Apologies were received from Councillor J Cadwallader.

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 30 January 2017 as a correct record, TO FOLLOW marked:  3

It was agreed that the minutes of the meeting held on 30 January 2017 be confirmed at the next meeting of the Committee.

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 15 February 2017. 

Two public questions had been submitted by Mr J Bickerton as follows:

‘Why haven’t West Midlands Ambulance Service met the commitment they made at the introduction of Make Ready on 30 June 2011 when they said we would get a better service in Shropshire’

‘It said in the Oswestry Advertiser that WMAS had been classed as outstanding.  How does that apply to Shropshire and how are you going to get up to that standard’

In response the West Mercia General Manager explained how the Make Ready system improvements meant that there would be an ambulance ready for the crew to come back to after a job to get straight back into. 

In response to the second question, it was confirmed that the CQC visit had been very thorough and had covered the whole region, including Shropshire.  WMAS was the only ambulance service in the country to have been rated as outstanding.

In response, Mr Bickerton referred to poor response times in rural areas.  WMAS officers said that for most patients, clinical outcome would be a more important measure than speed.

To receive any questions of which Members of the Council have given notice.  Deadline for notification is 5.00 pm on Wednesday 15 February 2017. 

A Member question had been received from Councillor K Pardy –

‘Can the chair tell me how many paramedics have resigned from the service in the eight months up until and including the 31st January 2017’

In response, WMAS officers reported that leavers in that time period had numbered 15.  One had transferred to another ambulance service, 12 had gone to Shropdoc, one had left for personal reasons and one had retired.

Councillor Pardy expressed concern about the service losing paramedics to Shropdoc and asked if better working conditions had attracted them to that organisation and if so, what was WMAS doing to retain staff.

The Director of Clinical Commissioning and Strategic Development said there were pressures on staff retention throughout the NHS and all ambulance services.  Having said that, he reported that ambulance staff did traditionally stay in service for a long time and many received long service awards.  People were now having to work harder than ever and were out on calls for the entirety of their shift.  WMAS had established a new career framework for paramedics and within two years this made them some of the best paid NHS staff compared to other health professions, including junior doctors.  He referred to the frustration felt by staff when they were delayed for long periods of time at the hospital.

The Committee has asked West Midlands Ambulance Service to attend the meeting to respond to questions about:   the WMAS proposed withdrawal from the 'Physician Referral Unit'; Progress on working with the Fire and Rescue Service; Performance in Shropshire by postcode.  Information provided by WMAS for the meeting is attached, marked:  6

Michelle Brotherton, General Manager, West Mercia, Mark Docherty, Director of Clinical Commissioning and Strategic Development/Executive Nurse and Pippa Wall, Head of Strategic Planning, will attend the meeting to answer questions.

The Chairman welcomed Michelle Brotherton - General Manager West Mercia, Mark Docherty – Director of Clinical Commissioning and Strategic Development and Pippa Wall, Head of Strategic Planning, West Midlands Ambulance Service (WMAS) to the meeting.  He congratulated the service on achieving ‘excellent’ in the recent CQC inspection. 

The Chairman said there some concern that this was not reflected in the more rural areas of the WMAS area.    The Director reported that WMAS was the only acute organisation in the West Midlands to achieve the rating of excellent and was the only ambulance service to achieve all mandated targets in 2015 – 2016.

The aspiration was to have a paramedic in every front line vehicle for 95% of the time and the figure for Shropshire was 95.2%.  He went on to present the information pack which had been supplied for the Committee and this provided:  an overview of the service, CQC rating, Vision Strategic Objective and Strategic Values, detail of the two year operational plan; draft Quality Account priorities; activity, demand and performance information.

In response to a series of questions from Members, WMAS officers explained:

·         At the peak time of day there would be 24 double crewed ambulances in Shropshire.

·         There were no current paramedic vacancies and if one was to occur it would be filled immediately.

·         The front line resource was being increased and there were 300 people in paramedic training

·         Staff were not moved between areas for the purpose of hitting targets.

·         The amount of ambulance resources coming into the county was always greater than that going out.

·         80% of the area covered by WMAS was classified as rural and issues around sparsity were recognised, the challenges in Shropshire being greater than other rural areas.

·         The Air Ambulance helicopter was the asset of the Air Ambulance Charity and raised money for the platform, running costs and pilot, but WMAS supplied the clinical resource.

·         The demand on the service was increasing, but major trauma cases were declining.  It appeared that people were using the service in a different way and the conveyance rate was declining.  If the service was used as it should be, the conveyance rate would be 100%

In response to a question about Mangar Elk lifting equipment, it was confirmed that there was one on every front line ambulance and that two people were required to use it.  A Member suggested that this might be something that nursing homes could buy and then train their staff to use which might help avoid ambulance call outs.   

A Member said it sounded as if WMAS was doing as well as it could internally and questioned why public perception was not more positive.  The Director emphasised that the Service was under great pressure and additional winter pressures had been high this year despite the mild weather and absence of a big flu or norovirus outbreak.  There were simply not enough resources and finances were stretched to the limits.

The Chairman asked if there was anything the Scrutiny Committee was  ...  view the full minutes text for item 59.

To receive the Shropshire CCG Prioritisation and Value for Money methodology, attached marked:  7. 

Julie Davies, Director of Performance and Delivery and James Aker,Associate Director of Commissioning will attend the meeting to present the report and answer questions. 

Julie Davies, Director of Performance and Delivery and James Aker, Associate Director of Commissioning, Shropshire CCG, circulated an update to the Committee on CCG Prioritisation and Value for Money methodology (a copy is attached to the signed minutes). In taking the Committee through the report, the significant financial constraints facing the CCG were outlined and particular attention was drawn to the CCG’s aim to increase public, patient and stakeholder engagement.    

The Structured approach taken to prioritisation was set out in the paper before members. It explained how the evidence base would be established and used as a basis for decision making.  This information would be made available on the website to increase transparency around decision making and give stakeholders and the public an additional opportunity to comment on accuracy or additional information needed.

Members asked how engagement would take place and heard that as broad an evidence base as possible would be sought.  The CCG would link in with Healthwatch and Patient Groups and service providers to collect information.  All the information normally required for a service review would be collected.  A member suggested using Shropshire Association of Local Councils and the voluntary sector to pull strands together and contact hard to reach groups.

Members were referred to the scoring process using the Portsmouth Scorecard to help robust decision making and the fifteen categories of information to be collected.  The approach would be used and modified as necessary once feedback was received.    

The Director of Adult Social Care commented that it was heartening to hear about the involvement of stakeholders in the prioritisation process and asked if there was an opportunity to formally name co-commissioners in the methodology, for example in appendix 4.  . 

A member asked if the CCG had the financial resilience to deliver its priorities.  CCG officers said that it did and referred to NHS England and Deloitte help in forming those initial priorities.

Another member asked if the methodology had been discussed or agreed with stakeholders.  CCG officers referred to a difficult period of time when initial proposals were made in 2016.  The new approach was an outcome of feedback received at that time, not least from the local authority.  CCG officers confirmed that it was intended to work proactively with the Council’s Director or Adult Services.  

The Director Adult Services said it was fair to say that the Council and CCG were now working together more closely, but that it was right for Members to challenge this relationship and input of stakeholders into the methodology. 

The Associate Director of Commissioning said he would be happy to respond to any questions or comments outside of the meeting. 

The Chairman expressed the Committee’s appreciation to the Director of Performance and Delivery and Associate Director of Commissioning for attending the meeting and responding to questions. 

To consider the proposed work programme for the Committee, attached marked:  8

A member suggested looking at the location of Midwifery Led Units in the county.