Agenda and minutes

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

No additional declarations.

RESOLVEDto refer the motion below to the Health and Care Overview and Scrutiny Committee:

This Council notes:

·        The value communities place upon the Accident and Emergency units in both Gloucester and Cheltenham

·        The enormous and varied contributions made by the seven minor injury units spread across Gloucestershire

·        The great value that communities across Gloucestershire place upon having hospital facilities close by

This Council further notes that all Walk in Centres, Urgent Care Centres, and Minor Injury Units will be rebranded as Urgent Treatment Centres by the end of 2019. 

This Council resolves to write to Gloucestershire Clinical Commissioning Group, to appeal in the strongest possible terms, that none of the services currently on offer to walk-in patients at any of the nine hospitals are removed, including that Cheltenham General Hospital must not be further downgraded to an Urgent Treatment Centre from an Accident and Emergency department.

2.1      The Committee noted the motion that had been referred from full Council and welcomed a presentation from the Senior Commissioning Manager for Urgent Care on developing the Gloucestershire model of care for Urgent Treatment Centres. It was explained that she was unable to confirm any details of Urgent Treatment Centres at this stage as further work and engagement was planned. Following engagement in the Spring and Summer a review would be undertaken and a more formal process of consultation would take place in Autumn/ Winter.

2.3      Members noted the national requirements including the March 2017: ‘Next steps of the NHS Five Year Forward View) and the July 2017 NHSE’ Principles and Standards. The NHS Long Term Plan stated the implementation of the Urgent Treatment Centre model by Autumn 2020. It was explained that the overarching principle of establishing Urgent Treatment Centres was to remove confusion and provide consistency of service offer to the people of Gloucestershire. 

2.4      In terms of outlining the need for change it was explained that the systems were confusing with fragmented pathways with multiple hand-offs, as well as staffing/ workforce constraint. Making the change would improve the quality of the patient experience, Urgent care was to become more planned in order to address system ‘surge’. It was explained that urgent care activity was very predictable but did create known demand surges that created pressures.

2.5      The national guidance had been reviewed and there had been a mapping of current services, reviewing patient experience feedback. Workshops were held involving clinical, managerial, Healthwatch and patient and public representatives. Draft service specifications had been prepared. There was still more to be done and there was encouragement for everyone to get involved.

2.6      Members were informed about what the Urgent Treatment Centre model would provide and how it would be less confusing for public, patients and staff and that it would provide a largely bookable service to allow it to be more planned. All services needed to be aligned so there was a less fragmented approach that provided the best use of staff skills. This would ensure the Emergency Department was preserved largely for people with ‘life and limb’ threatening conditions.

2.7      It was explained that the system was undertaking a number of test and learn initiatives via a  ‘Plan, Do, Study, Act’ approach to test assumptions and new ways of working.

2.8      Some members felt that there was confusion around the details of Urgent Treatment Centres (UTC) and asked for confirmation that there would be no downgrading of Cheltenham A & E to a UTC. In response it was explained that there was still a significant amount of engagement with the public and so no details could be confirmed.

2.9      In response to a question, it was clarified that it was a minimum 12 hours open time for UTCs and that where need arose this could be extended. It was also confirmed that there would be full integration with the out of hour’s services.

2.10    Some members spoke positively  ...  view the full minutes text for item 2.

The Committee are asked to note the report that was considered by the Health and Care Scrutiny Committee on 13 November 2018. At the meeting the committee agreed to hold an additional meeting to discuss this proposal to gain a better understanding of the detail of the proposal particularly the benefits for both staff and patients, what the implementation planning timeline looks like, including the decision points, and the frequency of updates to the committee.

http://glostext.gloucestershire.gov.uk/mgAi.aspx?ID=21876

Members are asked to refer to the Local Authority Health Scrutiny Guidance document at the link below:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/324965/Local_authority_health_scrutiny.pdf

Attached to the agenda is a letter from Cheltenham Borough Council.

3.1      At the Health and Care Scrutiny Committee on 13 November 2018, members agreed to hold an additional meeting to discuss the proposal around the General Surgery Reconfiguration Pilot. Members had requested more detail particularly around the benefits for both staff and patients, what the implementation planning timeline looked like, including decision points and the frequency of the updates to the committee going forward. Members were informed that the Committee had the role of a critical friend and could express views and concerns but that they did not have the power to refer to the Secretary of State as this was a pilot.

3.2      Cheltenham Borough Council had been in contact, asking for the Health and Care Scrutiny Committee to examine the proposals in detail and to allow an opportunity for the 57 consultants who had signed a letter raising their concerns to be able to address the meeting. The Committee had not received any contact from the signatories to attend the meeting. The Overview and Scrutiny Committee at Cheltenham Borough Council had considered the issue and heard from a representative and the draft minutes of that meeting had been circulated to members.

3.3      Peter Lachecki took the opportunity to update members on confirmation that the Trust had been graded by CQC as good a couple of weeks previously. There were many areas of outstanding practice identified in the report including an embedded systematic approach to quality improvement.

3.4      Members received a presentation from Sion Lanceley and consultants who were core members of the task and finish group that had worked up the options related to the model of emergency general surgery. It was explained that the current model of emergency general surgery did not meet national standards. It was important that there was a model of ensuring specialist teams were free to review new patients, that there was provision for ambulatory care services and consultant ward rounds. The current model allowed for patients to be admitted unnecessarily and to stay longer. It was recognised that 14 general surgeons agreed ‘do nothing’ was not an option and that all fourteen supported the centralisation of emergency general surgery to Gloucestershire Royal.

3.5      There was a majority clinical support for the proposed model of planned care, which it was explained was the only option which could be implemented in the short term. The pilot would be evaluated and, by its nature, was temporary; any substantive and permanent change would be subject to public consultation.

3.6      It was explained that general surgery comprises two abdominal specialities. It was broken down for the committee what emergency work included and what elective work included. 70% of emergency patients did not require an operation. It was explained that most of the work was completely independent; the first point of call if patients became unwell would be the team they were being looked after by. It was suggested that having surgery patients co-located made a lot of sense.

3.7      Members were informed centralising emergency general surgery would  ...  view the full minutes text for item 3.