinical Commissioning Group.  A report is attached, marked:  7

Dr Davies presented a briefing paper (copy attached to the signed minutes) in relation to the implementation of eligibility criteria for the Non-emergency Passenger Transport Service. 

She reminded the Committee of the reasons for the change and the public engagement and communication that had taken place beforehand. 

The Committee was pleased to note that there had been few complaints since the implementation took place.  All had been fully investigated and there had not been any appeals made to date.  No patient was refused transport whilst eligibility assessment was underway and monitoring took place on a monthly basis.  She emphasised that the CCG could only act on feedback received and any feedback from HealthWatch and Patient Groups was encouraged. 

Vanessa Barrett, Healthwatch representative, said that comments received by Healthwatch had referred to concerns about long waits or transport not turning up.  Six people had commented that they were no longer eligible.  She emphasised that the outcome of Future Fit would mean a heavier demand on transport to reach both hospitals.  Some members expressed concern that patient might end up in A&E if they did not attend appointments due to prohibitive transport costs.  Dr Davies agreed that this needed to be discussed as a system.   

The Chairman said that it was reassuring that the appeal process was unused to date and Dr Davies was thanked for providing the update. 

To consider proposals for the Committee’s Work Programme, attached marked:  9

The Cabinet Forward Plan is available from: 

http://shropshire.gov.uk/committee-services/mgListPlans.aspx?RPId=130&RD=0

It was confirmed that an extra meeting would be arranged to consider CCG Decommissioning and Disinvestment.