Agenda and minutes

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

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

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

Cllr Carole Allaway Martin declared a personal interest as she is a member of the Royal College of Nursing.

The minutes of the meeting held on Tuesday 8 March 2018 were agreed as a correct record and signed by the Chairman.

The committee to receive a presentation.

24.1     The committee was pleased to welcome the Managing Director and National Head of Service Development from Arriva Transport Solutions Ltd, and the Lead Commissioner from NHS Gloucestershire Clinical Commissioning Group (GCCG) to the committee to debate this issue with committee members. The committee received a detailed presentation from Arriva Transport Solutions Ltd and the GCCG. (For information - the presentation slides were uploaded to the council website and included in the minute book.)

24.2     The committee had last met with Arriva Transport Solutions Ltd in March 2017. Performance data at that time was showing a mixed picture; there has been some improvement in the overall picture, but concerns remain particularly relating to KPI4 and KPI5. Other challenges included the increasing number of bariatric patients. The committee heard that it was the volatility of the demand, not necessarily the volume that created challenge.

24.3     It was disappointing to note that there was still no national guidance relating to non-emergency transport or a national government lead; although Arriva Transport Solutions Ltd did lobby MPs on a general basis, and, of course, also engaged with them on an individual case basis as part of their constituency work.

24.4     Frustration was expressed by Arriva Transport Solutions Ltd that although the discharge process has improved such that transport was considered earlier in the process, this was still not the norm, and there was still a high number of on the day requests. The Chief Executive of Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) informed the committee that GHNHSFT had as much to contribute to a well performing system as Arriva Transport Solutions Ltd, and that booking on the day was not the best way. It was also stated that all partner organisations needed to get much better at planning; this was an expensive resource that should be used more efficiently.

24.5     The committee was informed that Arriva Transport Solutions Ltd was working with the local authority to ascertain if there was any capacity in the local authority fleet during ‘quiet’ periods. Members were also informed that following a successful implementation of dedicated routes for renal dialysis patients requiring frequent journeys in other areas this would go live in Gloucestershire on 1 May 2018.

24.6     Members were informed that an extension to this contract has been negotiated until 31 May 2019 to avoid a winter start date for a new contract. In response to a question it was explained that the re-commissioning process would be conducted in an open and transparent manner, as previously, and that there would be opportunities for the public and the committee to engage with the procurement process. It was also explained that all the KPIs were being reviewed as part of the re-commissioning process.

24.7     It was questioned where the boundary between this service and that provided by the Voluntary and Community Sector lay? It was clarified that the responsibility of NHS Commissioners was to commission a service for non-emergency medical (not including primary care), not  ...  view the full minutes text for item 24.

25.1     The committee had received this report at the committee meeting on 8 March 2018 but had not had time to give the report its full consideration. The Director of Public Health (DPH) therefore gave a detailed presentation on the key messages identified in the report (for information - the presentation slides were uploaded to the council website and included in the minute book).

25.2     The committee welcomed this report. Members liked the clean, clear approach to the report, which meant that the information was understandable, and direct.

25.3     Members agreed that this report presented a challenging picture of need and health inequality in the county, and agreed with the Director of Public Health that understanding the underlying issues could help to interrupt the cycle of adversity.

25.4     Committee members indicated that an important factor for children and families was access to early help/early years, and were interested in the Adverse Childhood Experiences (ACEs) work being led by the Gloucestershire Health and Wellbeing Board. Members were also pleased to note the restorative practice work taking in place in schools to try and reduce the number of fixed term and permanent exclusions.

25.5     It was commented, by one member, that the children centre changes had not helped, and that it was a struggle to keep them running properly. They also informed the committee that schools in their area struggled to get support from families. They mentioned the changes to the youth services, and that what was needed was team of detached youth workers. They also hoped that this report would be shared with the district councils in the county.

25.6     Members were very concerned that many young children were not ‘school ready’. The DPH explained that this was not always about the parents, but could be related to developmental factors, and also explained the role of Public Health visitors in this process.

26.1     The Deputy Accountable Officer and Director of Commissioning, GCCG, gave a detailed presentation of the report.

26.2     It was questioned what was meant by ‘achieve very low numbers’ with regard to patients placed out of area for acute psychiatric care. There was agreement that it was good to try and have low numbers out of county, but knowing exactly what the aim was would be helpful and give a better understanding of the objective.

ACTION:        Jane Melton  

26.3     In response to a question regarding social prescribing it was explained that the GCCG have a series of measures for measuring the impact. It was also explained that social prescribing allowed a response to a person’s wider health and wellbeing needs; and that the GCCG was seen as leading the way nationally. It was clarified that all GP practices in the county were involved in this approach.

26.4     It was questioned whether people in the county would be denied services if they were obese, or smoked. It was explained that there was no blanket policy in place in Gloucestershire, but that clinical guidelines for procedures would need to be followed.

27.1     The committee welcomed the news that the CQC has improved its overall rating of Gloucestershire Care Services NHS Trust to ‘Good’ following its inspection in January and February 2018.

27.2     The committee was particularly concerned with the financial position at Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT). Members were disappointed to note that the last reported forecast for the year (February 2018) was a £27.8m deficit against a planned deficit for the year of £14.6m, and was now at £30m, and questioned whether this was related to the problems with the TrakCare system.

27.3     The Chief Executive, GHNHSFT, informed the committee that the significant risk identified as part of the recovery plan had come to fruition, and that this did relate in part to the deployment of the Trusts electronic patient record, TrakCare. She reported that the GHNHSFT had received tremendous financial support from the GCCG through its contract process, and had hoped for the same level of support from other commissioners but this had not happened resulting in a significant income loss for the Trust (£10m). The Chief Executive noted that in respect of other aspects of the financial recovery plan, the Trust had performed exceptionally well achieving one of the highest levels of cost improvement in the sector, whilst dramatically improving operational performance and outcomes for patients.

27.4     However, it was important to stress that, in respect of the Trust’s ability to reduce its cost base without impacting on the quality of services provided to patients, it has achieved better than, not just the sector average, but was one of the strongest of the eleven Trusts that were in financial special measures. The Chief Executive wanted to stress that this was testament to the Trust’s staff. She further explained that GHNHSFT was evidentially delivering lower cost services than the national index, and due to the cost efficiency of the Trust it was delivering this scale of cost reduction without impacting on the quality of care to patients. She reminded the committee that it has seen on many occasions in the last year evidence of where standards of care have improved, eg. sepsis, trauma and orthopaedic, patient experience, improvement against the A & E 4 hour targets.

27.5     In response to a question as to whether the Trust’s financial position would result in cuts to services the Chief Executive reminded the committee that the Trust’s position had always been that the quality of care to patients would not decline as the Trust sought to balance its books. She reiterated that the Trust has no intention to cut services, as had been explained at previous committee meetings if the Trust cut services this would result in a loss of income from their commissioners so would do very little to improve the financial position. It was explained that the question of whether there would be cuts to services was for the commissioners to answer. She stated that whilst there were no plans to cut services, the status  ...  view the full minutes text for item 27.

The committee noted the report.

The committee noted the report.