To note any apologies for absence
Apologies were received from Cllr Helen Molyneux (Forest of Dean District Council).
Declarations of Interest
To confirm any declarations of interest
No declarations of interest were made at the meeting.
To confirm the minutes of the meeting held on 12 January 2021 (attached)
Subject to the following clarification, the minutes of the meeting held on 12 January 2021 were confirmed as an accurate record of that meeting.
Cllr Horwood referenced the dissatisfaction in the update provided at the January meeting from the South West Ambulance Service Foundation Trust (SWAST) and requested that the minutes expand on the concerns of the committee in more detail.
Cllr Horwood acknowledged the technical issues at the meeting but expressed his disappointment that the verbal presentation from SWAST had not provided the committee with more detailed information. Noting that the power-point slides referred to at the meeting had not been presented as a visual presentation and had only been circulated to members after the meeting, Cllr Horwood stressed the importance of receiving regular performance updates from SWAST, with a request for more comparative data, drawing on comparisons with the performance of other ambulance services.
Later in the meeting, it was suggested, (by Mary Hutton, as Accountable Officer of NHS One Gloucestershire), that SWAST include an update in the regular NHS CCG Chair/Accountable Officer report presented at each meeting. (The report currently includes provider updates from Gloucestershire Health and Care NHS Foundation Trust and Gloucestershire Hospitals NHS Foundation Trust).
The committee agreed it was too long to wait for an update on performance until the planned SWAST presentation to the committee at the 13 July 2021 meeting and welcomed the proposal to include regular data/performance updates at each meeting, in addition to the updates included in the CCG performance report to the committee.
Action: SWAST performance updates to be incorporated in the CCG Chair/Accountable Officer report to the committee, (presented at each meeting), alongside regular updates from GHC and GHT. The regular CCG performance report to continue to include SWAST performance data, including out of county comparative information. Action by - CCG
Over the past year the Gloucestershire Health Overview and Scrutiny Committee has piloted an approach whereby members of the public can make representations at committee meetings.
At each meeting, there shall be up to 20 minutes set aside for public 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 make representation at the meeting 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 2 March 2021 is 4.00 pm on Wednesday 24 February 2021.
To confirm your request to make a representation, please email Jo Moore at email@example.com
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.
Public Representation 1: Bren McInerney
I would like to offer my sincere thanks to all the people across all the services for all they are tirelessly undertaking during these unprecedented times. Thank you so very much for this, and for doing this Pre-Covid, Covid, and Post-Covid.
My questions are around external communication to people and communities in the county.
The NHS CCG responses are inserted below each question.
1) How assured are all the health organisations, and public health at the county council, too, confident that their communications and messages are being heard and understood by all our diverse population?
We are working together, across the ICS and with our VCS partners, to ensure that our communications are reaching and being understood by all of our local communities. Our local messaging also draws on national resources; ensuring that we can provide materials in a range of formats and languages.
In addition, we are doing lots of work to target communities who we know are potentially at higher risk of contracting COVID19 and more recently, those who may be hesitant in taking up the vaccine. This has included targeted work with our BAME communities, homeless people, extremely clinically vulnerable.
Over the course of the pandemic our ways of communicating have changed and been adapted depending on the audience. We have introduced a number of initiatives such as the Vulnerable People’s Hub, (which called people who were being asked to shield); Community Champions, (recruiting people from the BAME community to help share messages with their neighbours and networks); work with Gloucestershire Deaf Association to support our deaf community; a vaccination hub to reach the homeless, local testing centres including community testing at The Friendship Café.
Our use of social media has increased and we have created a range of media to share messages in engaging ways, (for example, we are currently working with people from BAME communities, making short film clips with people speaking in their first language).
We are also working on a Facebook live event led by local Polish speaking clinicians and have worked with community radio station GFM. We have been overwhelmed by offers of help with spreading messages relating to COVID and hugely grateful to everyone who has come forward.
2) What reflective process is built in to give this assurance?
This work falls under the remit of a number of cross-organisational working groups including a BAME C-19 Task and Finish Group and Vaccine Equity Group, but at a strategic level through ICC and Tactical Co-ordinating Group and its various work-streams, such as Communications. Detailed plans and evaluation programmes sit behind the work of each of these groups. Our assurance is provided through our data, the feedback from those living and active in our local communities and the reflection re what is working, or not, and why that is the case.
3) What measures do we use to give this assurance?
We are closely analysing data by Ward and GP practice to ... view the full minutes text for item 4.
To receive an update on changes to Community Phlebotomy Services.
Dr Andy Seymour, representing NHS Gloucestershire Clinical Commissioning Group (GCCG), gave a detailed update on local phlebotomy services.
Members were reminded that, in December 2019, the CCG had chosen to fund a new local phlebotomy service, (for primary care generated blood tests), for patients aged 12 years and over as part of its Primary Care Offer (PCO). From July 2020, GP Practices across the county began to offer this service to their patients.
In addition to undertaking primary care generated blood tests, and where capacity allowed, GP Practices were also asked to provide secondary care generated blood tests in order to avoid patients needing to travel to a hospital for a test.
Dr Seymour explained that the impact of the COVID-19 pandemic had, however, reduced the number of patients that could be accommodated at local clinics, transferring resources from phlebotomy services to concentrate on delivering infection controlled processes.
The increasing use of virtual appointments within secondary care, in addition to concerns around clinically vulnerable patients attending an acute hospital site for blood tests, had also led to significantly more secondary care patients wishing to access phlebotomy services at their GP Practice.
Responding to the challenge, a different approach to delivering outpatient services was adopted, including offering phlebotomy services at locations closer to home. In January 2021, the CCG agreed to offer additional funding to GP practices to enable patients requiring blood tests as part of their secondary care treatment to be tested at local GP surgeries. This would allow patients needing a secondary care initiated blood test to have the choice of whether to continue to attend the Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) drop-in phlebotomy service at Cheltenham General or Gloucester Royal Hospital, the bookable service available at Cirencester Hospital or at their local GP Practice (if available).
Noting specific concerns about phlebotomy services in the Cirencester area, Dr Seymour confirmed that the Cirencester Hospital phlebotomy service continued to offer a bookable phlebotomy service for patients aged 16 years of age and over, if required to have a blood test at the request of a hospital based health care professional. This service continued to be available to patients three days a week with a maximum wait time of approximately one week for routine blood tests. Acknowledging there would always be questions about waiting times for some NHS services, Dr Seymour stated that it was important to differentiate between urgent and routine appointments. Urgent appointments would be accommodated sooner, if required.
With the new measures in place, the bookable appointment service had provided 700 appointments between 9 December 2020 and 15 February 2021, of which, 99.3% had resulted in successful blood tests. Originally, the service had been temporarily staffed by Gloucestershire Health and Care NHS Foundation Trust, (GHCFT), using existing members of staff, (Health Care Assistants). Since this time, a recruitment process had been put in place to recruit staff on a more substantive basis. Dr Seymour confirmed that the new post-holder would be ... view the full minutes text for item 5.
To receive an update on the temporary service changes introduced in response to the COVID-19 pandemic.
The committee to consider proposals for the future.
Ellen Rule, representing the NHS Gloucestershire Clinical Commissioning Group (GCCG), gave a detailed update on the temporary service changes introduced by the Gloucestershire Integrated Care System (ICS) in response to the Covid-19 pandemic. The purpose of the update was to seek the committee’s views on the proposal to further extend the temporary service changes introduced in 2020 and ensure continued safe and effective delivery of health and care services in Gloucestershire.
In line with the locally agreed Memorandum of Understanding (MOU), detailed pro-forma documents had been produced to provide an overview of the affected service variations. Appended to the report, the pro-forma documents had been produced to assist members with their understanding of the nature of the changes and to consider the risks involved if the temporary arrangements were not extended.
In presenting the report, the committee was asked to comment on the proposed renewal of the emergency (temporary) service changes presented to the committee in July 2020, (and later extended for a further 6 months in September 2020). The committee was asked to comment on the proposal to extend the service variations from March to June 2021.
Subject to the ongoing success of the Covid-19 vaccination programme and the anticipated reduction in demands on the NHS from having to respond to the Pandemic, the CCG stated it was confident the changes would be reversed at the end of June.
The proposals presented at the meeting included:
1) Extension for a further three months of the temporary reconfiguration of Emergency General Surgery to Gloucestershire Royal Hospital (GRH) from Cheltenham General Hospital (CGH) (temporary change enacted on 1st April 2020, renewed in July 2020, with a further extension of 6 months from September 2020 – March 2021)
2) Extension for a further three months of a series of temporary service changes across the GRH and CGH sites, (enacted on 9th June 2020 and renewed in September 2020 for a further 6 months), to include: -
a) Cheltenham General Hospital, (CGH), Emergency Department to continue to operate as a Minor Intensive Care Unit, 7-days a week 8-8;
b) All 999 and undifferentiated GP referrals centralised at Gloucestershire Royal Hospital, (GRH), including centralisation of the Acute Medical Take, (a consequence of which, given the clinical nature of COVID-19, had resulted in more acute respiratory care moving to GRH since June). It was noted that a significant number of patients whose care pathways had started as assessment or admission at GRH had transferred to inpatient beds at CGH;
c) Acute Stroke Unit (ASU) to remain at CGH, (the Hyper Acute Stroke Unit (HASU) to remain at GRH) and a linked supporting reallocation of beds at the Vale hospital to support additional capacity in stroke rehabilitation care (see below);
d) Emergency and elective (planned) vascular surgery to remain at GRH (although, as part of the winter plan, more elective vascular activity to be delivered at CGH);
e) Emergency Urology pathway to remain ... view the full minutes text for item 6.
To receive an update on the performance of the Gloucestershire Clinical Commissioning Group (GCCG) against NHS Constitutional and other agreed standards.
Mary Hutton, (Lead Officer for the GCCG/One Gloucestershire Integrated Care System), gave an update on the performance of the Gloucestershire CCG against NHS constitutional and other agreed standards, plus a summary of local performance against national standards.
It was reported that, overall, Gloucestershire was performing well and in line with the national position in the NHS response to the pandemic, with the exception of the 4 hour Accident & Emergency (A&E) Department performance target and ambulance response times. It was noted that Gloucestershire A&E performance reflected a general decline in A&E performance nationally.
Delivery of cancer services in Gloucestershire remained strong and was noted for its excellent performance in spite of the pandemic. Good performance was also noted in the provision of mental health services and in the launch of the ‘Think NHS111” initiative, aimed at encouraging patients to contact NHS111 before visiting A&E.
In a short update on issues emerging since publication of the agenda, the committee was advised of a notable reduction in Covid-19 infections throughout Gloucestershire. However, with the steady flow of lower level hospital admissions, it remained important to keep the current Covid-19 safety arrangements in place for the immediate future. This, and the need to plan for the county’s recovery process, had impacted quite significantly on performance during February. It was hoped, with the successful roll out of the Covid-19 vaccination programme, the focus on the response to the pandemic would begin to ease, enabling the CCG to prioritise on other issues.
Cllr Paul Hodgkinson questioned the data on the number of excess deaths recorded for Gloucestershire during the pandemic and stated that he had been surprised that the figure, (reported at 6% higher than normal for Gloucestershire), was not higher. Conscious of the sensitivity surrounding the issue and noting the impact on NHS staff from the emotive repercussions of the pandemic, including treating patients with long-covid symptoms, it was agreed this was a difficult perspective to consider.
Sarah Scott, Executive Director for Adult Social Care and Public Health, clarified that the 427 excess lives lost to the coronavirus during the past year was more than had been anticipated at the outset of the pandemic. Potentially, however, some of the deaths could have resulted from other causes, regardless of the pandemic.
Supported by several other members at the meeting, Cllr Hodgkinson’s comments were noted, supplemented with a request for a breakdown of mortality rates and their causes over the course of the past year. It was agreed that the data would be provided after the meeting, with input from the Executive Director of Adult Social Care and Public Health Action by – NHS CCG
Acknowledging the enormous challenges presented by the pandemic, Cllr Andrew Gravells, commended the tremendous efforts of the NHS CCG in the response to the crisis and in particular, in reducing the number of Covid-19 cases in Gloucester City.
Other members noted a welcome improvement in the 4 hour A & E performance target for Gloucestershire ... view the full minutes text for item 7.
To receive an update on the work of the One Gloucestershire Integrated Care System (ICS) Partnership.
The report to include an update on the Covid-19 response, the Fit for the Future Consultation and the Forest of Dean Community Hospital Consultation.
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
Mary Hutton, representing the One Gloucestershire Integrated Care System, (ICS), gave an update on the work of the partnership in its response to the Covid-19 emergency. NHS partners include: 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.
It was noted that, throughout February 2021, the number of Covid-19 cases in Gloucestershire had continued to fall, with the rate of new infections at 81 per 100,000 population. The number of patients with Covid-19 being admitted to hospital was declining, but other acute services remained under pressure. The ICS aimed to provide as much routine activity as possible during this latest wave of the pandemic and, where possible, increase activity where capacity allowed.
Updating members on some of the issues emerging since publication of the agenda and in the ongoing response to the pandemic, Mary Hutton was pleased to report a huge increase in the number of people being vaccinated as part of the Gloucestershire Covid-19 vaccination programme. The committee welcomed this positive news and commended the success of the programme and all those involved in making this achievement possible.
Seeking clarification on the vaccination programme, Dr Andy Seymour updated the committee on the current position, (based on information reported at the time of the meeting).
The latest information about the community vaccination programme for Gloucestershire can be found on the NHS COVID-19 portal: https://covid19.glos.nhs.uk/vaccinations.
Responding to questions, it was explained that the order/the prioritising of cohorts for vaccination was determined in line with government guidelines. Nevertheless, every effort was being made to vaccinate as many people as possible, including taking a targeted approach to build confidence/vaccinate people from specific groups, including people from ethnic minority groups in which there has been shown to be more vaccine hesitancy.
The committee welcomed plans to recognise the enormous contributions of staff and colleagues in caring for Covid-19 patients and to commemorate the memory of those who had lost their lives during the pandemic. Events aimed to draw from the powerful campaign/video recording ‘every name a person’. To receive more information on the campaign please visit the website below: -
Work was being stepped up on providing end of life care in Gloucestershire, for which a new strategy, (Palliative and End of Life Care Collaborative Strategy 2021-25), would be published in April 2021 and presented to the committee later in the year.
It was suggested that another key aspect of work ‘living with pain’ should provide the focus of a specific event or agenda item later in the year. The Living Well with Pain Programme is a system-wide, ICS, initiative to support people living with persistent pain, helping them to live well and minimise the harms associated with medical treatments for pain
Other items suggested as possible items for consideration at future meetings included; mental health plans/initiatives; the future of the ICS in line with new legislation due in April 2022; ... view the full minutes text for item 8.
To note the NHS Gloucestershire Clinical Commissioning Group (GCCG) Clinical Chair and Accountable Officer report.
Mary Hutton and Dr Andy Seymour, (representing GCCG and One Gloucestershire Integrated Care System), introduced the NHS Gloucestershire Clinical Commissioning Group (GCCG) Clinical Chair and Accountable Officer Report. The report provided an overview of information based on updates from NHS health partners and broken down into the following subsections of the report.
Section A: General NHS Gloucestershire Clinical Commissioning Group (GCCG) commissioner update, incorporating national consultations.
Section B; Commissioner update focussing on primary medical care.
Section C: Trust updates from: Gloucestershire Health and Care NHS Foundation Trust (GHC) and Gloucestershire Hospitals NHS Foundation Trust (GHT).
Commending the hard work of partners and volunteers during the pandemic, members were advised of the award of funding to be invested in continuing the good work and maintaining the positive health and care outcomes.
Responding to questions, Mary Hutton reassured members it was unlikely GP practices in Gloucestershire would be affected by take overs/mergers to form ‘super practices’. It was confirmed that GP practices in Gloucestershire were stable and regarded as quite low risk in the need for financial investment.
Responding to a request from Cllr Martin Horwood for an update on the Gloucestershire Trailblazer Young Minds Matter programme, a detailed briefing note was circulated to the committee in advance of the meeting, (attached to the minutes). Cllr Horwood thanked the CCG for the update and proposed that a detailed report on the mental health of school children, (plus a full report on the trailblazer programme), be presented to the committee at a future meeting. Action by CCG
It was noted that a children’s mental health scrutiny event, (under the auspices of the Children and Families Scrutiny Committee), had been held in November and had been very useful. Going forward, it was hoped a further event would be held as part of the GCC member development programme. The members of this and the Adult Social Care Scrutiny Committee would be invited to the event. Action by - GCC Scrutiny Officers
The responses to questions on other, more generalised, issues, (submitted by Cllrs Martin Horwood, Paul Hodgkinson, Iain Dobie and Stephen Lydon prior to the meeting), are attached to the minutes of the meeting.
The NHS Gloucestershire Clinical Commissioning Group (GCCG) Clinical Chair and Accountable Officer Report was noted.
To review the work of the committee 2017-21 and make suggestions on scrutiny items for the new committee to consider post the council elections in May 2021.
Members were asked to review the work of the committee for the period 2017-21 and make suggestions on scrutiny items for the new committee to consider post the council elections in May 2021.
A summary of some of key items considered by the Health and Care Overview and Scrutiny Committee, (and, later by the Health Overview and Scrutiny Committee), during the period of the current council had been circulated to members prior to the meeting (attached to the minutes).
The following items were suggested as topics for the new committee to consider: -
1. Gloucestershire Trailblazer ‘Young Minds Matter’ Programme/Holistic approach to considering/safeguarding the Mental Health of Young People going forward (a pre-meeting to be arranged to consider specific aspects of work the new committee may wish to consider)
2. Palliative and End of Life Care Collaborative Strategy 2021-25
3. Living Well with Pain Programme
4. A review of the impact of the pandemic on Mental Health (Children and Adult)
5. Planning for ICS Legislation 2022
6. Fit for the Future Programme – including clarification on legal matters
7. SWAST – work and performance
Members were advised that the following suggestions would be considered under the auspices of the Adult Social Care and Communities Scrutiny Committee, for which updates would be shared with HOSC members: -
8. Sexual Health Issues (in relation to the impact of the pandemic)
9. Joint working between CCG Health and Care Teams and local (2 Tier) government departments (eg Housing) – members noted that this work related to the remit of the Adult Social Care and Communities Scrutiny Committee. To avoid duplication, updates to be shared with HOSC members.
10.Cheltenham Festival 2020
Prior to the meeting, Cllr Stephen Lydon had raised serious concerns about the decision to allow the Cheltenham (Horse Racing) Festival to take place in March 2020, amidst growing concerns about the Covid-19 coronavirus.
Seeking the advice of officers on the proposal to set up a scrutiny task and finish group to review the decision, Cllr Lydon had been advised that the County Council had no role in either licencing or permitting the Cheltenham Festival in 2020. Seeking the advice of Public Health England and from the UK Government, the decision to allow the Festival to take place had been taken in accordance with the national guidance at the time, allowing mass events to take place in public.
With the support of several members, Cllr Lydon proposed that the committee write to Public Health England, seeking clarification on the decision to allow the Cheltenham, (Horse Racing), Festival 2020 to proceed as planned, regardless of escalating concerns about the Covid-19 Global Emergency.
The committee agreed with the proposal that a letter be sent to Pubic Health England, seeking: -
a) An explanation on why the Cheltenham Horse Racing Festival had been allowed to take place in March 2020;
b) Clarification on why the decision had been taken at a time of national/international concern regarding the spread of the Covid-19 coronavirus;