Agenda and minutes

Purpose: To receive apologies for inability to attend the meeting (if any).

Purpose: To approve as a correct record the Minutes of the meeting of the Committees held on 23 May 2022 and 14 June 2022.

The Minutes of the meetings held on 23 May 2022 and 14 June 2022 were approved as true and correct records and signed by the Chairman.

Purpose: To remind Members of the need to record the existence and nature of any personal, disclosable pecuniary or other registrable interests in items on the agenda, in accordance with the Members’ Code of Conduct.

There were no declarations of interest received.

Purpose: To consider any petitions requiring an Officer response.

There were no petitions received.

Purpose: To present an overview of current performance including response times and hospital transfers, and winter service plans for 2022/23.

Mark Ainsworth, Director of Operations, South Central Ambulance Service (SCAS), presented the report on the Service (Agenda Item 5).

Mark Ainsworth gave an overview of the number of calls to the SCAS by category and the associated response times. He noted the increase in demand in category 2 calls (emergencies requiring an 18 minute response). Patients who normally presented as category 3, which required a two hour response, were presenting as category 2 which indicated a higher acuity of patients in communities than was the case. They were failing to achieve all of their performance standards, however SCAS benchmarked very well against other Trusts nationally. Their current focus was on improving category 1 calls where their average response times should be seven minutes.

Mark Ainsworth moved on to Berkshire West Performance. It was noted category 1 response times had increased by about 40 seconds more than the SCAS average. There were challenges in the Berkshire West region and particularly response times in rural areas. Mark Ainsworth moved on to give an overview of SCAS service outcomes. Some patients were responded to by clinicians in control rooms (hear and treat) and an ambulance or rapid response car went to the remaining calls. Some patients were dealt with on site (see and treat) and the remaining patients were see, treat and convey. He explained convey was not always to an emergency department. It could be a minor injuries unit or other speciality. Mark Ainsworth noted that year on year there had been a growth in hear and treat response rates. Last year’s slight drop in hear and treat was due to high rates of hear and treat during the pandemic the previous year. NHS England set a target of a maximum of 49% of patients being conveyed to an emergency department and Mr Ainsworth highlighted that SCAS was above that. They had an active campaign to introduce additional care pathways to avoid patients going to Emergency Departments. Mr Ainsworth advised that Berkshire West see and treat performance was higher than the SCAS average and that was because of the pathways they had in the community rather than conveying patients to hospitals.

Mr Ainsworth presented data on hospital delays. He advised that patients should be handed over within 15 minutes of arrival at hospital. This had been a challenge during Covid with hospitals having high bed occupancy. There had been a slight increase in average handover time in July 2022 of 40 - 43 minutes. The impact was that it took ambulances out of the system and therefore unable to respond to further calls. SCAS were working with all their acute trusts to reduce handover delays. For Berkshire West, Mr Ainsworth advised the majority of patients went to the Royal Berkshire Hospital (RBH). They had a very good working relationship with the RBH and they resolved issues when they arose. There were some challenging weeks, where bed occupancy was very high, but they had good processes to resolve things quickly.

Mr Ainsworth explained  ...  view the full minutes text for item 23.

Purpose: To present an overview of demand in urgent and unscheduled out-of-hours calls. Consider response and issues arising.

Ben Blease, Divisional Director Adult Community Health Services, Berkshire Healthcare NHS Foundation Trust presented the report on urgent and unscheduled primary care provided during the out-of-hours period in West Berkshire (Agenda Item 6).

Ben Blease first gave an overview of the Berkshire West Out Of Hours Primary Care Service, WestCall. She advised the Committee of the hours of operation, the locations and the services provided. Ms Blease then explained how they delivered the service including virtual triage (by phone), face to face and point of care testing. She spoke about how the diagnostic tests were beneficial for patients as it could mean avoiding admissions into hospital. Ms Blease noted the key role WestCall played in the Berkshire West system particularly in avoiding hospital admissions, supporting community beds, care home visits and supporting with flu jabs. They also worked with ambulance services, mental health services and social care.

Ms Blease moved on to explain WestCall activity in the Berkshire West system. In the Newbury area last year they saw 15420 patients which was 13% of all patients registered in West Berkshire. This was slightly higher than other areas of Berkshire West and was a large increase in demand from the previous year. Ms Blease advised that they did not have waiting lists as they had to see all patients by 8am. However, patients were prioritised by 111 and some patients might have faced delays when demand and complexity exceeded capacity.

Ms Blease advised that challenges were made worse when their patient management system (Adastra) was shut down for a number of weeks due to a cyber attack in August. This meant that paper records were needed and they could not access patient data. This caused huge delays. The digital outage also meant they could not communicate with patients as easily and so they received some complaints.

A further challenge to WestCall was staffing. Finding clinicians to work nights and weekends was difficult. They had sessional staff who expected higher rates of pay for working additional hours. In addition to the 16% increase in demand there was increased numbers of two hour wait referrals. Additionally the government no longer supported training packages for advanced practitioner training. A further concern was that 22% of referrals in the last year were closed with no other treatment required than self-care. That was a large number of patients that came through to the service when alternatives were more suitable than the urgent care service. Ms Blease gave an overview of the most common reasons for referral to 111 and WestCall. The main reason was needing updated medication for patients who had not been able to get a prescription from their practice. Other reasons were requesting advice for ill-defined signs and symptoms, often parents worried about children, and also for cystitis and viral infections. Ms Blease noted that education of the public was needed.

Ms Blease moved on to give an overview of how WestCall were breaking down access barriers to patients. As they had increased virtual  ...  view the full minutes text for item 24.

Purpose: To receive an update from the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board on their activities.

Belinda Seston, Interim Place Director of the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board (BOB ICB), presented her report on ICB activities.

Belinda Seston confirmed the BOB ICB went live on the 1^st July 2022. This meant the Berkshire West Clinical Commissioning Group (CCG) was disbanded. There was a great deal of work happening at a strategic level including developing the ICB Strategy and the Integrated Care Partnership (ICP). Ms Seston advised that Sarah Webster was the incoming Place Director for Berkshire West and would be the key point of contact for the Health Scrutiny Committee from the ICB.

Belinda Seston gave an overview of the flu and Covid vaccination autumn plan. She explained it would be co-administered where possible. She advised that additional money was available from NHS England to support winter resilience.  £1,600,000 was to build on the current infrastructure to help support discharge out of hospital and to support admission prevention. £500,000 was available for discharge (to assess beds for patients ready to be discharged) but needed some more time to have plans assessed. These built on the current infrastructure.

Ms Seston advised the Committee there would be an urgent care centre piloted in Reading. This would be from early October to support the considerable pressures on Emergency Departments. Emergency Departments could offer appointments there, along with GPs and there would be walk-in appointments. It would be an 18 month pilot to test how it worked. Ms Seston explained that elective care recovery was a national initiative following on delays to surgery due to Covid. The BOB ICB aim was that no patients were waiting more than 78 weeks for surgery by the end of 2022.

Ms Seston highlighted work happening on the management of long term conditions. She explained that September was ‘know your numbers’ month to encourage people to check their blood pressure. 21 practices across Berkshire West were taking part in the scheme to monitor blood pressure at home.

Ms Seston noted that dementia performance was picked up on in the Berkshire West Clinical Commissioning Group’s annual report. She advised that memory clinics were paused during the pandemic. There was a substantial transformational plan to address the waiting lists including an increase in staff. She advised that they were now on track to meet the national target by the end of the financial year.

Councillor Linden noted that he had his Covid booster vaccination along with the flu vaccination. He asked whether there was a plan for a booster in six months. Belinda Seston advised that they had enough supply to meet demand and had enough capacity to be agile if things changed.

Councillor Linden asked whether the urgent care centre was a replacement for the walk in centre in the Broad Street Mall. Belinda Seston advised that they were currently looking at tenders and were still deciding where the facilities would be located. Councillor Linden noted that 20-25% of West Berkshire would be able to access the urgent care centre but  ...  view the full minutes text for item 25.

Purpose: Healthwatch West Berkshire to report on views gathered on healthcare services in the district.

Sarah Deason advised the Committee that she was from Advocacy People who were the host provider of Healthwatch and was happy to take questions from Members.

Councillor Linden asked if there was anything particularly urgent from Healthwatch. Sarah Deason said that there was not currently and would take that question back to Healthwatch.  

Purpose: To receive updates from the Chairmen of Task and Finish Groups appointed by the Overview and Scrutiny Management Commission.

Councillor Macro advised the Committee that a peer review had taken place in relation to Continuing Health Care. It was agreed to await the report before any further work of the Task Group. 

The Chairman advised that she had reached out to Members regarding membership of the New Developments Task Group and was waiting to hear back.

Purpose: To receive new items and agree and prioritise the work programme of the Committee.

The Chairman invited Members to make suggestions or comments on items on the Work Programme. The Chairman noted that all suggestions would go through the prioritisation process and highlighted the form on the website for members of the public to nominate topics for the Health Scrutiny Committee to consider.