Agenda and minutes

The minutes were agreed as a correct record and signed by the Chairman.

It was noted that minute 35.4 (24 May 2011) indicated that information on the Ombudsman’s report on Care and Compassion would be included in the next report from the Chief Executive of NHS Gloucestershire (NHSG), but that this had not happened. It was explained that the report had not yet been approved by the NHSG Board but that it would be available to be circulated before the next meeting of the HCCOSC.

Cllr P Hall -        Member of the Royal College of Nursing, Gloucestershire LINk and 2gether NHS Foundation Trust

Cllr S Jeffery - Member of 2gether NHS Foundation Trust, Friend of Moreton Community Hospital

Cllr M Ogden - Retired member of the Royal College of Nursing

Cllr R Allen -      Winchcombe Day Care Foundation Member

Cllr R Apperley – SDC representative on Stroud League of Friends

The committee is asked to note the report from the Chair of the LINk Stewardship Board.

56.1     The committee was informed that the LINk had launched a new website and members were encouraged to try the site out and feedback any comments.

56.2     It was emphasised that the comments listed in the report related to the previous year (2010/2011). Members of the committee were interested to further understand the comments made around transport issues in the Forest of Dean and Cotswolds; and also whether comments about the out of hours service were positive or negative. The Chair of the LINk informed the committee that she would send further information to committee members.

ACTION:        Barbara Marshall

56.3     It was clarified that the issue relating to physical access to Winchcombe out-patients had been addressed.

56.4     Members of the committee indicted that they were happy to discuss any issues arising within their area with the LINk.

56.5     In response to a question the committee was informed that the LINk had regular meetings with providers and commissioners of services and that all comments received were fed into those meetings. The Chair of the LINk was clear that these comments did influence decisions on service development.

The committee to receive a verbal update on progress of the development of the community interest company which is due to ‘go live’ on 1 October 2011.

57.1     Jan Stubbings, Chief Executive NHSG, reminded the committee that the direction of travel from national government was for primary care trusts to cease direct provision of care services (Transforming Community Services). She also reminded members of the background and timeline of decisions that had led to the decision, by the NHSG Board, to form a social enterprise trust to deliver NHSG care services.

57.2     The Gloucestershire Care Services (GCS) board had originally been set up to provide the required separation (NHS Operating Framework 2008/09) between the commissioning and provision of services. By April 2009 it was required (NHS Operating Framework 2009/10) that provider services should be in a contractual relationship with their primary care trust which would provide separation from commissioning roles to avoid conflicts of interest.

57.3     In June 2010 the Department of Health published the Revision to NHS Operating Framework 2010/11, which stated that the separation of commissioning from provision remained a priority and should be achieved by April 2011. The NHS operating framework 2011/12 reiterated this priority making it clear that primary care trusts must divest themselves of these services.

57.4     Due to commercial sensitivity the NHSG Board discussion and decision with regard to the creation of a social enterprise trust had to be taken in confidential session (15 December 2010). On 24 December 2010 the GCS Integrated Business Plan was submitted to the NHS South West Strategic Health Authority (SHA).

57.5     The committee was also reminded that some services were transferred to the 2gether Trust and some to the Hospitals Trust.

57.6     Penny Harris, Chief Executive Designate, GCS Community Interest Company (GCS CIC), informed the committee that the social enterprise trust was being created in the form of a community interest company. The CIC would be providing NHS services free at the point of delivery. The company would be regulated by the Care Quality Commission (CQC). There would be both staff and community involvement.

57.7     The committee was informed that it was felt that the CIC has huge potential. It would be driven by its statement of social purpose which was about delivering responsive care in a timely manner and was seen as the best option for joining up health and social care.

57.8     When the company became operational every member of staff would become a shareholder (cost 1p). The CIC would also be encouraging community membership.

57.9     The committee heard that the objectives of the CIC were: -

Þ            To expand community based services, focussing on the needs of service users

Þ            To invest in staff development and also involve staff in decision making. Staff members have already been involved in electing a non-executive director, choosing the company logo and commenting on objectives.

Þ            To develop relationships/partnerships within the community, and with other providers.

Þ            To provide joined up services across health and social care. The CIC was a non profit making organisation, any surplus would be reinvested in services for the community.

Þ            To improve the quality  ...  view the full minutes text for item 57.

The Committee to be updated on issues arising in the health community.

58.1     Concern was expressed that the six NHS bed unit at Cleeve LINk Nursing Home was under threat, however it was clarified, by the CEO NHSG, that this was not the case.

58.2     In response to a question it was agreed that a tour of the new community hospital facility at Moreton would be arranged in due course, subject to health and safety approval.

ACTION:        Becky Parish

58.3     The question was asked as to the progress with regards to the establishment of national Trauma Networks. It was explained that the timeline was being driven by the Strategic Health Authority (SHA). It was anticipated that more information would be available at the scheduled meeting of the NHS reference Group in December 2011 and to the full committee membership in January 2012.

58.4     A member informed the committee that there had been some consternation expressed locally with regard to the potential for there to be a new community hospital build for Stroud and the fact that monies invested in the current facility by the Stroud League of Friends would be irrecoverable. He also commented that the NHS had also undertaken investment in the operating theatre at the current facility. He indicated that that reassurance was sought that there would be no reduction in beds at a new facility. The CEO NHSG informed the committee that this issue also involved the relocation of some GP practices. A full options appraisal would be necessary before any final decision was made. The committee was reminded that the model of care now was more about people receiving care in their own homes and community settings – this has previously been discussed by the committee. It was clarified that the ‘Stroud and Swindon’ Building Society site was not an option for a future build site for a new hospital.

58.5     The Chairman commented that if there was a document that discussed the proposals around the refurbishment of community hospitals that it could help with members of the public’s understanding of this issue. It was noted that there was an overarching strategy document which had been received by this committee. However given the cost of new builds it was difficult to plot an exact timeline. It was important to understand that there comes a point when the balance of the cost of supporting an old building against the cost of a new build has to be given serious consideration. Within the context of limited availability of capital funding this was an important discussion.

58.6     The Chairman commented that it would be important for the committee to refresh itself on the models of care. However the committee was informed that the health community in Gloucestershire needed to map out the provision across the county. This task would start soon. It would be good to try and get an understanding of what health provision in the county would look like in 5 years time. The Chairman expressed the view that it was important that the principles of heath care in  ...  view the full minutes text for item 58.

The committee to consider whether it is satisfied that performance is on track and if not that robust plans are in place to address the situation.

59.1     It was noted that the ambulance response times were still slightly underachieving. The committee was also informed that the BBC had reported that the cost of a 999 call to the Great Western Ambulance Service (GWAS) was twice that of other ambulance services. This issue and the performance issues would be discussed at the next GWAS Joint Scrutiny Committee meeting in October 2011.

59.2     The committee welcomed the news that the Telehealth project had started.

59.3     It was commented that it was good to note the downward trend in the number of admissions and it was asked if it was possible to identify if there was a particular reason for this. It was explained that it was difficult to isolate which particular action was making the most difference. It was hoped that each initiative was adding to the collective whole to make an overall difference to the large volume of admissions though A and E. It was questioned whether this could evolve into a useful indicator for the committee, potentially having the ability to demonstrate whether the new model of care with community based support was making a difference. It was noted that NHSG did compare favourably at the national level with regard to performance in his area.

59.4     With regard to the independent sector treatment centre it was asked whether, given that this is performing below planned levels, people were being encouraged to attend this facility. The committee was informed that people were being encouraged but it did of course come down to patient choice.

The committee to receive a briefing of the key issues from the past six months and a look forward to the second half of 2011/12.

60.1     Dr Harsent, Chief Executive Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT), informed the committee that the unscheduled care pathway (previously known as the Utopia project) had won a national award. The committee welcomed this news. Dr Harsent also indicated that the data demonstrating that this type of pathway worked had been shared with Professor Matthew Cooke, National Clinical Director for Emergency and Urgent Care.

60.2     In response to a question regarding maternity services the committee was informed that the GHNHSFT were committed to having a portfolio of care providing a range of choices to women. It was noted that the GHNHSFT were not currently experiencing any issues appointing midwives (in contrast to the national picture).

60.3     The committee was informed that the GHNHSFT had found the unannounced visits from the Care Quality Commission (CQC) to be very positive experiences. The GHNHSFT felt that these inspections were very helpful in identifying potential learning opportunities. They were also seen as good for the public who could be reassured by the outcomes. It was also felt that it was very good for staff members to be recognised for their good work.

60.4     It was questioned as to how the GHNHSFT knew that the multi storey car park had made a positive difference. It was explained that the number of complaints had dropped, and members of staff had sent emails thanking the Board for this development.

60.5     It was questioned as to how the GHNHSFT intended to be assertive with staff with regard to winter planning. Dr Harsent provided the committee with a an overview of the planned programme to make it easy for all frontline to receive the flu vaccination by providing opportunities within the workplace and by senior clinicians leading by example.

The committee is asked to note the report from the Director of Public Health.

61.1     A member asked what work was being undertaken with regard to the increase in the number of people diagnosed with AIDS (nationally?). It was explained that work was being undertaken with the health protection agency to develop a blood borne plan for the county.

61.2     It was noted that the number of people diagnosed with skin cancer in the county was above the national average and whether there was a particular reason? The committee was informed that malignant melanoma was the most serious form of skin cancer. It was a disease that was almost entirely preventable. The main risk factor was exposure to ultraviolet radiation from the sun, or from sun beds. The rate of new cases in Gloucestershire was significantly higher than the England rate. Like most cancers, skin cancer was more common with increasing age, but malignant melanoma was disproportionately high in younger people.  Malignant melanoma was almost twice as common in young women (up to 34) as in young men, but more men die from it.  This was a local Public Health priority and NHS Gloucestershire ran a campaign this summer to encourage people to enjoy the sun safely. Radio adverts ran through the school holidays reminding people to use shade, clothing, and at least SPF 15 sunscreen to protect themselves and their families from sun damage.

61.3     Members were also interested to understand why the number of pregnant women smoking was higher in Gloucestershire. It was explained that the figures were slightly higher that the national average. A lot of work was being undertaken with midwives to try and reduce this number.

61.4     In response to a question regarding the number of people diagnosed with breast cancer it was acknowledged that there was a relationship with areas of deprivation, although there were a number of factors involved.

62.1     Cllr Gravells, Cabinet Member for Health and Wellbeing, informed the committee that the portfolios of cabinet members had been redesigned to align them with the direction of travel for the county council. This had resulted in the fact that there were now three cabinet portfolios that covered the remit of the committee. (These (three) cabinet members would take turns in attending committee meetings.) Cllr Gravells’ portfolio related to health and wellbeing and was focused primarily on the prevention agenda. (Further information on cabinet posts could be located from this link http://glostext.gloucestershire.gov.uk/mgCommitteeDetails.aspx?ID=117)

62.2     In response to a question it was noted that the assessment of blue badges would be undertaken by occupational therapy, and that an appeals process was in place.

62.3     The Chairman commented that the committee should ensure that prevention was a theme throughout its work. Cllr Gravells informed members that he looked forward to working with the committee.

The committee to consider whether it is satisfied that performance is on track and if not that robust plans are in place to address the situation.

63.1     The committee welcomed the improvements to the report.

63.2     The committee was reminded that there was a programme of change underway which centred more on the prevention agenda, and therefore diverting people away from the need for long term care. The council and partners were looking more at a hub and spoke model which involved more provision in the community. The intention was that this would mean that people did not reach a crisis of care later in their life. Work on assessments was an important part of this work as if we were unable to respond quickly then people had the potential to reach a crisis.

63.3     It was explained that enablement was about getting someone back to where they were before ‘the incident’ had disabled them. It could also be about teaching life skills, for example when there had been a bereavement. For many people this would be a targeted 6 week intervention.

63.4     It was noted that the Fire and Rescue Service were in the process of developing new Fire Stations which included life skills centres and it was questioned whether there were opportunities for adult social care to make use of these facilities. The committee was informed that officers were discussing the potential for people with learning disabilities to attend these centres.

63.5     In response to a question regarding NI130 it was explained that all people assessed were receiving an individual budget, but that the number that were choosing to convert this into direct payments had not substantially changed. Work was needed to ensure that the assessment process was about ensuring that the individual understood the personalisation agenda and was given the opportunity to have more control over their individual budget.

63.6     With regard to the pending list this related to those people waiting on an assessment. However it was important to note that some people would have asked for a review of their care needs and therefore this did not relate completely too new assessments. In some cases people were waiting for a piece of equipment. It was expected that the pending list would be addressed by December 2011.

63.7     Members of the committee were concerned with performance relating to delayed transfer of care (DTOC). It was explained that one of the particular difficulties in this area was that the definition that the GHNHSFT was required to report to the NHS on was different to the definition that GCC adult care were required to report on. It was agreed that this was a somewhat farcical situation. The committee was informed that the GHNHSFT and Adult Care were working together to try to clarify the real position. It was questioned whether the creation of the social enterprise organisation would help to reduce this overlap but it was explained that this was not the case.

63.8     The committee was informed that although we were not in a position to redefine this indicator (DTOC) it was possible for GCC and the GHNHSFT to find a way to  ...  view the full minutes text for item 63.

64.1     Cllr Chris Pallet, Chairman of the task group, introduced the report. He reminded the committee that this task group had been set up jointly with the Budget and Performance Overview and Scrutiny committee. The task group had investigated: -

Þ       Why the external care packages budget has consistently overspent in recent years,

Þ       How effective were the steps that have already been taken to address this problem, specifically the establishment of locality funding panels

Þ       What more needed to be done.

64.2     It was important to drill down and understand the underlying issues and what was being done to address the overspending in this area (£9.5m overspend 09/10, £5.7m 10/11, £4m forecast for 11/12) as this budget alone makes up 22% of the total GCC budget.

64.3     Cllr Pallet informed members that there has already been substantial progress in bringing this budget under control. There were now robust processes for controlling and monitoring expenditure, and internal audit have been commissioned to undertake work in order that there was a better understanding of outstanding problems.

64.4     Cllr Pallet took this opportunity to thank the elected members on the task group, and also all the officers that had worked with the task group.

64.5     Cllr Pallet recommended that the committee kept a close look at progress in this area in order to ensure that the work to reduce the overspend maintained its momentum.

64.6     Cllr Gravells, Cabinet Member Health and Wellbeing, thanked the task group for this report. He informed the committee that he had been able to attend some of the meetings and had learned a great deal. He agreed with Cllr Pallet that it would be important to ensure that this work continued to move forward.

64.7     The Chairman thanked the task group for its work and welcomed the report. With the committee’s agreement this issue would be added to the committee’s agenda for a review in six months.

Members are asked to note the following items from the Gloucestershire Safeguarding Adults Board and identify any risks which they feel should be

monitored:

• Annual Report 2010/11

• Business Plan 2011-2014

65.1     Helen Godfrey, Head of Safeguarding Adults, and Roger Clayton, Independent Chair Gloucestershire Safeguarding Adults Board, presented this annual report. They drew member’s attention to the three year business plan that was attached to the report.

65.2     The committee was informed that the Board had been in place for two years. Policies and procedures were in place to safeguard vulnerable adults. There were also strong performance management and audit controls in place. Strong relationships had been developed with the other boards in the county - children’s safeguarding, domestic abuse and MAPPA (multi agency protection arrangements).

65.3     The committee heard that although there was no legal requirement to attend board meetings attendance was high. There was a memorandum of understanding between all agencies involved with the Board. The Board was rapidly developing an engagement process with users, carers and professionals.

65.4     In response to a question it was clarified that the priorities identified within the report had been arrived at in agreement with partners. Strong links were also in place with the Gloucestershire Public Protection Bureau which shared information on cases which enabled the potential for earlier identification of vulnerable adults who could be at risk.

65.5     The committee was informed that the prevention strategy was a national agenda, and was an essential part of the Board’s work. Members also heard that a proactive approach was taken to issues of domestic abuse – several initiatives had been taken from the Duluth Model (which has been recognised as the leading tool for helping communities eliminate violence in the lives of women and children http://www.theduluthmodel.org/).

65.6     Members were interested in how alerts were managed. The recent Panorama programme whereby an alert had been raised with the CQC rather than the local authority was mentioned and members wanted to understand the reporting stream. It was clarified that all alerts have to be reported to the Department of Health. These alerts could be raised by a range of agencies and members of the public. Where they were raised through agencies, they would always be shared with the Board. The process for managing alerts was clearly defined, with clear standards set for decision timelines. The committee was also informed that following the Panorama programme the Board had commissioned a piece of work to ascertain whether there were similar issues in Gloucestershire. It was expected that the completed report would be available in December 2011 (this would be a public report).

65.7     The Chairman commented that protecting vulnerable adults was an important issue and one that the committee should closely monitor. He welcomed input from Roger Clayton and Helen Godfrey at future committee work planning sessions. He suggested that future reports might benefit from more information about outcomes.

The committee is asked to note this report.

66.1     Colin Davies, Complaints Manager Adult Services, informed the committee that there had been a significant increase in the number of complaints received, and a decrease in the number of compliments. There had also been an increase in referrals to the local government ombudsman.

66.2     The Chairman commented that the report would benefit from moving the learning from complaints section to the front of the report. It was felt that information on how complaints had generated change in service delivery would also be helpful, as it would be good to be able to see ‘cause and effect’.

66.3     It was noted that some areas were not reporting the same level of complaints as others. It was explained that despite best efforts there was still inconsistency in reporting coming through from managers, and that it was difficult to be able to draw through all the necessary data.

66.4     It was noted that this was a valuable activity as it was important to expose how this information could improve service delivery.

The committee agreed to delegate the committee report to the Chairman.