Meeting documents

Apologies were received from Mrs Wendy Mathews.

Ms Thalia Jervis the new Chief Executive at Healthwatch Bucks was introduced as the new co-opted Healthwatch Member replacing Ms Shade Adoh. Ms Jervis sent apologies for the meeting and Mr Phil Thisleton Head of Research at Healthwatch was substituting.

There were no declarations of interest.

The minutes of the meeting held on 21st June 2016 to be confirmed as a correct record

The Minutes of the meeting held on 21^st June were confirmed as an accurate record with the addition of Mr A Green’s apologies and Julia Wassell’s comment that she had used social media to highlight the work of the HASC.

Julia Wassell questioned whether a majority view had been established for meetings to remain at County Hall. The Chairman stated that his understanding that a decision was reached at the last meeting and would be reviewed again in a years’ time.  Julia Wassell motioned for a vote of no confidence in the Chairman on the grounds of failure to listen to the voices of Wycombe representatives.  The motion was not seconded. 

The Chairman agreed that choice of venues for future HASC meetings could be discussed and agreed by HASC outside of the meeting.

Follow-up on actions

ACTION: Committee and Governance Adviser to investigate how information on public questions could be more prominent on the Bucks County Council web pages.

Currently being investigated

ACTION: Committee and Governance Adviser to invite the Primary Care Commissioner to the 26th July HASC to discuss the Lynton House Surgery decision. 

Mrs Lou Patten (Chief Officer Aylesbury Vale CCG) attended the meeting to present the decision briefing paper.

ACTION: Committee and Governance Adviser to write to NHS England to seek response to the formal submission to the Community Pharmacy consultation.

Responses from the Secretary of State for Health the Rt Hon Jeremy Hunt MP to the Rt Hon John Bercow MP and a response from the Rt Hon Cheryl Gillan MP were attached with the agenda. Mrs Aston requested that the issue be kept on the HASC’s agenda with an update at the next meeting.

Proposals from Department of Health were due in July and HASC Members would be circulated with the details.

ACTION: Adult Social Care to provide the current figures for delayed discharges.

These had been sent out to Members and would be re-circulated as new Members had joined the Committee.

ACTION: Buckinghamshire Healthcare Trust to provide HASC with re-admission figures.

The readmission rate for May 16 was 6.9%, an improvement on 8.9% in March 16. The Chairman stated that HASC would monitor these figures.

This is an opportunity for members of the public to put a question or raise an issue of concern, related to health.   Where possible, the relevant organisation to which the question/issue is directed will be present to give a verbal response.  Members of the public will be invited to speak for up to four minutes on their issue.  A maximum of 30 minutes is set aside for the Public Questions slot in total (including responses and any Committee discussion). This may be extended with the Chairman’s discretion. 

For full guidance on Public Questions, including how to register a request to speak during this slot, please follow this link:

http://www.buckscc.gov.uk/about-your-council/scrutiny/getting-involved/

The Chairman stated that responses had been sought on public questions raised outside the time deadlines for the previous meeting.  Concern was expressed that the responses had not been distributed at the meeting.  The Chairman explained that the responses had been received just prior to the start of the meeting so it was agreed that these would be circulated after the meeting.

The full questions and answers are attached.

This will include an update regarding the proposed 6% Cuts to Community Pharmacy Services.

Attached are the letters from the Secretary of State for Health the Rt Hon Jeremy Hunt MP to the Rt Hon John Bercow MP and the letter from the Rt Hon Cheryl Gillan MP to Cllr Angela Macpherson.

In addition an update on Mandeville Surgery where Locum GP cover on Thursdays and Fridays is causing concern amongst residents.

The Bedfordshire and Milton Keynes Healthcare Review

The Chairman has been advised that the cancelled 14^th June meeting of the Joint Health Care Review Board had not been re-convened as the team wanted to ensure alignment with Sustainability and Transformation Plans. A revised decision making timetable would be presented by the HCR team at the next HASC meeting on 6^th September.

Moving Closer to Home Pilot

The Chairman had met with the Chief Executive of Buckinghamshire Healthcare Trust (BHT) to express support for the pilot project.

(See Appendices 2 and 3)

Provision of Communications and Engagement Services to Aylesbury Vale and Chiltern Clinical Commissioning Groups

Buckinghamshire County Council (BCC) and the Aylesbury Vale and Chiltern Clinical Commissioning Groups (‘the CCG’) had established an agreement for a shared communications and engagement service, hosted by BCC.  The decision was ratified by the County Council on 25^th July.

Mandeville Practice

Concerns were raised with Mr B Adams regarding Mandeville Practice use of locum GP cover on a Thursday and Friday. 

Responses were sought from the Practice Manager who stated that:

 ‘I am sure you are aware of the challenging situation Mandeville has been experiencing and working through over the last 12 months, together with the national problem experienced by GP surgeries nationwide with regard to GP recruitment and retention.  Following The Practice U Surgeries Limited taking over the practice on 1st April, 2016 we have steadily been increasing our regular GP clinics.  Yes, like all other GP practices, we do need to use the services of locum or self-employed GP’s but we work very hard to ensure we have regular self-employed GPs to ensure patient continuity.  Our employed GPs work sessions across the week.  A new employed GP started with us recently and another will commence at the beginning of August to further support our current team.’

In addition the Head of Primary Care NHS Chiltern and Aylesbury Vale CCGs stated that:

‘Recruitment and retention is a national problem for primary care. Like many other practices, Mandeville Surgery has suffered recruitment issues. Throughout this difficult period the practice has remained clinically staffed although it has had to resort to employing locum staff at times.

A successful recruitment campaign has resulted in the employment of 2 new GPs and an Advanced Nurse Practitioner. We are pleased to report that from September 2016 the practice will be able to provide the local population with 50 – 52 GP sessions a week and will no longer be reliant upon locum clinical staff. This should increase the availability of patient appointments and improve the overall patient experience.

On the day appointments with a clinician continue to be available for patients morning and afternoon five days a week. However the surgery does recognise that there has been some irregularity regarding the number of emergency appointments available each day due to clinical capacity. With the addition of the newly appointed clinical staff this imbalance should resolve. From September 2016 a consistent number of on the  ...  view the full minutes text for item 5.

There were no Committee updates.

For Members to note the work programme

The work programme was noted.

The Committee at its last meeting on 21^st June requested that the Primary Care Commissioner be invited to the 26th July HASC to discuss the Lynton House Surgery decision. 

Attached is the briefing paper on the decision from NHS England South (Central) and the Equality and Health Inequalities Analysis which informed the decision.

Contributors: Lou Patten - Chief Officer, NHS Aylesbury CCG

Mrs Patten provided background context to the item reporting that she was now the Accountable Officer for the new Federation of Chiltern and Aylesbury Vale CCG.  Mrs Patten explained that the change provided clarity regarding staffing and structure and anticipated that communications with Committees such as HASC and the public would improve as a result.

The Committee heard that the CCG was currently working on the current and future population health, social care and infrastructure needs around the seven localities.

With regard to Lynton House, Mrs Patten confirmed that NHS England had been working with Chiltern CGG and that it had been decided to postpone the decision to close Lynton House for 6 months. Mrs Patten explained that this would provide time to review long-term provision for the health and social care needs of residents in East Wycombe which would need to take into consideration public health, housing needs and the desire for patients to be cared for closer to home.

During discussions the following points were made:

·         The risk assessment had shown that it was currently safe for patients to be seen at Lynton House.

·         It would be necessary to have clear options for consultation based on the needs and future need of the local population.

·         Members requested that the review be brought back to HASC

Action: Committee and Governance Adviser to liaise with NHS England and the CCG to ensure the review is considered by HASC at the start of the consultation.

To provide Members with an update on the current position, particularly regarding staffing and the recruitment of student midwives. 

This item will also provide Members with an opportunity to discuss areas of focus for the Maternity Services item on 6^th September.

Attached is the briefing paper from Buckinghamshire Healthcare Trust

Contributors: Carolyn Morrice - Chief Nurse and Director of Patient Care Standards, Buckinghamshire Healthcare NHS Trust

Mrs C Morrice clarified that the decision to temporarily transfer care for women using the Wycombe Birth Centre was temporary until 31^st October and that the decision had not been taken lightly and that clinicians had been fully involved.  Mrs Morrice explained that the primary concern was the safety of women and their babies and approximately 20 women per month gave birth at the Wycombe Birth Centre and that all affected women were fully consulted.

Mrs Morrice provided the following information:

·         24 maternity services staff had left the Trust over the past year – a mixture of staff retiring and moving to other posts.

·         Recruitment was impacted by an ageing workforce and reflected national trends.

·         Currently Buckinghamshire Healthcare Trust had 172 midwives in post and was 14 midwives short of its requirement.

·         The Trust was currently interviewing 24 Midwives.

·         The Wycombe Birthing Centre remained open for ante- and post-natal appointments.

During discussions, the following points were raised:

·         The Stoke Mandeville Unit would be clinically more difficult to close as women with more complex birth risks were referred to the Unit (around 50 women per month).

·         The Trust was using Birth Rate Plus as a tool for forecasting numbers of midwives needed.  The need to future proof services and include the community in discussions was acknowledged.

·         Perinatal mortality is 4.6 per 1,000 in Buckinghamshire against a UK rate of 5.9 per 1,000 (source: MBRRACEUK report 2014).

·         The Committee requested clarification around the local performance in relation to comparator CCGs in relation to the maternity services pathway at its meeting on 6^th September. 

ACTION:  Commissioning leads for Maternity Services to provide HASC on 6^th September with context and detail regarding the areas where the Buckinghamshire CCGs are performing worse than its comparator CCGs against the Commissioning for Value Tool.

The next meeting will take place on Tuesday 6^th September at 10.00am in Mezzanine Room 2. There will be a pre-meeting for Members at 9.30am.

The next full webcast committee meeting will be on 6^th September 2016 at 10am.