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 and as the council appointed Governor to the 2Gether NHS Foundation Trust.

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

The minutes of the meeting held on Tuesday 11 September 2018 were agreed as a correct record and signed by the Chairman.

54.1     The Acting Head of Adult Safeguarding presented the main areas of activity undertaken by the GSAB in the period 2017 to 2018. Using case studies she also drew member’s attention to safeguarding adults reviews undertaken during this time period. These cases illustrated the impact of adverse childhood experiences (ACEs) on the individual and their longer term effect.

54.2     The committee was pleased to note that the GSAB was already working closely with the Gloucestershire Children’s Safeguarding Board (GSCB) as it was clear that there is learning across the lifecycle.

54.3     It was agreed that Housing had a significant role in safeguarding matters; housing officers have powers that safeguarding officers do not, eg. the right to enter their property, and were well placed to spot concerns and report them. The committee noted that housing providers were active members of the GSAB.

54.4     The committee was concerned with regard to those people placed out of area, both by this council and by other local authorities placing people in Gloucestershire. People placed out of area were more vulnerable to abuse as they were at distance from family and friends and a case study described in the Annual Report deftly demonstrated this. A particular concern related to people placed in Gloucestershire by other local authorities. An important factor was that the placing authority should (continue to) ensure that placements were suitable and that the individual was safe. However the committee heard that this does not always happen and this council has no powers to enforce this duty. It is also of concern that providers did not always inform this council when a person from out of the area was placed with them, despite there being a clear expectation from GCC Commissioning. There was ongoing work in this area to address this.  Committee members agreed that this area would benefit from better regulation and agreed that it would write to the Secretary of State for Health and Care with its concerns.

ACTION         Andrea Clarke

54.5     In response to a question it was explained that the Multi Agency Safeguarding Hub (MASH) which was now located in Shire Hall, currently focused on children. The longer term ambition expressed by the Assistant Chief Constable was to make this an all age group. Members indicated that they would like to visit the MASH.

            ACTION         Andrea Clarke

54.6     It was explained that if a member of the public reported a concern it was difficult to let them know what action had been taken as the consent of the individual concerned was required.

54.7     Members questioned what was being done to identify young adults who were at risk and what support was available. In response it was explained that this would be a specific focus for the GSAB this year. It was stated that recent research talked of children “walking off the cliff edge at the age of 18” in terms of services available to them; it was important to understand how these gaps could be filled. In response  ...  view the full minutes text for item 54.

55.1     The Director of Public Health (DPH) presented the report. The committee had shared concerns with regard to drug and alcohol performance against target at previous committees. The DPH indicated that she had included additional information on this matter in her report to committee later on the agenda to inform on the wider context. The committee remained concerned and would need to discuss at its next work planning meeting whether this matter would be better addressed through a workshop.

            ACTION                     Andrea Clarke

55.2     It was stated that the data for Cheltenham relating to disadvantaged children and the effect of this on their life chances was stark, and it was questioned how the Gloucestershire Health and Wellbeing Board (GHWB) was addressing this issue. It was explained that the GHWB was in the process of refreshing the Joint Health and Wellbeing Strategy (JHWBS) and this matter was being included in the GHWB discussion around priorities. The GHWB was also leading on the Adverse Childhood Experiences (ACEs) work (please see www.actionaces.org); the council was leading on a restorative practice programme; and the council also lead on the Children’s Partnership Framework in Gloucestershire.

55.3     The DPH also explained that the public health team were working on population health dashboard and this would be shared with the committee in due course.

56.1     The committee continued to be concerned with regard to performance against reassessments. This concern was exacerbated by the lack of detail in the comments section about what was being done to address this situation; the committee has asked for this to be improved. The committee acknowledged that this was a complex area with various recording issues adding to the complexity, but does feel that it was time that there was a positive shift in performance against these targets.

57.1     The committee agreed that having previously expressed concerns with regard to the performance of the South Western Ambulance NHS Foundation Trust (SWASFT) against category 1 calls, it was only right to congratulate the Trust for now achieving this target. However, it was acknowledged that this would become more challenging as winter pressures built.

57.2     Some members continued to express concern at the difference in performance against the 4 hour A and E target across the two acute hospitals. However the committee was reminded that at the overall Trust level (which was the national reporting requirement) the 90%target has been consistently met in every quarter in 2018/19. These members questioned why performance at Gloucestershire Royal Hospital (GRH) was not at the same level as at Cheltenham General Hospital. It was explained that there were particular pressures on the GRH site, particularly related to the level of activity and acuity of patients. The Chief Executive, Gloucestershire Hospitals Trust NHS Foundation Trust (GHNHSFT), informed the committee that it was important to place this within the wider context of how does the GHNHSFT maintain resilience across available resources; matching resources to the demand.. She also added that excessive demand was primarily a daytime issue.

57.3     It was commented that it was disappointing that the committee was not receiving the most up to date data on Children and Young People Services (CYPS) delivered by the 2Gether NHS Foundation Trust (2G). It was explained that this was a timing issue. It was also explained that 2G and the GCCG were still waiting to hear whether the bid to become a trailblazer pilot to reduce waiting times has been successful.

57.4     It was explained that a significant factor in those areas where performance targets were not being met related to the available workforce. It was clarified that this was not about finance but about workforce shortages at the national level. A particular concern related to the two week wait and 62 day cancer targets which have been consistently not achieving target. The committee was informed that the GHNHSFT has just appointed two urology consultants and it was expected that the impact of these appointments would soon be seen in the performance reporting.

57.5     In response to concerns with regard to cross border factors relating to continuing health care the committee it was agreed that the committee would receive a written briefing from the GCCG.

ACTION:        Becky Parish

58.1     The committee was particularly interested in the structure and membership of the Integrated Locality Boards particularly with regard to whether/how they would engage with local government.

58.2     The committee noted the report.

To follow

59.1     To try to set the context for the debate on this matter the committee’s role in this process was explained. Unlike substantial/significant service change proposals the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013 were silent on proposals for pilot schemes. The committee’s role therefore was that of critical friend. If the committee agreed that the pilot was not something that it could support this would not prevent the GHNHSFT from proceeding to plan for the pilot. If the committee was so minded it could decide to write to the Secretary of State for Health and Care with its concerns, but this also would not prevent the GHNHSFT from proceeding, unless he chose to intervene. (It was important to set the wider context to this issue in that the first that the committee knew of this proposal was following a leaked internal staff memo by a GHNHSFT staff member two days after the committee’s 11 September 2018 meeting. This was followed by 57 GHNHSFT consultants writing to all members of the GHNHSFT Board expressing views on the preferred model of care, and which was subsequently the basis for articles in the local media.)

59.2     The Chief Executive, GHNHSFT, assured members that this was a pilot and that no irreversible steps would be taken during the pilot’s timeline. She expected a robust debate with members of the committee today.  She explained the timing for the different communications, noting that the approach for this proposal was identical for that previously taken for orthopaedics and gastroenterology and noted the timing of the Trust meeting and the HCSOC was unfortunate.

59.3     The Director of Strategy and Transformation at the Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) gave a detailed presentation on this proposal highlighting the benefits that were expected to be achieved, and the metrics that would be used in the evaluation of this pilot. Two consultant surgeons from GHNHSFT also explained to the committee what an average day in general surgery looked and felt like. (The presentation slides were uploaded to the council website and included in the minute book.)

59.4     In the discussion that followed, it was stated by members that this was just another step in the downgrading of Cheltenham General Hospital (CGH); that this meant that access to emergency surgery was not safe and quoted an anonymous consultant who had spoken on local radio that this proposal was not safe for patients.

59.5     Some members felt that the fact that this number of consultants (57) had written this letter and that to them this signified a high degree of concern; and also suggested that there was a culture of fear at the GHNHSFT whereby consultants were afraid to raise their concerns publicly. In response it was commented that as they had signed the letter this did not seem to indicate that they were afraid to raise their voice.

59.6     The Chief Executive, GHNHSFT, drew members attention to the wording of the letter which in fact  ...  view the full minutes text for item 59.

To follow

60.1     This item related to the need to implement a temporary service change.  It was important to note that changes could be made temporarily under regulation 23(2) of the s.244 Regulations (National Health Service Act 2006) because of a risk to safety or welfare of patients or staff and that in these circumstances it might not be possible to undertake any public involvement or consultation with the Local Authority.

60.2     The Director of Strategy and Transformation, GHNHSFT, and the Chief Operating Officer, Gloucestershire Care Services NHS Trust (GCSNHST) gave a detailed presentation of the reasons for the service change which were attributable to severe shortages in staffing which were jeopardising the GHNHSFT’s ability to provide acute radiology services safely. It was noted that this was the first time that the NHS in Gloucestershire has had to take this type of action.

60.3     Members were concerned regarding the impact on those people who would usually visit the community hospitals most affected by this change. They asserted that it would be important that there was clear communication on what services were available and when, otherwise there was the potential for the acute hospitals to be adversely affected by an increased footfall.

60.4     In response to members concerns regarding the reduction in hours it was explained that this was the minimum level of commitment. This service operated on a six week rota and with the goodwill of staff it might be possible to provide an additional day in Tewkesbury and the North Cotswolds. It was also explained that most of the referrals to the service were routine referrals from GPs and not related to emergency care.

60.5     The reasons for the service change related to the workforce; this was a national issue, and had recently been reported in the national media but the position in Gloucestershire was even more challenged with a 24% vacancy rate in radiographers. The committee would be regularly informed on progress but it was recognised that in the current circumstances GCSNHST and GHNHSFT were not able to specify when this service would be fully restored as it relied on the Trust’s ability to recruit new and retain existing staff.

61.1     The committee noted the report.

62.1     The committee noted the report.

63.1     A member raised anecdotal information which related to the issue of a specific thyroid medication being withdrawn, and asked for an explanation as to why this had been undertaken. She questioned whether the GCCG review panel was overriding a government ruling relating to prescription entitlement.

63.2     The Deputy Accountable Officer, GCCG, informed the committee that the GCCG was not overriding national guidance but rather was responding to it. The evidence related to this drug (in that it delivered better outcomes than alternatives) was limited. Individual cases should be reviewed by a consultant endocrinologist; and there were some exceptions. In Gloucestershire a Review Panel, which included clinicians and lay representation, had reviewed cases and letters regarding the review and the Review Panel’s decision. Due to data protection requirements, it was then for the GP to communicate the information to the patient.

63.4     The Deputy Accountable Officer informed members that the GCCG had a duty to regularly review financial resources. The Deputy Clinical Chair, GCCG, explained that the evidence was not there to support routinely prescribing this medication. He also informed the committee that this approach was supported by the British Thyroid Society.