Agenda item

·         A Performance Update on Health Developments in Monmouthshire (presentation to follow)

·         Discussion on ‘Dying Matters’ as a possible future area for scrutiny work with the Aneurin Bevan University Health Board (verbal)

·         Scrutiny of an Evaluation of the Choose Wisely Programme (to follow)

We welcomed representatives from the ABUHB:

G. Evans                     Director of Workforce

B. Bolt                         Deputy Chief Operating Officer

P. Buss                        Medical Director

D. Jenkins                   Chair of ABUHB

J. Paget                       Chief Executive

A. Davies                    Director of Planning and Performance

A. Brace                      Deputy Chief Executive and Finance Director

We received a presentation from the Chief Executive in order for Members to scrutinise, with ABUHB, the following areas:

·         A Performance Update on Health Developments in Monmouthshire.

·         Discussion on ‘Dying Matters’ as a possible future area for scrutiny work with the Aneurin Bevan University Health Board.

·         Scrutiny of an Evaluation of the Choose Wisely Programme.

Following the initial presentation on Health Developments in Monmouthshire, Members were invited to comment and discuss.  In doing so the following points were noted:

Members sought clarification on the review on the GP out of hours scheme.  In response we were advised that a challenge to the Health Board had been recruiting GPs to the out of hours service.  The service relied on being able to recruit salaried GPs or Sessional GPs, which had become increasingly difficult over the past 12 to 18 months.  In order to address the issue the Health Board had recruited more nurses to work alongside GPs and increased payment rates for GPs, which had not been particularly effective.  A complete route and branch review of the service had been conducted, which would have been carried out with the introduction of a new telephone number, the 111 service, to ABUHB in 2017. The review had looked at the number of calls coming in, the types of calls, if a different response could be provided.  The Health Board were focussing on a primary care approach to the out of hours service.  It was noted that the service was not being reduced, but enhanced.

Members referred to problems with car parking facilities at Neville Hall hospital.  In response we heard that a meeting had been attended which confirmed that planning permission had been applied for to extend the facility, but had been appealed against by National Resource Wales.  The Health Board confirmed they were committed to resolving car parking issues at both Neville Hall and Royal Gwent Hospitals.

A Member questioned the Health Boards policy surrounding smoking electronic cigarettes and it was confirmed that their smoking policy covered the ban of all types of cigarettes.

A Member raised concerns surrounding the role of the Community Health Council for the future. It was a concern that the future service may be more in-house.  The Chair of ABUHB expressed that there was a good relationship with the CHC and the CHC provided a much better informed service.  As far as the Health Board were concerned, the work of the CHC in Gwent was greatly valued, as was the support.  

A Member questioned if the scrutiny process was a hindrance to progress.  The Chief Executive of ABUHB considered the scrutiny process important and useful to test out views and plans.  It was thought to be essential that plans were tested through scrutiny and general discussions.  It was confirmed that ABUHB wanted to further develop engagement work which was welcomed by Members.

In response to a question regarding the availability of interpreters we were informed that there was an allocation to bring in interpreters or to use language line.  There was often help from family members in these instances.  Literature was copied into utilised languages.

A Member questioned if ABUHB had reviewed their management structure across the Health Board.  In response we heard that there was regular benchmarking of management costs.  There had been a similar structure in place for the last 5 years and early in 2016 there would be the commissioning of a fundamental review of structures.  With regards to clinical structures we were informed that doctors employed and deployed in the right way.  There was a plan over time to get to a fully functioning 7 day service providing 7 day, twice a day ward rounds.

Following a query relating to ambulance waiting times the Director of Planning and performance at ABUHB explained that there were several areas to take into consideration being:

·         That ambulances were not unnecessarily delayed in the emergency department.

·         Welsh Ambulance Service Trust staffing levels.

·         Working with the Welsh Ambulance Service Trust to organise services effectively.

We heard there was a much better foundation going forward.

Following a request for clarification on Welsh Government statement on improved funds, we heard that there was a growing need from the population and therefore a need to invest more.  There had been a struggle over the last 4 years to get a good balance.  The last comprehensive spending review had shown that the Welsh Government would be protecting other services such as Social Care.  It was important to consider how to get serious about integration and how best to pool services together.

The Chief Officer for Social Care and Health added that in terms of integrated services we were building on a strong position, but noted there were always next steps and more to do. Part 9 of the Social Care and Wellbeing Act requires us to pool more budgets and officers were looking at integration within those networks as challenge but exciting opportunity.

A Member questioned, with regards to patients nutrition, what was the policy on assisted feeding, and if appropriate people would be welcomed.  We heard that all staff encourage adequate nutrition as part of the policy.  A review of the nutritional standard had been undertaken and the Health Board were working at a high level.  There were some ongoing activities, and family members were encouraged to assist where possible.  We heard that some hospitals were using volunteers.

The Chairman thanked the ABUHB members for the discussion and introduced the Deputy Chief Operating Officer of ABUHB, who was presenting a report on ‘Dying Matters’.  Following the presentation Members were invited to comment, during which time the following points were noted:

Members felt that if the programme was to be implemented in Monmouthshire the name should be Live Well, rather than a Welsh name that would not be understood in many areas.

A Member expressed that it was important to make people comfortable for end of life care, and to avoid the trauma of going into a hospital situation at that stage.  In response we heard that we were very lucky to have 2 hospices in Gwent who were very responsive.  St David’s Hospice Response Service were renowned across Wales and parts of the UK as being an extremely responsive service.

The Chairman noted that the Committee were invited at this time to participate in discussion and would welcome the endorsement for further opportunities to work together.  The Committee accepted, in principle, the invitation and would welcome participation as, possibly, the first in Wales.

Lastly, we heard about the Choose Well campaign and the services were highlighted to the Committee.  Following the presentation Members were invited to comment.

The Chairman clarified that this referred to Monmouth rather than Monmouthshire, and Members would be happy to see the scheme move into the other areas of Monmouthshire.  Members were keen to note that they would be willing to help to engage, and felt it was important for many reasons, especially as a way of changing forms of services which had previously been bones of contention.

A Member stressed that we should never assume that all people have access to the internet, or know where to turn when help is needed.  Leaflets should be distributed to individual households.  It was suggested that where possible the information could be added to Members newsletters.