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.

Cllr Martin Horwood declared a personal interest as a family member works for the NHS.

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

Information on Integrated Care Systems is included at Section 8 of the One Gloucestershire STP Lead Report.

32.1     The Accountable Officer, Gloucestershire Clinical Commissioning Group (GCCG), informed the committee that in June 2018 it had been confirmed that Gloucestershire would become one of only 14 ICS in the country. The county was also given a huge vote of confidence and praised by the NHS England Chief Executive, Simon Stevens, for providing strong leadership, effective partnership working and its ambitious plans to join up support and services for the benefit of communities. It was explained that becoming an ICS was, in effect, a continuation of the work already in place and planned in Gloucestershire. It was emphasised that this was not a merger of organisations.

32.2     The committee agreed that it was good to see the close cooperation and greater integration between organisations. In response to questions it was explained that the Gloucestershire Health and Wellbeing Board (GHWB) was a very active part of the system, and that as per the committee’s work plan members of the committee would be scrutinising the work of the GHWB at the committee meeting on 11 September 2018.

32.3     Members also expressed concern with regard to the pressures on the workforce. It was explained that a workforce strategy was in place.

32.4     It was questioned whether this would lead to further integration and was this about achieving savings. The Accountable Officer informed the committee that the ICS would have to manage within the resources available. The aim was to provide quality care at the right time in the right place. An important part of this was about identifying and promoting self-care.

32.5     Members also questioned whether there would be an impact on the number of beds available in the county. In response it was explained that it was important to understand that things needed to be done in a more joined up way, and supporting people to be independent (if that was what they wanted). Within this context it was important to understand that the most important bed was the person’s own bed; creating bed equivalents in the home; developing care around the individual.

32.6     It was acknowledged that there would be financial challenges, in particular ensuring that one budget was not depleted at the expense of another, but that together we could do this better. It would be important to ensure that the Gloucestershire tax payer achieved the best value for their Gloucestershire Pound.

32.7     The potential impact on the people who lived on the county’s boundaries was questioned. The committee was assured that the GCCG had good working relationships with the CCGs on the border.

32.8     The committee agreed that it would be helpful for there to be a seminar for county and district members. This was agreed and will be held in the Autumn.

33.1     The committee was pleased to welcome Candace Plouffe, Chief Operating Officer (COO) Gloucestershire Care Services NHS Trust (GCS), Debbie Gray, Clinical Lead Therapist, Gloucestershire Clinical Commissioning Group (GCCG), and Dr Kate Hellier, Consultant Physician in Stroke and General & Old Age Medicine at Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT), to present and discuss the clinical case for change for bed based stroke rehabilitation. (For information the presentation sliders were uploaded to the council’s website and included in the minute book.)

33.2     It was acknowledged that the committee had been concerned about performance against stroke targets for some time, and in a previous council some committee members had visited the stroke pathway at Gloucestershire Royal Hospital. Members agreed that it was therefore good to receive this proposal.

33.4     Members agreed that the clinical evidence supporting this change was strong and that creating a centre of excellence for stroke patients in Gloucestershire would be the best way forward for patients. Members acknowledged that:-

Ø  it would deliver benefits to patients’ health and reduce social care needs

Ø  It would be staffed in line with the national guidance from the Royal College of Physicians and the Stroke Association

Ø  Stroke patients and their families, and the Stroke Association were very involved in the engagement activity

Ø  The options appraisal that was undertaken had identified the Vale Community Hospital in Dursley as the preferred location

Ø  Important factors were that the Vale has single rooms, as opposed to a ward setting, rehabilitation space and the location itself, which with the gardens and light traffic lent themselves to a 24/7 rehabilitation regime

Ø  The bed modelling undertaken by GCS had demonstrated that there would be no reduction in beds overall though the distribution of beds would change.

Ø  The other services delivered at the Vale Hospital would continue as normal

Ø  It was expected that this change would make the hospital sustainable in the long term.

33.5     Having said this the committee did have significant concerns with regard to the accessibility of the site; were public transport options sufficient to enable patients to receive visitors? (not everyone has access to private transport). It was commented that many of these patients visitors were likely to be frail themselves.

33.6     It was questioned that given that the greater population density was in the urban areas the Vale Hospital seemed an odd choice. The Chief Executive, Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT), informed the committee that the GHNHSFT had looked carefully at whether this service could be delivered at one of their sites, which were considered more accessible. The Trust, including the Clinical lead for Stroke Services had  serious concerns about the suitability of  the environment of an acute hospital site which did not lend itself to a rehabilitation ethos and that non-emergency services, on acute hospital sites, were at risk of being adversely impacted by winter pressures when there were peaks in patients with more urgent medical needs who often displaced  ...  view the full minutes text for item 33.

34.1     The Director of Adult Social Services (DASS) informed the meeting that overall performance was good. However performance against the reassessment targets remained a concern, although it was stated that the data was beginning to show some improvement but that this would take some time to show in the performance scorecard.

34.2     The committee noted that performance relating to carers and self-directed support was also not where it needed to be. The committee was informed that a report was going to Cabinet (18 July 2018) with regard to the procurement of a new carers contract. Within this context consideration had been given to how to make this funding more available. Carers have been asked, and officers have also looked at approaches in place at other councils. It was suggested that it might be better to make this a larger sum and over a three year period. The DASS agreed to consider this point.

34.3     In response to questions relating to safeguarding adults it was agreed that a briefing on Deprivation of Liberty Safeguards (DoLS) would be provided.

34.4     Some members stated that it was disappointing that not all the data in this report was the most current, and it was important that scrutiny be in receipt of the most up to date data. It was also stated that the structure of this report did not make it easy to understand the overall performance picture.

35.1     The Director of Public Health (DPH) informed the committee there continued to be a positive trend against performance targets in the Healthy Lifestyle Service. Performance relating to NHS Health Checks fell in quarter 3, although it was still above the regional and national average (based on the latest available data).

35.2     In response to questions it was stated that although drug and alcohol performance remained on target there was a downward trend. It was explained that this was due to the transition to the new contract. The DPH informed the committee that experience had shown that this was to be expected during the transition process, although it was of course a concern, and the council was working with the new provider to see what could be done to support these people.

35.3     Some committee members felt that it would be helpful to receive a wider range of public health indicators, eg. immunisation data. It was agreed that this was something that the committee could discuss at a future work planning meeting.

35.4     Members again commented that it was not helpful that the data for some targets was not the most up to date, and that the structure of the scorecard did not make for easy reading.

36.1     With regard to A & E performance the Accountable Officer (AO), GCCG, informed the committee that there had been significant use of the Emergency Departments in the last month by people with minor conditions. This level of demand was unmanageable in the long term. The AO informed members that this was disappointing given that the GCCG has extended the primary care offer, including greater capacity in appointments, including at the weekend.

36.2     Given previous concerns members were pleased to note that the investment in Improving Access to Psychological Therapy (IAPT) was making a difference with the service now achieving well. 

36.3     A member commented that it would be more informative for the committee to receive the A & E data broken down between sites rather than the performance for the Trust as a whole as this would demonstrate if one site was performing better that the other. This request was agreed.

36.4     Performance against cancer targets continue to remain of concern, particularly the two week wait. The GCCG were continuing to work to redress this position.

The committee noted the report.

The committee noted the report.

39.1     In response to questions the Director of Public Health (DPH) clarified that the work related to period poverty was a budget amendment at the meeting of full council in February 2018; it was not a council motion. It had been agreed that this work would be taken forward by the DPH and her team. She informed the committee that there was a lot of work already in place and the aim was to work with these people not establish another route. It was agreed that members would contact the DPH with information on any activity that was already in place in their communities.

39.2     It was commented that there was more to do at the planning level with regard to how to design housing estates. The committee was informed that Jon McGinty, Managing Director Gloucester City Council, and Commissioning Director Gloucestershire County Council, was the district lead on planning issues and was liaising on this aspect. The DPH also informed the committee that she had responded to the consultation for the Joint Core Strategy.

A member requested informing dating back to the service change relating to urgent care in 2013, in particular with regard to health outcomes. This change related to overnight (8pm to 8am) at Cheltenham General Hospital and affected those people who were transported by ambulance; ambulances now went directly to Gloucestershire Royal Hospital during these hours. Officers were of the view that it would not be possible to produce meaningful data, but did agree to see what was available.