Agenda and minutes

Apologies were received from Cllrs Pam Tracey, Helen Molyneux, Nigel Robbins and Robert Vines.

No substitutions were made at the meeting.

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

No declarations of interest were made at the meeting.

To follow

It was noted that members would be asked to approve the minutes of the meetings on 15 January and 20 February 2019 at the next committee meeting.

Chairman, Cllr Carole Allaway Martin, informed the committee that the actions from the additional committee meeting held on 20 February 2019 relating to proposals on the General Surgery Reconfiguration Pilot were underway and in progress.

Members recalled that at the Health and Care Scrutiny Committee meeting on 13 November 2018, the committee had requested more details on the proposals for the pilot, in particular, to the benefits for staff and patients; what the implementation planning timeline would be, (including decision points), and the frequency of the updates to the committee going forward. At the November meeting, members had been informed that the role of the committee was that of critical friend and whilst members could express their views and concerns on the pilot scheme, they did not have the power to make recommendations to the Secretary of State.

At the additional meeting on 20 February 2019, members had proposed that a scrutiny task and finish group be established to consider the proposals in more depth. A one page strategy, setting out the aims, ambitions and timescales for the task group was being developed and would be circulated to the committee for comment after the meeting. The terms of reference to be submitted to the Gloucestershire County Council Overview and Scrutiny Committee for endorsement. The work of the task and finish group would be a short exercise, anticipated to complete in March or April 2019.  

At the February committee meeting, members had also agreed to write a letter to the Secretary of State outlining their concerns about the lack of clarity on the role of Health Scrutiny with regard to the reconfiguration pilot. Several members reiterated the need for clarification on the role of the committee when writing to the Secretary of State.

https://www.longtermplan.nhs.uk/wp-content/uploads/2019/01/nhs-long-term-plan.pdf - January 2019

Slides to follow

Mary Hutton, Accountable Officer for GCCG, (Gloucestershire Clinical Commissioning Group), gave a detailed presentation on Gloucestershire’s ambitions for developing a local NHS Long Term Plan and making improvements for the future.

Please refer to the link below for information on the plan: -

https://www.longtermplan.nhs.uk/

Published in January 2019, the NHS Long Term Plan sets out ambitions and proposals for changing current primary legislation in relation to the NHS. The plan will provide opportunities for members of the public, patients, clinicians, NHS leaders, partner organisations, and national professional and representative bodies to express their views on how to better enable NHS organisations to work collectively.

The ambitions for developing the Long Term Plan for Gloucestershire aimed to focus on the question ‘What matters to you?’ The question would be related to three specific areas, including: 

Place - how individuals and families receive health advice, support and services when needed; in the home, the neighbourhood, within the local community and across the County;

Life Course – considering health priorities at all stages of life

Supporting better care – supporting staff; making best use of technology; reducing waste and making best use of resources.

Current challenges impacting on NHS services in Gloucestershire were noted as; the demands of a growing population with complex needs, (throughout all age groups); increasing demand for services from people who are unsure what services to use; recruiting and retaining staff with the right skills and expertise; and financial pressures. 

Highlighting the ambitions for the Gloucestershire plan, members were advised that the key focus would be to achieve several aspirations; to provide more care in, or near, to people’s homes; deliver high quality, joined up services; provide the right care, staff skills and equipment in the right places; ensure better use of funding for delivering health and wellbeing priorities; strive for healthy, active communities supplemented by strong networks of support; and encourage simpler, easier ways of providing advice, support and services over a seven day week.

Noting the challenges of limited resources in Gloucestershire and the huge amount of work required to provide end of life care, members noted the need to address the challenges using a collaborative approach and for partners, including General Practitioner Surgeries and social workers, to work together. The value and importance of planned treatment was also noted.

Responding to questions, representatives from NHS Together Trust, explained that one ambition for introducing changes to the NHS Gloucestershire was to address the governance arrangements and organisational structure of the Planned Care network. In time, this would hopefully provide a more integrated service and improvements in joined up working. Gloucestershire was already advanced nationally in this approach and had engaged in a significant amount of work over the past year, including work with local pharmacies and local schools. 

Noting the committee’s concerns about resource planning, NHS Trust representatives confirmed that workforce challenges continued to present the greatest challenges to NHS Gloucestershire. Measures had been put in place  to address the challenges and there was  ...  view the full minutes text for item 4.

Sarah Scott, Director of Public Health at Gloucestershire County Council, presented the Quarter 3 Public Health Performance Report for 2018/19. The report highlighted gradual improvement in a number of service checks.

Responding to questions, it was agreed to make further investigations into the data analysis collated for prevention services, (to establish any rising trends). Action by: Sarah Scott

One member questioned the usefulness of some of the performance indicators, for which it was suggested the Public Health Team undertake a review of the value of the indicators and whether they continued to provide useful information. Action by: Sarah Scott

The Director of Public Health confirmed that the introduction of a Public Health Dashboard would be introduced shortly, for which the information would focus on providing a snapshot of information and help identify where efforts were most needed. The Dashboard would include a narrative on the performance data.

It was explained that the information included in the performance report was restricted by the number of indicators that could be reported on. It was acknowledged that a number of the indicators for drugs and alcohol continued to present positive outcomes.

The report was noted.

Mary Hutton, Accountable Officer for GCCG, (Gloucestershire Clinical Commissioning Group), gave a detailed update on the progress of key projects within the Gloucestershire’s Integrated Care System (ICS).

It was noted that, since the introduction of the Gloucestershire Sustainability and Transformation Plan in April 2018, significant progress had been made in embedding and delivering key schemes outlined within the plan. This had been undertaken in an increasingly challenging health and care environment, for which the CCG continued to focus on developing delivery plans to reflect key priorities. 

One member questioned some of the phraseology used in the report and asked if this could be reviewed. Another member asked if more detail could be provided on some of the projects, for which it was suggested an end of year overall performance report be provided to give an evaluation of progress year by year. The suggestions were noted. Action by – GCCG  

Noting the report, members welcomed the progress being made and commended the value of the work being undertaken in preparation for the development of the Gloucestershire 10 year plan. 

Mary Hutton, Accountable Officer for GCCG, (Gloucestershire Clinical Commissioning Group), gave an overview of performance against in year organisational objectives 2018/19. The report included a summary of performance and actions against national and local standards reported to the GCCG Governing Body.

Detailed updates were provided on unscheduled care (A & E), planned care and cancer patient referrals.  

The committee noted concerns about the demand and performance against targets for A&E admissions during winter months and the work being undertaken to address local and national trends. It was agreed to report on this issue at a later meeting and to include measures to prevent further misuse of A&E services as part of the Gloucestershire 10 year plan. Action by – GCCG

One member questioned the value of some of the information included in the report and suggested introducing a dashboard approach for future updates, in particular, for the updates on bed spaces. Another member requested more information on the numbers and turnover of ambulance vehicles and the impact of changes in ambulance providers The suggestions were noted. Actions by – GCCG

The report was noted.

Margaret Willcox, Director of Adult Social Care at Gloucestershire County Council, presented the Health and Care Overview and Scrutiny Scorecard Quarter 3 2018/19.

Members were informed that, overall, performance was good, with only 2 areas of key concern. The first concern was the fall in the proportion of carers receiving direct payments; the second was the fall in the number of people receiving reassessments. Work would continue, (locally and nationally), to manage both concerns, for which it was anticipated there would be improvements.

A member requested more information on the number of people experiencing mental health issues who relapse or deteriorate whilst in care. It was noted that this would be difficult to measure but that the matter could be looked at as a joint working exercise between the GCCG and GCC (Adult Mental Health). Action by - GCCG and GCC (Adult Mental Health)

The report was noted.

Margaret Willcox, Director of Adult Social Care at Gloucestershire County Council, updated members on recent issues.

The committee noted the report.

Sarah Scott, Director of Public Health at Gloucestershire County Council, updated members on recent issues.

Members attention was drawn to the Resilience film screenings to be delivered as part of the Gloucestershire’s ACE’s (Adverse Childhood Experiences) Communications Campaign. Screenings to be made on the following dates; -

20 March 2019 – Gloucestershire County Council (open to all Councils)

April 2019 – Cheltenham Borough Council

May and June 2019 - Tewkesbury Borough and Gloucester City Councils

The committee noted the report.

Mary Hutton, Accountable Officer for GCCG, (Gloucestershire Clinical Commissioning Group), gave a detailed update on the activities of the NHS Gloucestershire Clinical Commissioning Group and Integrated Care System.

Members were informed that:

a)    Health and Care Leaders in Gloucestershire had welcomed the publication of the national 10 year plan for the NHS in January 2019, saying that it was ‘perfectly in sync’ with the development of support and services locally.

b)    In 2018, Gloucestershire had been named as one of only 14 Integrated Care Systems (ICS) in the country. The county was praised for effective partnership working and ambitious plans to prevent ill-health and joined up support and services for the benefit of communities. Gloucestershire had also been recognised for improvements in access to GP services, developments in community and mental health services, A&E performance as well as a reduction in cancelled operations and delays for people ready to leave hospital.

c)    Progress was being made towards implementing the new service models set out in the NHS Long Term plan. During 2019/20 Integrated Locality Partnerships (ILP) will be developing across Gloucestershire on the three current Integrated Locality Partnerships Pilots implemented in 2018-19. The Integrated Locality Partnerships to perform a key role in bringing together health and social care at district level.

The committee welcomed the good work being undertaken and noted the report.