Agenda and minutes

To note any apologies for absence.

Apologies were received from Cllr Helen Molyneux, (representing Forest of Dean District Council).

No substitutions were made at the meeting.

Members to advise of any pecuniary or personal declarations of interest on matters relating to the agenda.

No declarations of interest were made at the meeting.

To confirm the minutes of the meeting held on 17 November 2020 (attached)

The minutes of the meeting held on 17 November 2020 were confirmed as a true record of that meeting.

The Gloucestershire Health Overview and Scrutiny Committee is piloting an approach whereby members of the public can make representations at committee

meetings.

At each meeting of the Health Scrutiny Committee, there shall be up to 20 minutes set aside for representations, (3 minutes allocated per member of the public).

Any person who lives or works in the county, or is affected by the work of the County Council, may make a representation on any matter which relates to any item on the Health Overview and Scrutiny Committee agenda for that meeting.

Notification of your intention to attend the meeting and make a representation should be given by 4.00 pm three clear working days before the date of the meeting, (excluding the day of the meeting).

The notification deadline to make representation at the committee meeting on Tuesday 12 January 2021 is 4.00 pm on Wednesday 6 January 2021.

To confirm your request to make a representation, please email Jo Moore on jo.moore@gloucestershire.gov.uk

Please note, this meeting will be held as a remote access meeting, for which it will be necessary to join the meeting by electronic means via the Webex application. An invitation to join the meeting will be provided prior to the meeting. If you have any questions on this process, please include in the email.

No public representations were made at the meeting.

Chairman, Cllr Brian Robinson, referred to the public representation statement made by Mr Marco Taylor at the committee meeting on 17 November 2020 relating to changes to community phlebotomy services in the South Cotswolds.

Cllr Robinson also referred to an email received from Mr Taylor after the meeting, questioning the accuracy of some of the statements made by the NHS CCG. Cllr Robinson advised the committee that the NHS CCG had since confirmed that the statements made at the scrutiny committee meeting on 17 November 2020 were valid.

An email to this effect, including the comments made by Mr Taylor and the response by the NHS CCG were shared with the committee prior to the meeting and attached to the minutes of this meeting. 

Members noted that an update on community phlebotomy services would be presented at the committee meeting on 2 March 2021.

To receive an update on South West Ambulance Service Foundation Trust (SWAST) performance indicators, including an update on performance in response to COVID-19 requirements.

The committee received an update from Stephanie Bonser, (County Commander for the South Western Ambulance Service NHS Foundation Trust), on the performance of the South Western Ambulance Service (SWAST). The data briefing note presented at the meeting is attached to the minutes and can be viewed here.

The County Commander confirmed that activity in the Gloucestershire area had increased during the 12 month period from January to December 2020, (in response to the impact of the COVID-19 emergency). Activity had decreased slightly during the initial lockdown, increased slightly from June, and was currently showing a significant increase since December 2020. It was confirmed that, after a slight reduction from an average of 8.2 minutes for the Category 1 average response target in November 2020, there had been a significant challenge on response targets since December. Increased pressure on service crews has resulted in handover delays. Category 2 response targets had also been affected during this time, with an average response time of 22.4 minutes against a target average of 18.

Prior to December, response times for the 12 month period commencing October 2019, had reported performance averages against Category 1 response targets, (life threatening injuries and illnesses/target average of 7 minutes), as fairly steady, whilst performance averages against Category 2 response targets, (emergency calls/target average of 18 minutes), and Category 3 response targets, (urgent calls/target average of 90% within 120 minutes), had improved during the last 3 months.

Collaboration with Gloucestershire Fire and Rescue Service, (GFRS), from November 2020 had resulted in crews attending 428 incidents. The work of paramedics, trained first responders, community response managers and the rigorous hygiene and infection control of ambulance crews, aimed to ensure minimal impact on the welfare and care of patients during the COVID-19 emergency, including admissions to Gloucestershire Royal Hospital. The Trust continued to adhere to Government guidelines in order to protect its staff, patients and members of the public.

An update on performance against agreed national standards was included in the GCCG performance report to the committee, (this item was considered at item 8 of the agenda).

Responding to concerns about ambulance response times in rural areas, (prior to and after the pandemic), it was acknowledged that, whilst this would always present a challenge, the position was comparable to other rural areas nationally. Rota planning and projections of where calls from rural locations were most likely would continue to assist in managing the issue. A decision a few years ago, to place an extra ambulance crew in the Cotswolds District, had not made a significant impact.

Other questions related to the need to review performance response time averages; the relationship between SWAST and GFRS; and the vaccination roll out to ambulance crews. In response to the questions, it was confirmed that performance averages would be reviewed if the national average continued to increase; the relationship between community first responders and GFRS crew had been excellent during the pandemic, (it was recognised that it was important to continue this  ...  view the full minutes text for item 5.

To consider outputs from the Fit for the Future Consultation (information to follow).

The committee received an update on the NHS Fit for the Future Consultation from the Gloucestershire NHS Clinical Commissioning Group, (representing One Gloucestershire Integrated Care System), on the proposals for the ICS Consultation on the development of specialist hospital services at Cheltenham General Hospital (CGH) and Gloucestershire Royal (GRH) Hospital. The consultation forms part of the Gloucestershire Fit for the Future Programme and long term vision of ensuring Gloucestershire is placed at the forefront of healthcare delivery nationally. The consultation ran from 22 October 2020 until 17 December 2020.

Details of the consultation are available on the NHS One Gloucestershire website and can be viewed here

Details of the interim output of consultation report (published on 11 January 2021) can be viewed here

Responding to comments about the limited time for members to consider the interim output report, it was explained that the proximity of the closing date of the consultation, (on 17 December 2020), to the date of the meeting had made it difficult to publish the information with the agenda. Members were advised that there would be other opportunities, including the Health Overview and Scrutiny Committee meeting on 2 March 2021, to express their views.

The purpose of the Fit for the Future Consultation is to seek views on the future provision of five specialist hospital services in Gloucestershire, comprising:-

a)    Acute Medicine – the coordination of initial medical care for patients referred to the Acute Medical Team by a GP or an Emergency Department and where decisions are made on whether patients require a hospital stay;

b)    Gastroenterology inpatient services - medical care for stomach, pancreas, bowel or liver problems;

c)    General Surgery conditions relating to the gut, (specifically, emergency general surgery, planned lower gastrointestinal (GI) (colorectal) and day case upper and lower GI surgery);

d)    Image Guided Interventional Surgery (IGIS) including vascular surgery;.

e)    Trauma and Orthopaedic inpatient services, including diagnosis and treatment of conditions relating to the bones and joints.

Noting concerns about consulting during a pandemic and the challenges of having to adhere to government guidelines, it was confirmed that the Fit for the Future Consultation included a broad range of communication channels, involving;

a)    The distribution of approximately 5,000 consultation booklets;

b)    The distribution of 297,000 door-to-door leaflets, generating 1700 plus requests for information;

c)    Over 75 consultation events;

d)    More than 1000 socially distanced face-to-face contacts with the public, plus 350 staff;

e)    Facebook postings involving a reach of over 140,000 people, 1,500 engagements, and over 1,000 clicks on the consultation link;

f)     35 plus tweets, generating 30,000 plus impressions and almost 800 engagements;

g)    700 plus Fit for the Future surveys completed

Feedback to the consultation was received in two ways; from the responses to the Fit for the Future Survey (Main Survey and Easy Read Survey), and from other correspondence and written responses, including an alternative survey set up by REACH to inform their response to the proposals. The responses can be  ...  view the full minutes text for item 6.

To consider outputs from the Forest of Dean Community Hospital consultation (information to follow).

The committee received an update from the NHS Clinical Commissioning Group on the NHS Gloucestershire Integrated Health and Care System (ICS) Consultation regarding the delivery of services proposed for the new community hospital in the Forest of Dean District. The consultation commenced on 22 October 2020, ending on 17 December 2020.

Analysis of the responses to the consultation can be viewed in an Output of Consultation Report, published on the NHS website on 11 January 2021. The report can be viewed here

Based on the responses from previous stages of the consultation, it was confirmed that the new hospital would be located in Cinderford, replacing the Dilke Memorial Hospital and Lydney and District Community Hospital.

Members were reminded that the purpose of this consultation had been to seek feedback on the following aspects: -

i.      Number of hospital beds required to meet the needs of the local population;

ii.    Outpatient services, including consultation, treatment and group rooms and additional areas for online consultations for the provision of outpatients services;

iii.   Urgent care facility;

iv.   Diagnostic services, including x-ray, ultrasound and blood-testing (phlebotomy); purpose-built endoscopy unit and space for mobile units, such as Chemotherapy Bus and Breast Screening Service;

v.    Parking for approximately 150 vehicles; agreement on the location of a bus stop, (on or adjacent to the site);

vi.   Flexible meeting space for access by health and care organisations plus wider voluntary sector organisations

Thanking everyone who had participated in the survey, Caroline Smith from the CCG informed the committee that there had been a good response to the consultation. From first analysis, there appeared to be a range of mixed views, particularly in respect of the proposals relating to inpatient care and urgent care for the South of the Forest. The consultation had followed a different timescale to the Fit for the Future Consultation, with no further plans for a Citizens Jury. (A Citizens Jury had been used during an earlier stage in the consultation process).

It was confirmed that a ‘consultation review period’ would now take place. If supported by the NHS Clinical Commissioning Group’s Governing Body at its meeting on 28 January 2021, the proposals would be included in a service specification, for which the Gloucestershire Health and Care NHS Foundation Trust would be required to produce a formal business case, setting out the design specification and financial plan for the new building, along with the arrangements for the operation of the new hospital going forward. Final approval of the proposals would be required from the Board of the Gloucestershire Health and Care NHS Foundation Trust in March 2021.

Responding to concerns about the replacement of the existing hospitals and the perceived loss of facilities in certain parts of the Forest, members were advised that the inadequacy of the ageing buildings and the need for modern, fit for purpose, facilities had  been accentuated during the Covid-19 pandemic emergency. Noting the concerns, including concerns raised by members of the public, the committee was advised that, all considerations  ...  view the full minutes text for item 7.

To receive an update on the performance of the Gloucestershire Clinical Commissioning Group (GCCG) against NHS constitutional and other agreed standards.

The committee received an update on the performance of the NHS Gloucestershire Clinical Commissioning Group, (GCCG), including notification that NHS CCG oversight assessments published in November 2020 had rated Gloucestershire CCG as ‘Good’ against NHS Constitutional and other agreed standards.

With the exception of A&E and Ambulance Category 1 response times, performance against key standards continued to follow national trends. It was confirmed that there had been a significant decline in overall A&E performance nationally during the 12 month period to November 2020, (attributed to the recent surge in Covid-19 cases and in response to national lockdown measures).  Locally, 4 hour performance targets remained a concern. Ongoing pressures in the availability of acute hospital bed spaces was making it increasingly challenging to meet the required standards.

Across all other standards, both the national and GCCG position showed general improvement. Members noted, however, that the impact of the second wave of COVID-19 was likely to have a negative impact on performance during December 2020 and January 2021.

With no significantly large increase in COVID-19 admissions evident during the initial months of the pandemic, this position had changed in recent months, with admissions rising steeply at the end of October 2020. Workload pressures continued throughout November and December, with notable repercussions from the impact of increased COVID-19 admissions and occupancy at Gloucestershire Royal Hospital. Current reports indicated continuation of this challenging situation, particularly in terms of bed occupancy and hospital flow.

To relieve some of the pressures on hospital admissions, efforts had been made to treat some patients experiencing COVID-19 symptoms at home as part of the Home First programme and from the Virtual COVID-19 Ward. Both provisions took into account the risks to staff when looking after COVID-19 patients in non-hospital environments. COVID secure arrangements and regular monitoring to detect early signs of deterioration in patients receiving treatment at home were important considerations. The roll out of the COVID-19 vaccination to NHS staff, (reported in an update to the committee under item 10 of the agenda), was proving very successful.

Earlier in the meeting, it had been reported that ambulance service activity in the Gloucestershire area had increased in the 12 month period between January and December 2020, (during the pandemic). Although activity had decreased slightly during the initial lockdown, there had been a significant increase in activity since December 2020, with notable increased pressure on ambulance service crews and in the frequency of handover delays. An update on SWAST service performance activity to be presented at the 13 July 2021 meeting.

Expanding on the extraordinary response by Gloucestershire ICS during the pandemic, NHS professionals commended the work and commitment of NHS staff. Dr Andy Seymour said it was a privilege to work with staff and colleagues in the fight against the virus. Supported by new and innovative pathways, it was hoped the performance of the Gloucestershire ICS would continue to hold strong during this challenging time.

The committee commended the work of NHS staff and the support of  ...  view the full minutes text for item 8.

To receive an update on the work of the One Gloucestershire Integrated Care System (ICS) Partnership.

NHS Partners include: -

NHS Gloucestershire Clinical Commissioning Group

Primary Care (GP) Providers

Gloucestershire Health and Care NHS Foundation Trust

Gloucestershire Hospitals NHS Foundation Trust

South West Ambulance Service NHS Foundation Trust 

The committee received an update on the work of the One Gloucestershire Integrated Care System (ICS) Partnership in its response to the Covid-19 emergency. Partners included: NHS Gloucestershire Clinical Commissioning Group; Primary Care (GP) Providers; Gloucestershire Health and Care NHS Foundation Trust; Gloucestershire Hospitals NHS Foundation Trust and South West Ambulance Service NHS Foundation Trust. 

Advising the committee that the partnership was taking a business as usual approach, it was reported that the challenges of increasing COVID-19 infection rates was placing extreme pressures on the work of the ICS and the delivery of NHS services locally.

Focussing on the progress of the Gloucestershire vaccination roll out, members were informed that the initial stages of the roll out had been very positive. Primary Care Networks were involved in the delivery of the vaccine, with local GPs and community NHS teams administering vaccinations to priority groups from mid December. The programme was due to expand to include other priority groups later in the month. The rate at which vaccinations were being administered across the county was anticipated to increase as additional vaccine supplies became available.

GP practice teams, NHS community services and volunteers were praised for the efficiency in which they had kick-started the programme in Gloucestershire. At the time of the meeting, a network of 10 community vaccination centres were in place, positioning Gloucestershire at the forefront of the community vaccination response and well placed to benefit from increased vaccine supplies.

The report was noted.

To note the NHS Gloucestershire Clinical Commissioning Group (GCCG) Clinical Chair and Accountable Officer report.

Mary Hutton, (representing GCCG and One Gloucestershire Integrated Care System), introduced the NHS Gloucestershire Clinical Commissioning Group (GCCG) Clinical Chair and Accountable Officer Report.

Expanding on the county’s response to the coronavirus pandemic, members were informed that the close partnership working arrangements that existed had, in the first wave of the crisis, responded well to the consistently high demands placed on the delivery of services from increasing COVID-19 infection rates. There were, however, real concerns that the demand for NHS services would increase significantly in January.

Updating members on the progress of the Gloucestershire COVID-19 vaccination programme, the CCG announced that anecdotal evidence reflected a very positive initial roll out for the county. Delivered via the Gloucestershire Hospital Foundation Trust (GHFT) and at 10 community based Primary Care Network sites, 25,000 vaccinations had been administered by 31 December 2021. The majority of vaccinations had been administered to the 80 plus age group, in addition to health and social care workers and to staff and residents from over 49 Care Homes in Gloucestershire.

Recent updates indicated that the roll out continued to be delivered at great pace, in spite of changes to delivery of the second dose of the vaccine.  Responding to concerns about the decision to defer delivery of the second dose to enable more people receive their first vaccination, the NHS CCG explained that the decision was supported by strong scientific evidence and on the advice of the Chief Medical Officer. It was confirmed that no more second doses would be administered in Gloucestershire at this present time. Administering vaccinations to the residents and staff at care homes was a priority. 

Enquiring whether supply issues might hinder the roll out of the vaccine in Gloucestershire, members were reassured that the county had good supplies. This could, however, start to level out over the next few weeks as other parts of the country began to step up the delivery of their programmes.

Responding to questions, Deborah Lee, Chief Executive of the Gloucestershire Hospitals NHS Foundation Trust, outlined some of the limitations that restricted the publication of data relating to the number of vaccinations being administered locally. She explained that the release of information locally was subject to national guidelines and government approval.

When asked if some NHS employees had refused the vaccination, the CCG confirmed that this had not been an issue in Gloucestershire and that only a small number of staff had been cautious about receiving the vaccination. This was primarily due to allergies and known reactions.

The committee commended the speed and efficiency of the Gloucestershire vaccination programme and acknowledged the huge support that had been provided by the voluntary sector and from the Gloucestershire Fire and Rescue Service. Noting the planned approach to administering the vaccine, members were informed that the vaccination would be cascaded to other priority groups as quickly as possible. This included people who were unable to leave their homes. 

The report was noted.

To note the committee work plan and suggest items for consideration at future meetings.

2 March 2021

15 June 2021

13 July 2021

14 September 2021

16 November 2021

In addition to the regular updates to the committee, it was suggested that the committee add the following items to the work plan for consideration at future meetings: -

1.    Contract Patient Transport – Update

2.    Phlebotomy Services in the South Cotswolds – Update

3.    SWAST – Presentation to the new Committee

4.    It was suggested that the committee consider a summary of the work of the committee under the current council with suggestions going forward for the new committee post the May 2021 local elections, and this was agreed.

Updating the committee on the review of Gloucestershire County Council’s scrutiny arrangements introduced in 2019, members were informed that an email would be sent to the members of this and the other scrutiny committees, seeking their views on the scrutiny structure going forward. The review to seek the views of all county councillors, co-opted scrutiny members, district councils, GCC Corporate Leadership Team, plus representatives from partner organisations and other stakeholders.