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Minutes of the Extra Ordinary Town Council Meeting held in the Council Chamber, Town Hall, Bideford on Thursday 25 July 2017 at 6.30 pm

PRESENT:   

North Ward:   

Councillor D A D McGeough (Town Mayor)
Councillor P J Pester
Councillor T J Johns

South (Outer) Ward:   

Councillor D Howell

East Ward:   

Councillor J A McKenzie
Councillor  S Robinson

IN ATTENDANCE:   

Mrs H J Blackburn (Town Clerk)
Mr R Coombes (Deputy Town Clerk)
Northern Devon Healthcare Trust:
Dr Alison Diamond, Chief Executive
Jessica Newton, Communications Manager
8 x Members of the Public


Prior to the start of the Meeting the Town Clerk confirmed that everyone had appended their details on the Fire Register and instructed, to the assembled, the Building Evacuation procedure.

051  APOLOGIES FOR ABSENCE

Councillors D Brenton (South Ward – personal), D Bushby (North Ward – personal), P Christie (North Ward – personal), Mrs R Craigie (East Ward – personal), Mrs P Davies (East Ward – illness), J Day (South Ward – personal), A T Inch (South Ward – personal), S G Inch (South Ward – personal), M Langmead and B Wootton (South Ward – illness).

The Town Clerk advised Mr Geoffrey Cox QC, MP had been invited to the meeting but he too had sent his apologies.

052  DECLARATIONS OF INTEREST ON ITEMS ON THE AGENDA

There were no declarations of interest.

053  PUBLIC PARTICIPATION SESSION

Six members of the public raised the following points / questions:

•    Concerns over Care in the Community safeguards and time spent travelling to clients was not time spent administering to them.  It was felt that irregularities would be more visible during Hospital Care provision as opposed to Home visits.

•    If the intention is to save £550 million by 2021 how can it be achieved?  Where do the priorities lie for the essential departments?

•    Will services be lost through inadequate staffing?  Specialist nurses and technicians are needed; recruitment and staff retainment must be addressed.  Does priority of saving money override services?

•    Are there plans to recruit consultants, especially in stroke and older care, specialist nurses and other technicians?  Is there a timeframe for the next stage of planning / testing for the future?

•    How many registrars and junior doctors are on call at any one time, especially in A&E and minor stroke units?

•    Whilst promoting the advanced stroke services at the R, D & E, what provision will be available at the NDDH.

054  PRESENTATION BY DR ALISON DIAMOND – NORTH DEVON HEALTHCARE TRUST

a.   The Chairman welcomed Dr Alison Diamond, Chief Executive Northern Devon Healthcare Trust.

b.   Dr Alison Diamond thanked the Mayor for the opportunity to address the Council and introduced her colleague, Jessica Newton, Communications Manager to the Hall.

She indicated that there would be two parts to her presentation:

•    Acute Services Review.
•    Trust Plan 2017/2018.

The Review was established by the need for a change in healthcare provision given the growth in demand, finance constraints and workforce issues.   It involved a number of clinical workshops with stakeholders including more than 100 clinicians, managers and patient representatives.

The reviews for the following priority services have been completed:

•    Stroke
•    Urgent and emergency care (UEC)
•    Maternity, neonatal and paediatrics (MNP)

Some ‘Vulnerable’ services reviews have been completed but others remain in progress.

The consultations saw proposals (the Clinical recommendations) to keep 24/7 Emergency Department services at the four Devon hospitals.  Also:

•    Investment in two new specialist hyper-acute stroke units (HASU) (Plymouth and Exeter) - improving outcomes.
•    Stroke, maternity, neonatal and paediatrics at the four hospitals.
•    Co-locate midwifery-led units with consultant-led care (not North Devon).
•    Proposals for relocation to be developed and consulted on.
o    Potential impact on Newton Abbot, Okehampton, Honiton, Tiverton.
•    New networking solutions across sites to ensure clinical sustainability.
 
Dr Diamond referred to the Vulnerable services (and the recommended delivery):

•    Histopathology – accessed through local hospital, like X-rays, reported through two or three new specialist digital laboratories.
•    ENT – full service in Plymouth, Exeter and Torbay with an addition of day surgery in NDDH to existing outpatient and diagnostics.  (Technicians and specialists in Exeter.)
•    Neurology – Devon-wide referrals and networked delivery i.e. North Devon outpatients only (nursing support locally, doctors travel up from Exeter).
•    Other reviews still underway (breast surgery/radiology (national shortage), dermatology interventional cardiology, interventional radiology and vascular).

Dr Diamond advised the Meeting on the engagement process, how they informed the public on the criteria for change.

•    Twelve public engagement sessions across Devon – >360 people attended – public, voluntary sector, etc.
•    Staff roadshows.
•    Meetings with local councils.
•    Clinical and public consensus on ‘safety first’.
o    There are work force issues; working with Trusts across Devon to enhance opportunities and ensure sustainability.
•    Feedback collated for the Sustainability and Transformation Plan leaders to review.

Dr Diamond spoke about the next stage of the process with the need to ensure that the recommendations can be delivered with safe, cost-effective and reliable staffing solutions.  She alluded to finding alternate ways of working through new partnerships between hospitals and Devon-wide service networks which will necessitate changes to the ways that clinicians work.  They will have to consider different levels of cooperation for different services:

•    Level 1 support: services operate within a clinical network with expert discussion on best care for individual patients across all four hospital sites.
•    Level 5 (most integrated networks): services managed and staffed by one provider, who would have responsibility for the standards and delivery of services in each of the other locations where treatment is provided.

Dr Diamond invited Members to raise questions and comments that included: 

•    An apology for the pitiful turn out of councillors and members of the public.
•    Recruitment policy in the face of any perceived threat to future services.
o    50,000 have seen recruitment video.
o    NDDH is a high performing hospital.
o    The area is a great place to work.
o    The future presents real opportunities.
o    There is a drive in acute medicine recruitment:
    Elderly care.
    Surgeons.
    Orthopaedic.
o    Nurses are continually recruited (currently at record levels).  The training programmes with Exeter and Plymouth Universities have proved very successful.  Many Nurses remain resident in North Devon whilst taking their respective degrees / training.  NDDH / Universities are developing specialist training / post graduate courses / programmes (two to two and a half year duration).
•    Stroke Services.  Immediacy of treatment vital.
o    First treatment in NDDH (clot busting drugs) leading to second distant treatments.
•    £550 million pounds saving.
o    Whilst there is a need to save £150 million across the whole of Devon this year the North Devon Healthcare Trust will make a contribution of £12 million;  Devon is expected to break even (eradicate the deficit) in 2019 / 2020.
•    Care in the Community, calibre of agency workers and loss of nursing staff.
o    There is an annual (nursing) turnover of nine to ten per cent, which is fairly stable and compares favourably with the national thirteen per cent figure. 
o    The Care in the Community internal Social Care Team has been in existence for ten years.  The Service is the NHS Internal Health Care Team made up of nurses, therapists and social workers. 
o    Northern Devon Healthcare NHS Trust is the prime provider for personal care across northern and mid Devon. The Domiciliary (social) care is provided by them through Devon Cares, with the Trust having successfully tendered for the role from DCC.  It commissions the agencies to organise care.  (The staff are paid for their travel to clients; the standards and rates of pay have been improved upon compared to the model prior to the Trust’s involvement).
•    How are savings to be made whilst still delivering services to patients?
o    Emphasis on Value for Money / most cost effective delivery.  Corporate Services review to stream line, standardise, best value procurement / equipment, Trust control panels for recruitment.
•    Delays in issue of medicines on Hospital discharge.
o    Recognised but remains a problem.  Introduction of more pharmacists has provided some improvement.
•    Concerns over addressing perceived unsatisfactory treatment received in the home.
o    Incident / complaint reporting system in place.
o    Importance of delivery of safe care:
    European Directives.
    Care Quality Commission.
    Training.
•    Doctors’ contracts.
o    The Trust does not insist on “opt out”.
    Highly motivated staff that go the extra mile.
    Staff provide pool of good ideas.
•    Personal experiences confirmed first class care.

Dr Diamond spoke about the North Devon Health Care Trust’s plan for delivering high quality and sustainable services that support health and well-being for the future.  It would be based on their successful starting position as one of the best performing Trusts in England but with the caveat that they had a responsibility to provide clinically and financially sustainable services.  It was noted that the acute services review confirmed the need for four sites (across Devon).

She highlighted the Trust’s priorities to deliver safe, high quality care, achieve the constitutional standards, within budget and work with partners to tackle inequalities.   
 
Dr Diamond stated that in 2017/18 the Trust will deliver access to “high-quality” services, seven days a week and will ensure that the waiting time for A&E will not exceed four hours.  (A&E services will see a £1 million investment.)   Provision for onsite urgent GP service in Emergency Departments will be made and there will be fundraising (launch 28 July 2018) for the cancer wellbeing centre (and support for families of sick patients).  The Stroke unit will see the co-locating of acute and rehabilitation (services).

Dr Diamond intimated that the Trust is looking to provide a better experience for patients and service users through a balance of health and social care.  She reaffirmed their work through Devon Cares that sees the Trust work with local providers to organise care.

She referred to working with partners, including One Ilfracombe, in delivering the social care in the Community and extended an invitation to work with One Bideford.

Dr Diamond praised the staff / workforce and referred to an event celebrating the work of nurses and midwives across the Trust that featured presentations from staff, who talked about new developments and shared innovative ideas that resulted in excellent patient care.

In seeking to achieve cost savings of £12 million in 2017/18 to maintain local services Dr Diamond concluded the presentation by declaring the Trust’s aim to:

•    Reduce waste.
•    Use resources more efficiently.
•    Be more productive.
•    Improve efficiency of outpatient departments and theatres in preparation for theatre upgrade (not a simple task).
•    Use buying power of NHS to save money.

c.   The Chairman thanked Dr Alison and her colleague for addressing the Meeting.

Councillor Howell invited Dr Diamond to return to the Council in twelve months’ time.


The business of the Extra Ordinary Meeting having been concluded the Mayor thanked the members for their attendance, at the meeting, which concluded at 7.32 pm.



























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