Agenda and minutes

To note any apologies for absence.

Apologies for absence were noted from new committee member, Cllr Terry Hale. Cllr Hale has replaced Cllr Kathy Williams as a permanent member of the committee

Chair, Cllr Andrew Gravells, welcomed the following new members and officers to the meeting.

Cllr Susan Williams (replacing former member, Cllr Tim Harman).

Cllr Gemma Madle (representing Tewkesbury Borough Council).

Cllr Julia Gooch (representing Forest of Dean District Council). Cllr Gooch joined the meeting via remote access.

Douglas Blair, Chief Executive Officer of Gloucestershire Health and Care Foundation Trust (GHC)

A Cotswold District Council representative will be announced in late July 2023.

Joining the meeting by remote access for item 5 of the agenda were Dr Simon Pirie, (Chief of Service: Women & Children) and Lisa Stephens, (Director of Midwifery - NHS Gloucestershire).

Other officers included:

Professor Sarah Scott, Executive Director for Adult Social Care, Wellbeing and Communities at Gloucestershire County Council

Mary Hutton, Chief Executive of NHS Gloucestershire Integrated Care Board

Ingrid Barker, Chair of Gloucestershire Health and Care Foundation Trust (GHC)

Professor Mark Pietroni, Medical Director of Gloucestershire Hospitals NHS Foundation Trust

Becky Parish, Associate Director, Engagement and Experience, NHS Gloucestershire Integrated Care Board.

To note any declarations of interest.

Cllr Collette Finnegan declared a personal interest in the meeting as a volunteer with the Gloucestershire Health and Care Foundation Trust.

To confirm the minutes of the meeting held on 23  May 2023 (minutes attached).

To note the actions from that meeting (summary of actions attached).

The minutes, (including summary of actions), from the meeting held on 23 May 2023 were confirmed and agreed as a correct record of that meeting.

Members noted progress on the following actions, (arising from discussions on the GP Out of Hours PPG Service and Maternity (Temporary Changes) Services updates). 

GP Out of Hours Service: Having questioned the timelines and actions taken by NHS Gloucestershire to respond to CQC inspection reports, (over the course of the past 5 years), it had been agreed that Cllr Gravells write to NHS England on behalf of the committee to escalate the matter to a higher level. A letter was sent to NHS England on 9 June 2023, and a response received on 16 June 2023. The committee’s concerns were noted.

Maternity Service Changes: Responding to concerns about the decision by Gloucestershire Hospitals NHS Foundation Trust to temporarily close 6 post-natal beds at Stroud Hospital in October 2022, it had been proposed that a small delegation of members meet with Health Ministers/NHS England, (either in person or via remote access), on issues affecting the recruitment and retention of midwives in the local area and the impact of such on the provision and delivery of maternity services in Gloucestershire. Cllr Gravells had since written to the MP for Stroud, Siobhan Baillie, requesting that a meeting be arranged from which to seek the MP’s/Health Minister views on how to address local concerns. The MP’s Office had responded, and had agreed to schedule a meeting with the Chair and a small group of members to consider the issues.

Motion 910: Dentistry: The committee received an update on Council Motion 901 ‘Tackling the Crisis in Dentistry’. Members were informed that at the GCC Corporate Overview and Scrutiny Committee Meeting on 19 April 2023, members had received an update on Motion 910, with specific reference to the work of the Gloucestershire Health Overview and Scrutiny Committee.

During the discussion, a member suggested the idea of a Task and Finish Group to explore the issue in greater depth and to provide an objective view on the issue. It was however, agreed to split the resolution into two parts and to request that:

1.    The Health Overview and Scrutiny Committee consider a piece of work specifically looking at the recruitment of dental professionals and, that

2.    The Economic Growth Scrutiny Committee consider a broader piece of work looking at employment in the county, the attraction/barriers of people moving into the county for work (‘magnet county’), to include a sectoral analysis.

Once each piece of work has been completed, the Chair of the respective Committee to report back to the Corporate Scrutiny Committee, at which point, if members feel further work is needed, a Task and Finish Group may be considered. It was confirmed that the matter would be considered in more detail at the Health Overview and Scrutiny Committee meeting on 28 November 2023, with a verbal update back to the Corporate Overview and Scrutiny Committee on 6 December 2023. Action  ...  view the full minutes text for item 3.

At each meeting of the Health Overview and Scrutiny Committee, there shall be up to 20 minutes set aside for members of the public, (including non-committee members), to make representation at the meeting. The process for submitting a representation will follow Gloucestershire County Council Constitution rules for making representation at public meetings.

The Council’s Constitution states that ‘any person who lives or works in the county, or is affected by the work of the County Council, may make written representation on any matter which relates to an item on the Health Overview and Scrutiny Committee agenda for that meeting’.

Notification of the intention to make representation is required three clear working days before the date of the meeting, (excluding the day of the meeting). Where the person making representation attends the meeting in person, that individual will be invited to address the committee, (3 minutes per representative), to respond to the information received in response to the original representation.

The notification deadline to make representation at the committee meeting on 11 July 2023 is 4.00 pm on Wednesday 5 July 2023.                     

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No public questions.

An update on the temporary service changes at the Aveta Birthing Unit, (Cheltenham General Hospital), and at Stroud Maternity Unit. Following an extension of the arrangements in January 2023, the committee to consider the anticipated outcomes of a review of the changes, including: -

a)    Cheltenham Birthing Unit (to remain closed to births for a further 6-month period (review date July 2023)

b)    Stroud post-natal beds to remain closed for a further 6-month period (review date July 2023)

The committee to also receive an update on the actions being considered to progress midwifery recruitment and retention in Gloucestershire. 

The committee received an update on the delivery of maternity services at Cheltenham General Hospital and Stroud Maternity Unit, including the actions taken to progress midwifery recruitment and retention.

Members recalled that at the committee meeting in May 2023, the committee had received information on Gloucestershire Hospitals NHS Foundation Trust’s maternity service staffing position and the actions associated with consideration of alternative staffing models to support the opening of the birth centre in Cheltenham and post-natal beds in Stroud.

Dr Simon Pirie, (Chief of Service: Women & Children) and Lisa Stephens, (Director of Midwifery), for NHS Gloucestershire joined the meeting via remote access to respond to questions. 

Key points highlighted at the meeting included: -

An increase in the midwifery vacancy rate from 7.6% in January 2023 to 13.9% in May 2023, equating to 30 full time vacancies.

Despite the seasonal fluctuating annual picture, the position was looking more favourable in relation to the recruitment and retention of midwifes, with a possible re-opening of services at the Cheltenham Birthing Unit in January 2024.

Efforts were being taken to avoid the repeated opening and closure of maternity facilities in Gloucestershire when responding to workforce challenges.

Exploration of a long-term sustainable solution from which to address current staffing issues using a different maternity workforce model was ongoing.

A key priority was to provide one to one care to expectant parents.

The preferred model for Cheltenham proposed a designated Cheltenham Birth Centre and Home Birth Service, supplemented by on-calls. Midwives to work at the birth centre from 08:00-20:00. Outside of these hours, midwives would be redeployed to the Gloucester Birth Centre, returning to the Cheltenham Birth Centre if required during the night.

Community midwives working within the Cheltenham area will have a smaller caseload, but are likely to experience an increased number of calls to support homebirths in the Cheltenham and Gloucester areas. The remainder of community midwives to be enrolled on a dedicated on-call rota to respond to activity at the Cheltenham birth unit. Key to adopting this model, will require support and buy-in from other teams outside of the Cheltenham area, for which further consultation will be undertaken.

The Cheltenham model was not anticipated to impact on postnatal bed provision at Stroud Maternity Hospital.

The model for postnatal bed provision at the Stroud Hospital will require an assessment of the potential use of the non-midwifery registered workforce.

Having secured £2.7M of capital funding to provide a new Birthing Unit at Cheltenham General Hospital, the Hospitals Trust continue to work with the capital project team to finalise the design and construction timeline for the unit.

At the October HOSC meeting, members to be advised of:-

The preferred long-term midwifery workforce model and the impact on birth units in Gloucestershire;

The preferred long-term non-midwifery model for postnatal care provision and the impact on maternity services in Stroud;

The construction timeline for the new Cheltenham Birthing Unit, and

Indications of how the combined elements above will enable the re-opening of the Cheltenham and Stroud  ...  view the full minutes text for item 5.

To note the dates of future meetings (below) and to review the committee work plan.

10 October 2023

28 November 2023

11 January 2024

12 March 2024

21 May 2024

16 July 2024

15 October 2024

26 November 2024

The Health Overview and Scrutiny Committee (HOSC) work plan was noted and the following items suggested for consideration at future meetings. 

1)    NHS Gloucestershire Winter Plan (agenda item) – 10 October 2023

2)    Newton Europe Progress Update (to be aligned with the Winter Plan presentation) – 10 October 2023

3)    Maternity Update (ICB Update Report) – 10 October 2023

4)    Frailty Project (ICB Update Report) – 10 October 2023

5)    Verbal Update from the Chair re the meeting with Siobhan Baillie MP and Health Ministers – 10 October 2023

6)    NHS Workforce Plan (agenda item) – 28 November 2023

7)    Pharmacy/Optometry/Dentistry (POD) (agenda item) – 28 November 2023

An overview of some of the digital initiatives being explored by NHS Gloucestershire.

Having suggested the committee consider the use of digital technology in the delivery of services by NHS Gloucestershire, Cllr David Brown was invited to introduce the item.

Cllr Brown referred to the benefits of developing a ‘joining up your information’ approach when considering the current and future needs of the delivery of services by NHS Gloucestershire. He also highlighted some of the risks and challenges this may involve, and the need to strike a balance in outweighing risks to security and data protection with advances in communication and the efficient sharing of information within the county.

Paul Atkinson and Peter Wathen from NHS Gloucestershire gave a detailed presentation on Digital Health Care in Gloucestershire. To view the presentation, please refer to the link here. Members were informed that the presentation included a summary of information based on the aims and ambitions of the Gloucestershire Health and Care Digital Strategy 2022-25. A more detailed version of the presentation is available and can be viewed on the Gloucestershire Integrated Care Board (ICB) website.

Key points highlighted during the presentation included: -

      i.        The Gloucestershire Health and Care Digital Strategy 2022-25, (published in May 2023), had been developed using a system approach, with involvement from all NHS Gloucestershire partner organisations;

    ii.        The strategy defines a level of ambition considered both pragmatic and achievable;

   iii.        The strategy recognises that significant investment is required to meet the needs of the citizens of Gloucestershire from use of digital technology;

   iv.        An investment case was being developed to underpin funding

discussions with NHS England;

    v.        The current gap in funding to be addressed from engagement in regular discussions and from prioritisation using a system approach

Outlining key activities (Year 1) included in the Outline Delivery Plan and presenting a summary of the anticipated financial investment required from which to progress the strategy, members were informed that the financial plans for years 2022/23 and 2023/24 has been agreed, albeit, £5.4m of funding for 2023/24, whilst anticipated, had not yet been confirmed. Members were advised of the high degree of confidence the monies would be received.

Although a number of unfunded schemes formed part of the plan for the 2024/25 financial year, the ICB intended to take full advantage of any opportunities that might arise in respect of investing for the long term.

Responding to concerns about financial uncertainties, the ICB was confident the anticipated funding would be awarded.

Enquiring about cross-border arrangements and the risk of artificial intelligence brought about by the sharing of information based on different standards, members were informed that the Southwest region was anticipated to develop at an earlier pace than some of the other regions in the UK involved in the national digital programme. Dr Atkinson informed members that whilst national cross-border engagement presented some challenges, he was in constant communication and met regularly with his Welsh counterparts.

Noting concerns about the potential lack of confidence by older people in the use of digital applications, it was agreed to include the outcomes/information  ...  view the full minutes text for item 7.

To receive an update on the performance of the Gloucestershire Integrated Care System (GICS) against NHS constitutional and other agreed standards.

The report to be taken as read with an opportunity for members to ask questions.

The committee noted the Gloucestershire Integrated Care System, (ICS), Performance Report relating to the performance of the NHS Gloucestershire Integrated Care Board. The report included information on performance, quality and workforce. The report was taken as read at the meeting.

Information highlighted by the report included the following updates:

Urgent and Emergency Care (UEC) had experienced days of excellent performance during recent months, with tangible improvement against a number of key metrics, including Category 2 ambulance response times and total time lost to handover delays. On some days, Gloucestershire had seen performance for UEC metrics among the best systems in the county. Challenges in specific areas can however impact on the day to day fragility of the system.

Ambulance handover delay performance improved during May 2023, with a total of 1950 hours lost, (against a target of 2150), and an average handover time of 48.7 minutes, (against a target of 54.1 minutes).

Urgent care 2 hour responses continued to meet performance targets with May seeing 83.7% of incidents meeting the 2 hour target.

Work was ongoing ahead of the launch of the transformation programme based around the Newton Europe review held in 2022. An update will be presented at the next committee meeting.

Winter planning will commence in August 2023, with a full report to the committee in October.

Notification of further industrial action by Junior Doctors was ongoing. Mitigation plans have been implemented including deployment of additional respiratory hubs to manage demand but inevitably this was anticipated to impact on patient safety and further loss of elective activity.

A caretaker contract was in place for Drybrook Surgery to allow the surgery to remain open, providing interim arrangements for 6 months while the primary care team continue to progress with the procurement of a longer-term contract.

The uptake of physical health checks for people with serious mental  illness (SMI) increased significantly during 2022/23, with the full year position at over 56% of the SMI register receiving a full physical health check. While below the 80% national target, this still represented a huge improvement from the under 10% compliance report at the start of 2023.

Eating disorders - Children and Young People and Adult routine and urgent referral to treatment waiting time targets had been missed throughout 22/23 with the service under pressure from high demand and significant workforce challenges. During 2022/23, the team had significantly reduced the urgent adolescent assessment waiting list numbers and waiting times and had focussed on providing alternative support to those waiting in collaboration with voluntary sector partners. Improvements have been reported in April, with 85.7% urgent referrals recorded in 1 week against a 95% target.

Throughout 2023, Children and Young people’s mental health access continued to be high across all providers, including Gloucestershire Health Care Foundation Trust (GHC) and Young Gloucestershire, with pressure on core services to deliver an assessment within the 4 weeks target. Additional capacity had been rolled out during 2022/23, particularly for Mental Health Support teams, with further plans to support 2023/24  ...  view the full minutes text for item 8.

A report from the NHS Gloucestershire Integrated Care Board (ICB), known collectively as NHS Gloucestershire. The report to include updates from Integrated Care System (ICS) partners responsible for overseeing the day-to-day commissioning and provision of NHS services in Gloucestershire.

The report to be taken as read with an opportunity for members to ask questions.

The NHS Gloucestershire Integrated Care Board, (ICB), report was taken as read at the meeting. The report included updates from Integrated Care System (ICS) Partners with responsibility for overseeing the day-to-day commissioning and provision of NHS services in Gloucestershire.

The report confirmed that Deborah Lee would be standing down from her role as Chief Executive Officer of the Gloucestershire Hospitals NHS Foundation Trust after seven years in post. Deborah will remain in post until March 2024.

A new Dental Strategy Group for the county had been created to support the planning and commissioning of primary, community and acute dental services from 1 April 2023. Membership includes Healthwatch Gloucestershire, two patient representatives, Gloucestershire Local Dental Committee (LDC), NHSE, Gloucestershire Health and Care NHS Foundation Trust (GHC), Gloucestershire Hospitals NHS Foundation Trust (GHFT), the Southwest Dental Network, Gloucestershire County Council Public Health team and ICB staff.

The business case for a new Hucclecote Surgery has been approved. The new practice will be relocating into a purpose built facility for around 10,000 patients on a Gloucestershire County Council owned site at North Upton Lane, in Hucclecote, 0.4 miles from the existing surgery. The surgery will be part of a mixed development funded by the County Council and is planned to be opened in August 2025.

Further to the recent media coverage of reports relating to Wotton Lawn Hospital in May 2023, based on reports from patients and their families about incidents at the hospital, it was confirmed that, all of the reports had previously been investigated in accordance with national and local protocols, including allegations about staff behaviour.

Following the media coverage, the NHS Gloucestershire Integrated Care Board (ICB) had convened a rapid quality review meeting under NHS England National Quality Board Guidance, where it had been agreed that there would begin a period of ‘enhanced surveillance’ to enable the ICB to receive additional regular reports and information about the hospital.

In addition, the ICB agreed to establish a task and finish group involving service users to explore how discharge communication can be improved, and a review of the advocacy service. This will be in addition to ongoing work already underway within Gloucestershire Health and Care NHS Foundation Trust, including regular quality audits and reporting, and the introduction of additional security measures within the hospital.

As announced by Committee Chair, Cllr Andrew Gravells, earlier in the meeting, Ingrid Barker had agreed to seek an alternative date for the Gloucestershire Health Care Annual Meeting with the committee to allow the meeting to be arranged as an in-person meeting at Wotton Lawn Hospital, (the focus of the meeting will be mental health services). Chief Executive, Douglas Blair and Senior Staff at the hospital will be invited to join the meeting to respond to member questions. Cllr Gravells requested that the date of the meeting is brought forward from 18 October 2023 to an earlier date in September. Members were asked to submit questions in advance of the meeting. Action by – Democratic Services

The report  ...  view the full minutes text for item 9.