Agenda and minutes

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

Cllr Roger Wilson declared a personal interest as a Governor of the 2gether NHS Foundation Trust; and as a Trustee of the Gloucestershire Rural Community Council which hosts Healthwatch Gloucestershire.

Cllr Brian Oosthuysen declared a personal interest as a Governor of the Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT).

The committee to receive the minutes of the meetings held on 15 December 2016 and 10 January 2017.

77.1     The minutes of the meeting held on Thursday 15 December 2016, and Tuesday 10 January 2017 were agreed as correct records of those meetings and signed by the Chairman.

77.2     Cleeve Link Update

77.2.1  In light of the closure, last week, of Cleeve Link, one of the council’s home care providers, the Chairman asked the Commissioning Director Adult Social Care to update the meeting on the current position.

77.2.2  The Director informed the committee that thanks to the goodwill, and commitment, of the Cleeve Link staff, there was a continuation of care to customers following the closure. This was particularly impressive given that many of these staff members had not received payment for some weeks. Over the weekend the council had supported these staff by providing free petrol/diesel (via the Gloucestershire Fire and Rescue Service) and food; and had subsequently arranged for advances to those people who have not been paid.

77.2.3  Members were pleased to note that officers were working, with other providers, to ensure that these vulnerable people continued to receive their care in the long term; and that the council was also supporting self-funders through this process.

77.2.4  There were questions as to whether the council should have been aware of this position earlier and also why did the council not know. The committee was assured that due diligence had been undertaken at the time of the contract being awarded to Cleeve Link. The original owner had sold the business to Primus Medical last year, and following a restructure Primus then decided to sell this part of the business this year. It was sold to a third party on 16 February 2017. The council had been informed that this sale would go alongside a capital injection, but this ultimately did not happen. The committee was reminded that it was the CQC’s decision as to the registration of a business; and it was the responsibility of the owner to inform the CQC of their decision to enter into voluntary liquidation.

77.2.5  The committee agreed that, whilst this was an unfortunate situation, it was good to see that all partners across the health and social care landscape in Gloucestershire had come together to ensure that these vulnerable people were safe and supported. The committee would revisit this issue in the new council.

78.1     The committee was pleased to welcome the Chief Executive and Chair of GHNHSFT to the meeting. The Chief Executive apologised that she was not able to present the findings of the financial governance review at this meeting as originally planned. Whilst the committee was frustrated with the delay, members acknowledged that the cause was not of the Trust’s making. The report would not now be able to be received by the committee until the new council.

78.2     The committee engaged in a robust and detailed discussion of the Trust’s current financial position and the recovery plan. The Trust planned to return to a breakeven financial position at the end of March 2019. The committee was, of course, concerned as to the potential impact of the Trust’s financial situation on services. The committee was reminded that in the NHS the funding followed the patient and therefore there was no incentive for the Trust to stop providing services. However that was not to say that the Trust would not be looking for opportunities to do things differently/better; and the Gloucestershire Clinical Commissioning Group (GCCG) reminded the committee that the direction of travel described in the Sustainability and Transformation Plan (STP) (self-care, prevention) would affect some services, but emphasised that this was about ensuring the best level of care for the people of Gloucestershire, within the current funding climate.

78.3     The committee commented that a significant factor in achieving the recovery plan was the engagement and willingness of staff to buy in to this process. It was felt that previously there had been some challenges with regard to the working culture at the Trust, and that this would need to be addressed. The Chair of the Trust informed the committee that there needed to be a culture of openness, and that this needed to start at the top of the organisation. He felt that the level of challenge at Board meetings between the Trust’s Non-Executive Directors and the Directors demonstrated that the culture change was already in progress.

78.4     In response to a question it was clarified that the ‘must do’ actions identified in the CQC Inspection Report (June 2015) have all been delivered, bar two which were ongoing. A follow up inspection by the CQC has recently been undertaken and the report was expected to be published in April/May 2017. This activity was separate to the actions in the recovery plan. This was also the case for any service changes that might come through the STP; these would be distinct from the recovery plan.

79.1     The committee was pleased to welcome the SWASFT Director of Operations to the meeting. The Director gave a presentation updating the committee on the Ambulance Response Programme (ARP), staff rota changes and the re-profiling of vehicles in Gloucestershire (for information the presentation slides were uploaded to the council website and included in the minute book).

79.2     The committee was informed that the additional time available under the ARP to triage calls has meant better identification of which calls required an 8 minute response, and the despatch of the clinically appropriate vehicle rather than the nearest. Sheffield University has undertaken a review of the ARP and the final report was in the process of being prepared. It was important to note that if the ARP report was to recommend a permanent change to the target framework, and this was approved by the Secretary of State for Health, this would require Parliamentary approval.

79.3     The committee was informed that SWASFT has been consulting staff on changes to the working rota. The consultation in the North Division (which included Gloucestershire) was complete and the changes would be implemented in April 2017. The changes were to ensure that there were the right number of staff on at the right time and in the right place, to better manage peak demands. Alongside this there was a re-profiling of vehicles in Gloucestershire. This would mean that there would be 16 more double crewed ambulances (DCAs) in Gloucestershire with a reduction in the number of rapid response vehicles. This re-profiling has been undertaken to better meet demand. SWASFT continued to work with the GCCG on demand management.

79.4     Committee members agreed that the role of the Community First Responder (CFR) was an important factor in the delivery of emergency response times, and it was important to ensure that they remained engaged with service. Members were pleased to note that, in Devon, SWASFT was piloting using CFRs to respond to calls relating to falls. If the evaluation of this pilot was positive members would wish to know if SWASFT would be implementing this across the region. Members were also interested to note that SWASFT continued to work with the Gloucestershire Fire and Rescue Service (GFRS) to identify other areas where the GFRS could support SWASFT.

79.5     In response to a question it was explained that SWASFT did collect data on how many times CFRs responded to calls. It was agreed that this information would be shared with committee members.

ACTION:        Neil le Chevalier

79.6     It was explained that the increase in the number of double crewed ambulances (DCA), particularly in the rural areas, meant that patients would be taken to hospital more quickly as they would negate the need to wait for another vehicle, as happens when a rapid response vehicle (RRV) was the initial call out vehicle.

79.7     In response to questions it was explained that at present SWASFT was performing well in Gloucestershire on category 1  ...  view the full minutes text for item 79.

A briefing on Non Emergency Patient Transport Services will be sent to committee members separately.

80.1     The committee was joined by the Managing Director, Head of Patient Transport Services South, Locality Manager Gloucestershire, and Communications and Engagement Manager from Arriva Transport Solutions Ltd (ATSL) the provider of the Non Emergency Transport Service.

80.2     Committee members were aware that performance against targets continued to present a mixed picture. However this position was reflected across the country which suggested that some of the problems were systemic rather than local or specific to any particular provider. It was important to note that nationally providers were leaving this market; and that the service was funded on a very tight margin.

80.3     The committee was reminded that ATSL have been subject to an unannounced inspection by the CQC. The Managing Director informed members that ATSL welcomed the inspection and were pleased with the outcome. An action plan was in place to take forward the recommendations from the inspection.

80.4     The briefing provided to committee members identified the significant challenges to the service. Members were disappointed to note that a significant number of aborted journeys resulted from patients cancelling their hospital appointment but not their transport, or making their own way to the hospital but again not cancelling their transport. The committee was informed that a text reminder service was being introduced this month and it was hoped that this would help to reduce these wasted journeys. It was agreed that better communication with patients was needed to ensure that they understood the importance of cancelling their transport if it was not required. ATSL also intended to hold a workshop with the GHNHSFT and this would include the impact of aborted journeys on the system. Members hoped that this activity would have a positive impact; but did feel that it would be more productive if the system was more joined up.

80.5     Members remained concerned with regard to the performance data; and also discussed how the hospital discharge process could impact on this service.

80.6     The committee would continue to monitor progress.

81.1     The committee noted the report.

81.2     The committee was aware that that as of 1 April 2017 a new organisation would be providing the Healthwatch service in Gloucestershire. The Chairman thanked the current provider for the work undertaken over the last 4 years to support the people of Gloucestershire, and for the informative reports to this committee.

The committee noted the report.

83.1     The committee applauded the ambition for Gloucestershire to become the most physically active county in the country; and members gave their support to the Gloucestershire Moves project.

83.2     Cllr Roger Wilson declared a personal interest as a county council appointed member of the Cotswold AONB Conservation Board. He informed the committee that the AONB has been trying to become involved with ‘health walks’ but as yet has not had any success. The Director of Public Health agreed that she would feed this back to the appropriate body.

84.1     The Accountable Officer informed the committee that the GCCG was in the process of writing the STP Engagement Outcome Report; the GCCG had received good feedback from members of the public.

84.2     A member referred to a survey of NHS Commissioners with regard to STPs which indicated that 52% of STP areas were planning to downgrade A & E provision; the detail of Gloucestershire’s STP was still not clear. The member asked the Accountable Officer to comment. The Accountable Officer informed the committee that she was not aware of this survey, and could not comment on this data as she did not know its provenance. She assured the committee that any significant service changes would be formally consulted on as they were identified.

84.3     In response to a question with regard to the tender for the provision of community connectors (VCAs and Social Prescribing) the Accountable Officer informed the committee that specification was close to completion and would be going out to tender soon.

84.4     The Chairman congratulated the Gloucestershire Hospitals NHS Foundation Trust on achieving Leader status under the government’s ‘Disability Confident’ employer scheme.

84.5     The Chairman also congratulated the 2Gether NHS Foundation Trust on being rated as one of the top two mental health trusts in the country, based on service users ratings in the National Community Mental Health Patient Survey (Adults) 2016.