Agenda and minutes

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

Cllr Stephen Hirst declared a personal interest as a Chair 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 12 September 2017 were agreed as a correct record and signed by the Chairman.

The committee to receive the Gloucestershire Safeguarding Adults Board (GSAB) Annual Report 2016/17.

The committee will also receive a presentation of an adult safeguarding review on self-neglect.  

19.1     The committee was pleased to welcome the Independent Chair of the Gloucestershire Safeguarding Adults Board (GSAB), and the Interim Head of Adult Safeguarding to the meeting to discuss this important matter with members. The Independent Chair presented the GSAB Annual Report 2016/17 and the GSAB Strategic Plan. He highlighted that a significant challenge going forward related to the risks associated with social isolation, hoarding and self-neglect.

19.2     The Interim Head of Adult Safeguarding gave a detailed presentation of a safeguarding adult review of a self-neglect case where decisions made by the individual, John, had led to a life threatening situation. It was emphasised that a significant challenge in this case, and many others, was that when an individual had the mental capacity to make their own decisions (even though others might think that they were the wrong decisions) their right to do so must be respected; and this right was enshrined in law. In this particular case the only point at which John lost that ability was when he became unconscious and family members present made the decision to call 999.  

19.3     John survived the situation and participated in the review of his case; he does not apportion blame to any agencies. The review did highlight learning opportunities including raising awareness of safeguarding issues with private housing landlords. The committee was pleased to note that after a long period of rehabilitation John was doing well, and welcomed the information that he was happy to work with the GSAB to help improve awareness of self-neglect issues.

19.4     This review prompted a lot of debate and concern. Members welcomed the work that the GSAB was doing to try and reach vulnerable adults, and that it was working closely with the voluntary sector and the Gloucestershire Fire and Rescue Service (GFRS) through the Safe and Well visits, to try and make contact with isolated individuals. It was acknowledged that some people did not wish to be in contact or contacted by social care; this was why it was important to utilise partner agencies, GFRS in particular, to help overcome this reluctance.

19.5     It was questioned whether there was an urban/rural split as many properties in the rural areas of the county were isolated. The Independent Chair informed the committee that the GSAB was aware of this aspect and worked closely with the VCS to try and reach these people.

19.6     This review raised the question of the right of entry to a property. It was explained that the GSAB has collated together the powers of all partner agencies for ease of reference when situations such as these arose. An information pack relating to hoarding behaviour was also available to partner agencies. It was commented that it might be helpful for elected members to see this pack. The Independent Chair agreed to take this request back to the fire safety sub group.

ACTION:        Sarah Jasper/Paul Yeatman

19.7     A question was asked relating to the additional £400k allocated to learning disabilities during  ...  view the full minutes text for item 19.

The committee to receive a presentation describing the consultation proposals.

20.1   The committee was aware that the work to identify health needs in the Forest of Dean area and develop proposals had started two years ago, and was therefore pleased that consultation on the way forward was now beginning.

20.2   The committee received a detailed presentation from the Chef Executive of Gloucestershire Care Services NHS Trust on the proposal. Given that there were people resident in Gloucestershire but registered with a Welsh GP members agreed that it was reassuring to hear that GPs in the Monmouth and Chepstow area were aware of this proposal and information would be available in their surgeries.

20.3   In response to a question it was explained that although it was clear in the consultation that there was a preferred option this did not mean that concerns/issues raised in the consultation period would not be listened to. The Trust wanted to have an open and honest conversation with people. Members were also informed that there was strong support for the consultation from both the Dilke and Lydney Hospitals Leagues of Friends.

20.4   It was commented that there should be a greater emphasis on wider transport factors, not just a reliance on private transport, within the consultation. This was acknowledged, and the committee was informed that there was a good community transport service in the Forest of Dean area and it was hoped that the Trust and NHS Gloucestershire Clinical Commissioning Group (GCCG) would be working more closely with this service in the future.

20.5   Committee members were aware that the GCCG has already undertaken a lot of work with Forest of Dean communities, and felt that the level of consultation activity proposed should reach most people. The GCCG would also be utilising social media.

20.6   The committee agreed that it could support this proposal going out to consultation; and would receive the outcome of this consultation at its meeting in January 2018.

21.1     In September 2016 the Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) announced an unexpected and significant deterioration in its financial position. As a consequence of this, the GHNHSFT Board (in partnership with its regulator NHS Improvement), commissioned an independent review into the circumstances that contributed both to the financial decline and the fact that it had gone unreported for such a significant period of time. The report by Deloitte was published on 7 July 2017.

21.2     The Chair of GHNHSFT gave a detailed presentation of the activity undertaken by Deloitte during the investigation and brought the committee up to date with progress against the report’s recommendations, in particular the work to strengthen governance and finance reporting. There was a concern with regard to the potential impact on services, but it was explained that as GHNSFT was commissioned by the GCCG to provide specific services it must deliver them.

21.3     In response to questions the Chief Executive agreed that the new appointments at Director and Non- Executive level did mean that there was in effect a new leadership team with the challenge of delivering rapid change. She was confident that this could be achieved. Both the Chief Executive and Chair felt that there was now more and better challenge at Board level, and invited committee members to observe future public Board meetings.

21.4     It was acknowledged that there has been a lot of anger and frustration across the county with regard to how the GHNHSFT had arrived at this position. The speed with which the Chief Executive had addressed this situation was welcomed as was the work to improve transparency across the governance process. In response to a question it was explained that if appropriate, staff had been referred to the relevant professional regulatory body.

21.5     The committee was pleased to note that the learning opportunities from this review have been shared with STP partners; and that NHS Improvement was also using this experience when working with other NHS Trusts. The committee would continue to closely monitor this situation.

The committee to engage with the consultation.

22.1     The committee welcomed the opportunity to be both informed about the Public Health Nursing Services (PHNS) and to also participate in this consultation. The committee noted that the council was responsible for commissioning Health Visiting services for families expecting a baby until the child turned 5 years and also a School Nursing service for children aged 5 to 19 years. The PHNS were delivered by Gloucestershire Care Services NHS Trust (GCSNHST).

22.2     The committee was informed that in December 2016, the Cabinet had approved a remodelling of the PHNS to bring Health visiting and school nursing together into a single service for children and their families from pre-birth to age 19, which would provide specific support at key developmental stages in a child’s life.

22.3     The committee received a detailed presentation outlining the proposals. Members welcomed this consultation and in the main agreed that the direction of travel was appropriate. Members recognised that this service presented a good opportunity to identify safeguarding concerns and asked that care was taken that this aspect was not diminished.

22.4     The committee was pleased to note that funding had been received to enable the development of a perinatal mental health service. The importance of appropriate mental health support throughout the life journey was raised and it was agreed that the Future in Mind Transformation Plan programme of work be included in the committee’s work plan.

ACTION:        Andrea Clarke

22.5     Members shared some anecdotal evidence regarding the transition period from midwife to health visitor. The Director of Public Health asked members to encourage people to report these matters as they happened so that they could be addressed.

22.6     The committee would be interested to see the outcome of this consultation.

The committee noted the report.

The committee noted the report.

25.1     The Accountable Officer informed the committee that the GCCG would be bringing an item on the Non Emergency Patient Transport Service to a future committee meeting. Work was currently in place with the other CCGs in this contract looking at eligibility criteria.

25.2     In response to a question the committee agreed that this was a useful report and welcomed the level of information contained within it.

25.3     The committee agreed that a briefing on the benefits of the NHS111 and Out of Hours Service being delivered by the same provider, and how these services were performing would be welcome.

ACTION:        Becky Parish

25.4     Members were aware of significant housing developments within the county and questioned whether discussions were already in progress with regard to the provision of primary care services in these areas. The committee was reminded that within the STP there was an estates strategy, led by the county council, which would be addressing these matters.