Minutes:
County Councillor J. Pratt declared a personal non-prejudicial interest for this item as her brother is a Professor of Medicine and delivers lectures.
Purpose:
A presentation was provided by the Integrated Service Manager (MCC), Integrated Project Manager (ABUHB) and Divisional Director Primary Community Care (ABUHB) introduced by the Head of Social Care, Safeguarding and Health.
Key Issues:
The Select Committee has requested a presentation from the Aneurin Bevan University Health Board (ABUHB) to focus on the future direction of integrated working between Health and Social Care (linked to Care Closer to Home) and also plans for Chepstow Community Hospital.
Member Scrutiny:
· A Member noted that GPs provide an important part of service delivery and commented that the plans looked over bureaucratic, and also services were not locally delivered in North Monmouthshire. It was queried how many GPs work in the county, the local availability of Living Well Living Longer health checks to tackle obesity etc. and the average number of patients per GP.
In response, numbers of GPs will be provided following the meeting. It was noted that there is some difficulty in recruiting GPs currently and that this strategy is beginning to improve this situation. It was explained that patients often see a GP for matters better dealt with by others and action is being taken to direct patients to appropriate services. It was added that, whilst the plan looks bureaucratic, the aim is to remove pressure points and provide the right integrated support at the right time. Regarding preventative health clinics, locations in Monmouthshire will be investigated and reported back.
· A Select Committee Member welcomed the integrated approach but was concerned about generic all-age medical care in Chepstow Hospital and asked for an explanation of the services available in the hospital noting the likely closure of Lydney District Hospital, and the need to travel significant distances for care. In response, it was confirmed that generic services are being built up and outpatient appointments in Chepstow Hospital are being increased. It was added that previously there were community beds at the hospital and a limited range of outpatient clinics and a minor injury unit. The community beds have closed because of the success of the integrated team allowing more people to stay at home. The number of outpatient clinics is increasing. It is aimed to provide high volume services for people who can’t travel to other centres, in particular for older people and children. Regarding all-age health care, it is the aim to provide all services locally for all ages. It was clarified that the Older Adult Mental Health ward has been mothballed.
· A Member was encouraged by the plans described and acknowledged that there will be occasions when it is necessary to travel to access the best treatment available in the region. The offer was made to include details of services available in pharmacies in ward newsletters to reduce demand for GP services.
· A Member suggested hosting a surgery in the Livestock Market to target the rural community and farmers to encourage early diagnosis and treatment. It was agreed that this was a great opportunity for a team of specialist nurses to hold a clinic.
· It was commented that there is an elderly population in Wales and some concerns were voiced about the balance of local, integrated and effective services, and also the balance between treatment and bureaucracy. It was queried why there are three different boards with responsibilities. It was confirmed that the boards are set by statute. The Integrated Partnership Board tends to be where the main work is done e.g. integration of community services.
· A Member asked how the model works elsewhere, how effectiveness is being measured and urged the use of voluntary groups to assist with public engagement. An update on progress on the new hospital was also requested.
It was explained that the partnership with Swansea University is a research project to look at the early intervention, place-based model and this is part of the evaluative process. The Integrated Service Partnership Board evaluates performance data, and is working towards measuring outcomes for individuals. This is work in progress. It was agreed that the use of the voluntary groups is a key aspect.
· A Member commented regarding Chepstow Hospital that there are young people in the county living and working with chronic illness, not just elderly people. It was responded that access for younger people with chronic illnesses to local services is a priority. It was added that significant travel for appointments and visitors is unacceptable and stressful, and so local services are vital. Communication is also vital to make patients aware of services available locally. Considering the additional services, it was queried how many have been implemented and when they will be available. It was confirmed that the 6 additional services are in place and the other services mentioned will be live in about 2 months’ time.
· A Member commented that more capacity is needed in primary care for better and healthier lives. Minor ailments should be signposted away from GPs to pharmacies. It was added that residents are concerned about the removal of some services (Continence Outpatients, Podiatry Outpatients, Gynaecology Outpatients, Ear, Nose and Throat outpatients and, most importantly, Minor Injuries Unit). It was agreed that this list would be checked and advised that consultants are being asked if they are willing to provide clinics at different locations. A further update on progress with general health care was requested.
The suggestion of community chemotherapy being brought to Chepstow has not happened. It was responded that Velindre Hospital was approached about providing an outreach service in Chepstow but has been unable to meet the request to date.
The Member asked about funding and pooled budget arrangements. It was confirmed that there are already pooled budgets, that there is the opportunity for flexibility and that risks are shared too.
· A Select Committee Member raised the issue of unsatisfactory parking at Nevill Hall Hospital.
· County Councillor D. Dovey was reassured that there is a plan for Chepstow and supported the offer but emphasised the need to consult with councillors as the voice of the people, and to not make misleading statements.
· County Councillor A. Easson informed the Committee that a concern raised at the last meeting had been resolved. He requested more information about the 5 surgeries for 47,000 patients in the south of county and queried depth and response within this capacity, especially in view of proposed housing developments. He asked about plans for Cae Mawr Rd, Caldicot and asked that local members are kept briefed. With other Members, he too was unaware of the services available at Chepstow Hospital. He asked for details of all services provided in Chepstow
In response, it was confirmed that there are 5 practices in the South Monmouthshire Area (3 in Chepstow, 1 in Caldicot and 1 in Tintern). It was explained that practices are independent businesses funded on a per patient basis so if there is new housing, the practice will be funded for the extra patients and the surgery will decide how best to utilise the money to meet the needs of the patients. If there are no recruitment difficulties, there would be no objection to new housing being built. It was added that Monmouthshire is not a particular concern in terms of GP recruitment. Regarding Cae Mawr Rd, an undertaking was given to brief councillors about developments.
· A Member observed that there needed to be a balance between generic health services and the integrated care centre, suggesting different buildings. Concern was expressed about increasing centralisation of some specialist hospital services that will be more difficult for those who rely on public transport.
· County Councillor Dovey asked if changing demographics are taken account of in view of the increase in applications for new housing in Chepstow and over the border. It was confirmed that the Health Board is aware of these changes. It was added that if a specific request for housing is received it is directed to the neighbourhood care team. The Health Board is notified about longer term developments and is part of the planning process. There are early discussions about involvement in the development of the new Local Development Plan. It was commented that information is also required from across the border.