Agenda and minutes

Apologies for absence were received from Cllr Suzanne Williams, (substituted by Cllr Joe Harris).

The Chairman welcomed new and returning committee members to the meeting. Cllr Brian Oosthuysen to replace Cllr Eva Ward and Cllr Suzanne Williams (not present at the meeting) to replace Cllr Colin Hay.

To receive any declarations of interest.

Please see note (a) at the end of the agenda.

Cllr Stephen Andrews declared a personal interest as a Community First Responder with the South Western Ambulance Service NHS Foundation Trust.

To confirm the minutes of the meeting held on 13 November 2018

The minutes of the meeting held on 13 November 2018 were noted and signed as a correct record of that meeting.  

The following actions arising were noted: -

1.    Gloucestershire Safeguarding – a letter expressing the committee’s concerns about people being placed out of area had been sent to the Secretary of State;

2.    Visits to MASH (Multi Agency Safeguarding Hub) – members of the Health and Care Scrutiny Committee and Children and Families Scrutiny Committee were advised to contact Amie Moore, (Executive Support Assistant to Julie Miles, Head of Service for the Cheltenham Safeguarding and Assessment Teams), to arrange visits to the Multi Agency Safeguarding Hub located at Shire Hall, Gloucester. It was requested no more then 5 people visit at the same time

Proposed dates for visits included:

Wednesday 6 February from 2 pm until 3 pm

Thursday 14 February from 11 am until 12 pm

Wednesday 20 February from 2 pm until 3 pm

Thursday 28 February from 11 am until 12 pm

Wednesday 6 March from 2 pm until 3 pm

Thursday 14 March from 11 am until 12 pm

3.    Public Health Performance Report – a discussion on concerns regarding drug and alcohol performance will be made at the work planning meeting on Monday 28 January 2019;

4.    Members received a short update on concerns relating to cross border factors and continuing health care. Cllr Andrew Stephens stated that he had been notified of the person to contact to discuss the concerns but that a meeting had yet to be arranged.  

5.    It was confirmed that an additional scrutiny committee meeting would be held on 20 February 2019 for the committee to discuss the intention to pilot the proposed reconfiguration of General Surgery Services across Gloucestershire Royal Hospital and Cheltenham General Hospital. Members were requested to submit their comments in writing to the Chairman by Friday 18 January 2019. Any comments to be incorporated into an outline letter for discussion at the committee meeting on 20 February 2019. Subject to the agreement of the committee at this meeting, the letter would be sent to the Gloucestershire Hospital NHS Foundation Trust and GCCG Boards for consideration.

To note a petition presented to Gloucestershire County Council on 28 November 2018 relating to concerns about X-Ray services at the North Cotswolds Hospital, Moreton-in-Marsh.

The committee to receive an update on changes to the provision of radiographic services in the county.

Briefing Paper circulated 10 January 2019

The committee was asked to note a petition presented at the Gloucestershire County Council meeting on 28 November 2018 expressing concerns about the future of X-Ray services at the North Cotswolds Hospital in Moreton-in-Marsh.

It was explained that the petition relayed ‘grave concerns that the NHS acute trust would be reducing radiology services from around 30 hours to 8 hours per week. This could have significant repercussions for minor injuries involving breaks and fractures, which would require making travel arrangements to Cheltenham or Gloucester should the service be reduced. The petition sought to ‘maintain the current level of local X-Ray services and ensure that the North Cotswold Hospital continued to serve the residents of Moreton-in-Marsh and surrounding villages’.

Members were informed that, prior to presentation of the petition at the Gloucestershire County Council meeting, Cotswold District Councillor for Moreton West, Cllr Alison Coggins, and members of Moreton-in Marsh Town Council met with NHS officials on Monday 12 November 2018 to discuss the provision of X-Ray Services at the North Cotswolds Hospital.

Chairman, Cllr Carole Allaway Martin, reported that the petition, (presented to the County Council in November with a little over 5k signatures), had increased in recent weeks, totalling 7k signatures at the beginning of the January 2019, now totalling nearly 9k. She clarified that a large proportion of the signatories signing the petition since November 2018, lived out of County. She explained that, in essence, petitions should reflect issues impacting on members of the community who lived or worked in Gloucestershire. For this petition, however, it was accepted that the context of the issue reflected general concerns, both nationally and locally.

Members attention was drawn to section 7 (implementation update section) of a briefing paper considered at the Health and Care Overview and Scrutiny Committee (HCOSC) meeting on 13 November 2018, advising of the intention (by the Gloucestershire Hospitals NHS Foundation Trust) to introduce temporary changes to the provision of radiographic services across Gloucestershire.

At the committee meeting in November, members were informed that the key driver for the changes was the ‘unsustainable level of staff vacancies and the risk of jeopardising safe provision of specialist interventional radiology services provided at the 2 acute and 7 community hospitals in Gloucestershire’. Proposed changes to the service were developed on the basis of patient safety, patient experience and workforce impact, with an anticipated reduction in service hours across the County’s 7 community hospitals from 252 hours to 177 hours per week (30%).

Members had been informed that, whilst radiographic services in Gloucestershire were regarded as ‘high quality’, recruitment for the service was unable to keep pace with the levels of staff turnover, resulting in an unsustainable position whereby the Gloucestershire Hospital NHS Foundation Trust was unable to provide the full range of radiology services; nor maintain the safety of patients.

Noting that the shortage of radiographic staff reflected the current national position, it was reported that the situation in Gloucestershire was significantly more acute than elsewhere in the South West  ...  view the full minutes text for item 4.

To receive a presentation on Gloucestershire’s urgent and emergency mental health care services.  

The committee received a presentation from the 2gether NHS Foundation Trust on emergency mental health care services in Gloucestershire. Representatives from partner organisations ‘Kingfisher Treasure Seekers’ and ‘Swindon and Gloucestershire Mind’ were in attendance at the meeting.

Noting some of the initiatives emerging from the Gloucestershire Mental Health Crisis Care Continuous Action Plan, members commended the presentation. Acknowledging the commitment and dedication from organisations participating in the multi-agency partnership, the committee noted progress and the hard work being undertaken. With anticipated improvements from the extensive recruitment programme underway, the committee welcomed the opportunity for change.

Members received a summary of the initiatives and of the progress to date of the range of services and community involvement included in the four stages of the urgent and emergency mental health care model developed to support people back to their day-to-day life

The four areas included: -

i.      Providing support before crisis point

ii.    Urgent and emergency access to crisis care

iii.   Quality of treatment and care when in crisis

iv.   Recovery and staying well/preventing future crisis

Responding to questions, the Together NHS Foundation Trust endorsed the desire for earlier intervention as a means of preventing crisis situations and agreed the support provided before a crisis was of vital importance. The Trust confirmed its commitment to providing 100% support to young people with mental health issues and advised that Gloucestershire had been the first county to sign up to a Mental Health Crisis Care Continuous Action Plan.

A reoccurring message throughout the presentation was the significant amount of work being undertaken, the outcomes of which were achieved through a dedicated multi-agency effort, including police support. It was acknowledged that, whilst progress to date was favourable, there was no room for complacency. Systems of regular monitoring of progress had been introduced with encouraging multi-agency partnership involvement and evidence of attracting funds for further development.

Members were requested to visit a You Tube Video at the link below to gain a deeper understanding of some of the work being undertaken by the specialist areas that represented the core team of service providers of urgent and emergency access crisis care in Gloucestershire: -

https://www.youtube.com/watch?v=8PyEiH6ZHpw

It was announced that Gloucestershire’s annual results from the National Patient Survey had suggested the Together NHS Foundation Trust was delivering a good experience of service overall. It was hoped this positive message would extend people’s confidence of the efforts being invested in the whole system of mental health care in Gloucestershire. It was agreed ‘Gloucestershire was currently in a good position’.

The committee thanked Karl Gluck (Joint Commissioner); Jane Melton (Director of Engagement and Integration); John Campbell (Director of Service Delivery) and Les Trewin (Locality Director) for an informative presentation. Members also thanked those involved in the work and continuing development of the Multi Agency Mental Health Team.

To receive a presentation from the Director of Public Health

Sarah Scott, Director of Public Health at Gloucestershire County Council, presented the county’s third Public Health Annual Report. The focus of this year’s report was mental wellbeing. Following on from the previous years report and the emphasis on the health and wellbeing of children and young people, the Director gave a detailed presentation on the provision of timely and good quality treatment and support for people of all ages living with mental illness.

The annual report presentation included a detailed update on the actions being undertaken to improve Gloucestershire Mental Health Well-being. The Director of Public Health hoped the efforts being taken would assist in placing health on the wider spectrum of the Mental Health Movement.

Outlining the council’s movement to promote good mental wellbeing and prevent mental illness, it was confirmed 29 organisations had signed up to the ‘Gloucestershire Commitment’. Led by the Gloucestershire Health and Wellbeing Board, the movement is a countywide movement to promote good mental wellbeing and prevent mental illness. The aim of the campaign is to increase focus on the contributing factors of mental wellbeing; where people live, education, employment and social and community networks. Another aim was to assist organisations and communities recognise where improvements can be made to produce a positive impact on day to day wellbeing.

Taking a new approach to how health and social care services are delivered, (moving away from the historic perceptions of mental wellbeing), it was suggested that to focus on factors affecting a person’s day to day wellbeing would place individuals in a better position of keeping themselves well and less likely of hitting crisis point. Working in parallel with the work of the Gloucestershire Vision 2050 Programme, the intention was to adopt simple measures and to try to eradicate some of the stigma attached to mental health.

The committee welcomed the update with the majority of members commending the report and the decision to focus on a specific topic. It was announced that the topic selected as the theme for the 2019/20 report would focus on the influences of prosperity and links between wealth and health.

To consider more information on the work of the Mental Health Team, members were invited to visit the ‘positive actions for better mental wellbeing’ web page at the following link: www.gloucestershire.gov.uk/glow

An update on the progress of key programme and projects across Gloucestershire’s Integrated Care System

Mary Hutton, Accountable Officer for the Gloucestershire Clinical Commissioning Group (GCCG) gave an update on the progress of key programme and projects across Gloucestershire’s Integrated Care System (ICS).

Members received an update on the Enabling Active Communities Programme and development of the Gloucestershire Prevention and Shared Care Plan, (led by Public Health).

Some of the key priorities for 2018/19 included:

      i.        Aiming to reach a target of over 5,000 patients being on the National Diabetes Prevention Programme

    ii.        Appointing a GP Clinical Champion in Diabetes to further raise the profile of diabetic care in general practice (action completed)

   iii.        Commissioning a new Child Weight Management Service and implementing a new Adult Weight Management Service Model to support people to reduce their weight in a sustainable way

   iv.        Continuing to deliver an early identification and intervention model for victims of domestic abuse

    v.        Developing a Breastfeeding Social Marketing campaign

   vi.        Progressing the Gloucestershire Moves Project (striving to getting 30,000 inactive people active)

  vii.        Launching a new Gloucestershire Self-Management Education Programme called ‘Live Better, Feel Better’

viii.        Creating a direct route into the community wellbeing service from urgent care A&E

   ix.        Increasing the focus on supporting the following pathways with self-care and prevention schemes: Adult Mental Health; Paediatric Epilepsy; Paediatric Type 1 diabetes; Tier 3 obesity; Adult chronic pain and adult respiratory pathways

The committee received a detailed update on the work of the NHS Gloucestershire Clinical Commissioning Group (CCG) and partner organisations in improving services for people requiring palliative and end of life care. It was clarified that as a health and social care community, sustainable change and improvements were better realised when working in partnership and with shared vision.

The Gloucestershire End of Life Care Strategy had been developed, an important step towards making improvements. The strategy was developed with input from a wide range of people, including health and social care providers, voluntary sector, families and carers and outlined how the CCG aimed to take forward the development of palliative and end of life care services in Gloucestershire over the period 2016-2020.

To view the strategy, members were advised to access the following link:

https://www.gloucestershireccg.nhs.uk/wp-content/uploads/2012/03/End-of-Life-Strategy-FINAL-nov-2016.pdfv

Members were informed more research would be undertaken by the Integrated Locality Partnerships Board, with a report to the committee on Integrated Council Partnerships at a later meeting.

The committee noted the report. Noting the report, one member asked for more consistent use of language with less acronyms.

To consider a report from the Commissioning Director: Adults and DASS

Mark Branton, Deputy Director: Adult Social Care, introduced the Director of Adult Social Services Report. Responding to questions, the Deputy Director welcomed the opportunity to reassure members about the capabilities of the adult social care sector for Gloucestershire.

It was reported that existing carers’ support contracts were due to expire on 31 March 2019. To ensure continued services from April 2019 an open and transparent procurement process had been undertaken. The specification for the tender had been developed through extensive engagement with local carers and had taken into account local policies, strategies and national best practice. PeoplePlus had been awarded the Adult Services element of the contract. The council was now working with PeoplePlus in respect of mobilisation and implementation.

Responding to questions submitted prior to the meeting, the Deputy Director assured members that it had been accepted by Care Gloucestershire, (the previous contract provider), that the tender process for the new contract had been a fair and transparent process. It was explained that there had been concerns about the former care provider and that the concerns had been legitimate criticisms. The Deputy Director agreed to share the scoring criteria for the tender process with the committee. Action by – Mark Branton

The Deputy Director confirmed that the Adult Care Single Programme of Change, (introduced to modernise and transform Adult Social Care), was progressing at pace. The programme, (with over 80 projects), was on track to deliver a modern Adult Social Care fit for the next ten years.

The report was noted.

To note that an additional meeting of the Committee will be held on 20 February 2019.

The meeting to include consideration of Motion 825 - Protecting Gloucestershire Hospitals’ Walk in Services, considered at the Gloucestershire County Council meeting on 28 November 2018. (Motion attached).

At the Health and Care Scrutiny Committee on 13 November 2018, members agreed to holding an additional meeting to discuss the proposal around the General Surgery Reconfiguration Pilot. At the meeting, members had requested more detail on the pilot, including the benefits anticipated for both staff and patients, information on the implementation planning timeline, including decision points, and the frequency of updates to the committee going forward. Members had been informed that the committee formed the role of critical friend and could express views and concerns on the issue but did not have the power to make recommendations or seek action from the Secretary of State as the this was a reconfiguration pilot.

It was announced that an additional meeting would be held at Shire Hall on 20 February 2019. Arranged at the request of the committee, the meeting would be arranged to provide members with an opportunity to gain a better understanding of the proposal to ‘pilot the reconfiguration of General Surgery Services across Gloucestershire Royal Hospital and Cheltenham General Hospital’.

Members were requested to submit their views and any concerns on the proposals before the end of the week. The responses to be incorporated into a draft letter that would be used to form the structure of the discussion at the meeting on 20 February 2019. Subject to approval by the committee, the letter to be sent to the Gloucestershire Hospital NHS Foundation Trust and GCCG Boards for pre-consideration. 

It was agreed the additional meeting on 20 February 2019 would include a second item - Motion 825 ‘Protecting Gloucestershire Hospitals’ Walk in Services’. Motion 825 was debated at the Gloucestershire Full Council meeting on 28 November 2018, where it had been agreed to refer the outcomes of the discussion, (including the resolution below), to this committee for further discussion.

Motion 825 to Full Council – 28 November 2019

Council noted:

      i.        The value communities place upon the Accident and Emergency units, in both Gloucester and Cheltenham

    ii.        The enormous and varied contributions made by the seven minor injury units spread across Gloucestershire

   iii.        The great value communities across Gloucestershire place upon having hospital facilities close by.

The Council further noted that all Walk in Centres, Urgent Care Centres, and Minor Injury Units will be rebranded as Urgent Treatment Centres by the end of 2019, and

RESOLVED to write to the Gloucestershire Clinical Commissioning Group to appeal in the strongest possible terms, that none of the services currently on offer to walk-in patients at any of the nine hospitals be removed, and that Cheltenham General Hospital to not be further downgraded to an Urgent Treatment Centre from an Accident and Emergency department.

Full details of the minutes can be viewed at the following link:

http://glostext.gloucestershire.gov.uk/documents/g8885/Printed%20minutes%20Wednesday%2028-Nov-2018%2010.00%20County%20Council.pdf?T=1

Clarity on the context of the motion was questioned by the Chief Executive of the Gloucestershire Hospitals NHS Foundation Trust. It was explained that the motion would be considered in the context as that referred to the full council meeting on 28 November 2018,  ...  view the full minutes text for item 9.

A report from the Director of Public Health

Sarah Scott, Director of Public Health gave a detailed overview of some of the work undertaken by the Public Health Team at Gloucestershire County Council.

Referring to the success of the Action on ACE’s, (Adverse Childhood Experiences), Conference held on 8 November 2018, (involving members of the Children and Families Overview and Scrutiny Committee, elected members, senior executives from GCC, GCCG, GHNHSFT, the 2gether Trust, Police and representatives of voluntary and community groups), attention was drawn to the ACE’s Panel Roadshows planned for 23 January and 13 February 2019.

The committee noted that the screening of a ‘resilience’ documentary would be made at each of the roadshows, followed by discussion.  Directed by James Redford, the film considered the biological effects of the ACE’s Team and how professionals and communities could work together to overcome established harm. More information would be included in the council’s weekly Members Matter publication, including details of the screenings. Alternatively, members were encouraged to visit the ACE’s Gloucestershire website at www.actionaces.org.

The report was noted.

A report from the NHS Gloucestershire Clinical Commissioning Group (GCCG)

A detailed overview report detailing the work and activities of the NHS Gloucestershire Clinical Commissioning Group (CCG) was considered.  

Particular attention was made to the ‘No Show’ campaign launched in December 2018, encouraging people to cancel appointments when they are unable to attend. It was confirmed that more than 60,000 hospital appointments had been missed in Gloucestershire in 2018, along with 125,000 GP surgery appointments.

Members were advised to follow the campaign using the #NoShow on twitter and website at the following link: https://www.gloucestershireccg.nhs.uk/no-show-campaign-to-tackle-missedappointments/

Members attention was drawn to confirmation of the new non-emergency patient transport provider. The committee noted that, following a thorough procurement process, a new provider had been selected to provide non-emergency patient transport services in Gloucestershire. Subject to contract, patients with a non-emergency medical need who require help with transport to reach their hospital appointment will benefit from a dedicated service operated by E-zec Medical Transport Services.

The report was noted.