Agenda and minutes

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

Cllr Stephen Hirst declared a personal interest as a Trustee of Tetbury Hospital.

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

The minutes of the meeting held on Tuesday 6 June 2017 were agreed as a correct record and signed by the Chairman.

It was agreed that the committee would consider how to structure an item looking at a joined up approach at the point of delivery at its next work planning meeting.

The committee to receive a presentation on the outcomes of the STP engagement exercise.

12.1     The Associate Director, Engagement and Experience, presented the outcomes of the 12 week engagement exercise on the STP (November 2016 to February 2017), this included both quantitative and qualitative information. (For information - the presentation slides are available on the council website.)

12.2     The Gloucestershire Clinical Commissioning Group (GCCG) had wanted to test whether there was still support for the objectives of the Joining Up Your Care objectives. The message back from the general public included approval of a focus on prevention and self-care, difficulties in navigating a complex system, importance of treating the whole person, and better use of technology. It was noted that for the first time a significant amount of feedback related to the physical environment.

12.3     The STP Lead informed the committee that service change proposals were now being worked through the NHS England (NHSE) Assurance process. It was emphasised that any proposal coming through the STP would be driven by clinicians, and would receive robust challenge through the South West Clinical Senate. (Post meeting note: Clinical Senates came about through the Health and Social Care Act 2012 and were established to be a source of independent, strategic advice and guidance to commissioners and other stakeholders to assist them to make the best decisions about healthcare for the populations they represent.) Once through the NHSE Assurance process significant/substantial variation service change proposals would be received by this committee as a statutory consultee.

12.4     Some members felt that the number of responses (638 completed surveys) was relatively small, and suggested that this related to the lack of detail in the STP. It was acknowledged that it was expected that there would be a significant increase in responses once the proposals for change were put out to consultation. It was hoped that the consultation process would begin later this year. It was further acknowledged that in a rural county it was always a challenge to ensure that a wide range of stakeholders were engaged, but the GCCG were of the view that the engagement activity did cut across all parts of the county, was not just focused on Cheltenham and Gloucester, and were developing a ‘consultation road map’.

12.5     Members emphasised the importance of ensuring that any consultation/engagement was meaningful to the general public. Some members informed the committee that many of their constituents had felt that the engagement on the Minor Injuries and Illness Units (MIIUs) had been a ‘fait accompli’, and that it was important that going forward people did feel that they had a voice.

12.6     In response to a question it was explained that the GCCG did regularly engage with Patient Participation Groups (PPGs), and had an active PPG network.

12.7     Committee members questioned the potential impact of urgent care centres (UCCs) on MIIUs. It was explained that the proposal relating to UCCs was still being worked through and that the GCCG and Gloucestershire Care Services NHS Trust remained committed  ...  view the full minutes text for item 12.

13.1     The committee engaged in a detailed debate on this matter with the Director of Adult Social Services (DASS). Members agreed that the way in which members of staff and Cleeve Link carers had responded to this situation was to be commended, particularly the carers who had gone into work despite no longer being employed by the organisation.

13.2     The report described in detail the lessons learnt; despite this detail there remained a shared view and concern that signs had been missed. In response to questions members were assured that the Commercial Services team did have the necessary level of expertise in procurement and contract management, that the Finance Teams also had the necessary skill base and that if the situation required it additional expertise would be brought in.

13.3     In response to a question it was explained that the funding attached to contracts was sufficient to enable providers to pay the living wage; and that the contract specified that the council would wish to check that staff were being paid the living wage.

13.4     Members agreed that the best way in which to get underneath the CQC registration issues would be to discuss these with the CQC at the planned CQC workshop. The committee suggested that an LGA peer into this area of work review may be beneficial. However the committee was informed that a peer review was planned for 2018 and this suggestion would be taken forward when deciding the area to be covered by the peer review.

13.5     There was deep concern that the council was not aware of how unmanageable staff rotas were until the collapse of the company. This was a significant learning point for the council, and how to take this aspect forward in future contracts was important. However, it was explained that, due to the volume of complaints received, the council had been working closely with Cleeve Link and had managed to significantly improve this position when the company went into liquidation.

13.6     It was questioned how much this situation had cost the council? In response it was explained that it had been cost neutral as the council had not had to pay Cleeve Link. It was also questioned whether it would be more practicable to bring domiciliary care back in-house. It was explained that the council has not had an in-house service (apart from reablement) for many years, and that the national model was predominantly that of external provision. The volume of the domiciliary care market was such that it was important to have a mixed economy of provision; and that there was no national evidence to say that in-house provision was better or safer.

13.7     New performance boards have been established to facilitate greater understanding and challenge on performance in this area, and a senior officer was overseeing this work. The committee will be holding a performance workshop in the Autumn (once the new datasets were in place for adult social care) and would follow through on this matter  ...  view the full minutes text for item 13.

14.1     The committee noted that the CQC (follow up) Inspection of Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) had taken place and the committee would consider this inspection report in its CQC workshop. The CQC Inspection report had stated that there was no designated room for mental health practitioners to conduct mental health assessments within the emergency department at Cheltenham General Hospital (CGH), and it was questioned as to how the GHNHSFT intended to respond to this issue. The Chief Executive, GHNHSFT, informed the committee that the proportion of people who presented and needed this support was limited but that this did not mean that they should not receive care in a safe place. The GHNHSFT was currently bidding for capital funding to develop a secure area at CGH. In the meantime the GHNHSFT was looking at how it could better use the area in the emergency department.

14.2     It was questioned whether an Urgent Care Centre at CGH would be located at CGH. The STP Lead explained that the service proposal was still in development, had not been out to consultation and therefore she could not comment.

14.3     Members remained concerned with regard to the situation with the Minor Injury and Illness Units in the Stroud area. A briefing on this matter had been shared with committee members, and a significant issue was workforce resilience. It was important that the committee continued to monitor this issue, particularly as the proposals relating to urgent care centres were unknown at present. It will also need to consider the workforce stream of the STP to test out the principles supporting the work. Members requested that information on occasions when the MIIUs had had to close be included in the committee’s agenda packs for September 2017. Members also requested information on the salary structure, and whether there was a differential between Gloucestershire and Bristol, and whether this reflected the national position.

ACTION:        Katie Norton

14.4     In response to a question the Chief Executive, Gloucestershire Care Services NHS Trust, informed the committee that when planning the remedial works at Tewkesbury Community Hospital due consideration had been given to ensuring that the impact on patients and the wider system would be minimal. There has been positive feedback, so far, from both staff and patients.

14.5     The STP Lead assured the committee that the GCCG did work closely with neighbouring CCGs to ensure that they were aware of service change proposals coming through, and what the impact could be on Gloucestershire residents.

15.1     The Director of Public Health presented the report, which focused on mental health issues, to the committee. However, she did inform members that this report had in fact been received by the committee the previous year and had been submitted in error. The correct report would be shared with the committee.

ACTION:        Sarah Scott/Andrea Clarke

15.2     The DPH informed the committee that the recently published Public Health Outcomes showed that Gloucestershire was no longer an outlier with regard to death by suicide.

15.3     The committee was informed that the Prevention Concordat for Better Mental Health, which has been developed by Public Health England would be published soon. This would be received by the Gloucestershire Health and Wellbeing Board.

15.4     It was commented that despite the funding made available through the NHS England Five Year Forward View for Mental Health this was struggling to make its way through the system.

15.5     It was agreed that it would be helpful for the committee to receive the evaluation report on the evidence based preventative intervention work which aimed to reduce the incidence of eating disorders in young women who were at risk which had been trialled in four Gloucestershire schools.

ACTION:        Sarah Scott

16.1     The Director of Adult Social Services (DASS) gave a detailed presentation of the report.

16.2     A member drew the committee’s attention to an article in the local press that day regarding the CQC ratings for 4 care homes in Gloucestershire. Having been in meetings since 8am the DASS was unable to comment on the detail of the article and would follow up on this matter on her return to her office. She did, however, assure members that officers did monitor the care of GCC placements in care homes.

ACTION:        Margaret Willcox/Tina Reid