Agenda and minutes

Health Overview & Scrutiny Committee - Tuesday 13 July 2021 10.00 am

Venue: Council Chamber - Shire Hall, Gloucester. View directions

No. Item



To note any apologies for absence


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


Chair, Cllr Andrew Gravells, announced the recent appointment of Cllr David Drew as Vice Chair of the Committee. The appointment was made at the Gloucestershire County Council meeting on 30 June 2021.


Declarations of Interest

To receive any declarations of interest at the meeting


Cllr Ray Padilla, (Gloucester City Council representative), declared a non-prejudicial interest in relation to his employment as a registered nurse at Gloucestershire Royal Hospital. Cllr Padilla confirmed there were no conflicts of interest in the items for discussion at today’s meeting.


Cllr Stephen Andrews, (Cotswold District Council representative), declared a non-prejudicial interest in relation to his work as a volunteer first responder with SWAST, (Southwest Ambulance Service NHS Foundation Trust). Cllr Andrews confirmed there were no conflicts of interest in the items for discussion at today’s meeting.


Minutes pdf icon PDF 5 MB

To confirm the minutes of the following meetings: -


a)    26 January 2021 (Joint meeting with Adult Social Care and Communities Scrutiny Committee)


b)    2 March 2021


c)    22 March 2021 (Extraordinary Meeting)

Additional documents:


Subject to the minor amendment below, the minutes of the meetings held on 26 January, 2 March and 22 March 2021 were noted and agreed as a correct record of those meetings. The members of the former committee present at the meeting included, Cllr Andrew Gravells MBE, Cllr Stephen Andrews, Cllr Stephen Hirst, Cllr Jill Smith and Cllr Robert Vines.


The committee noted a correction to page 9 of the minutes of 2 March 2021, (page 39 of the agenda pack), and reference to ‘Minor Intensive Care Unit’ recorded at 2 a) of the minutes. The wording of the minute was corrected to read: -


Cheltenham General Hospital Emergency Department to continue to operate as a Minor Injury & Illness Unit (MIIU) 7days a week from 8am to 8pm.


Public Representations

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 the intention to attend the meeting and make a representation is required three clear working days before the date of the meeting, (excluding the day of the meeting).


The notification deadline to make representation at this committee meeting is 4.00 pm on Wednesday 7 July 2021.



No public representations were made at the meeting.


Public Health COVID-19 Update pdf icon PDF 3 MB

An update on the Covid-19 emergency in Gloucestershire from the Executive Director of Adult Social Care and Public Health.


The GCC Covid-19 Early Warning Indicators report will be presented at the meeting.


Due to unforeseen circumstances and the requirement for presenting officers, Professor Sarah Scott, (Executive Director of Adult Social Care and Public Health), and Siobhan Farmer, (Deputy Director of Public Health), to self isolate, the committee noted the attached Covid-19 Early Warning Indicator Daily Summary Update and was advised to submit any questions relating to the information to after the meeting.


Review of Temporary Service Changes pdf icon PDF 461 KB

To consider an update of temporary service changes proposed for Gloucestershire Hospitals

Additional documents:


Simon Lanceley, representing Gloucestershire Hospitals NHS Foundation Trust, (GHT), and Paul Roberts, representing Gloucestershire Health and Care NHS Foundation Trust  (GHC), gave a detailed update on the status of the COVID-19 Temporary Service Changes introduced during 2020/21, including a brief summary of the proposals presented to the former committee and an outline of service restoration plans. 


It was explained that, as part of the Gloucestershire Integrated Care System’s (ICS) response to the COVID-19 Pandemic, several service changes had been implemented by GHT and by GHC. The changes were implemented as Temporary, (Emergency), Service Changes, as defined in a Memorandum of Understanding agreed between the ICS and the Health Overview and Scrutiny Committee (HOSC). The changes were implemented in 3 phases between April 2020 and January 2021.


The report to the committee, (plus the associated report considered at item 7 of the agenda, Fit for the Future Programme), set out the ICS plans for the continued development of Gloucestershire’s Health Services. The plans aimed to make improvements and sustain the quality of health services in Gloucestershire, in addition to proposing further temporary measures intended to ensure the ICS was able to maintain a state of preparedness for future COVID-19 waves that might impact on health services during the remainder of the year.


In accordance with the commitment to limit the use of temporary service changes, members were informed that proposals to restore the majority of services, including those with the largest impact on patients, had now been completed.


Taking into account ongoing learning from COVID-19 and the current status of the pandemic, including current national COVID-19 regulations, it was proposed that the following Temporary Service Changes be retained: -


1)    Retention of high care respiratory at Gloucestershire Royal Hospital (GRH) (forming part of the acute medical take change).


It was proposed that High Care Respiratory remain at GRH as a Temporary Service Change for the remainder of the fiscal year, (to March 2022), to enable GHT and GHC maintain their ability to be responsive to further ‘waves’ of COVID-19 that might impact during the rest of the year. It was proposed that work continue on the evidence to develop a longer-term proposal for Respiratory Care in Gloucestershire, for which an update would be provided at the next meeting of HOSC.


2)    Retention of Acute Stroke and Rehabilitation at Cheltenham General Hospital (CGH).


It was proposed Acute Stroke & Rehabilitation Services be retained at Cheltenham General Hospital and for the additional Stroke Rehabilitation beds located at the Vale Community Hospital be retained as a Temporary Service Change until March 2022. It was agreed work should continue on developing a longer-term proposal for Stroke Care in Gloucestershire, for which an update would be provided at the next meeting of HOSC.


3)    Retention of Medical Day Unit at Cheltenham General Hospital CGH


Given the positive benefits already identified from locating the Medical Day Unit at CGH, (both for patients accessing  ...  view the full minutes text for item 6.


Fit for the Future Programme pdf icon PDF 476 KB

To receive an update on Fit for the Future Consultation Programme



The committee received an update on the progress of the Fit for the Future (FFTF) Programme, including an overview of issues raised by HOSC at previous meetings and proposals relating to the next stage of implementation of the programme (FFTF Phase 2). 


Fit for the Future (FFTF) is part of the One Gloucestershire ICS vision focussing on the medium and long-term future of specialist hospital services at Cheltenham General Hospital and Gloucestershire Royal Hospital. The aim of the programme is to:


a)    Improve health outcomes for the people of Gloucestershire

b)    Reduce waiting times and ensure fewer cancelled operations

c)    Ensure patients receive the right care at the right time in the right place

d)    Ensure safe staffing levels, including senior doctors available 24/7

e)    Support joint working between services to reduce the number of visits patients make to hospital

f)     Attract and retain the best staff in Gloucestershire.


Following publication of the NHS Long Term Plan in January 2019, HOSC has received more than 10 reports and presentations relevant to the development of specialist hospital services in Gloucestershire: dedicated FFTF agenda Items; and regular updates as part of the NHS Gloucestershire CCG Clinical Chair and Accountable Officer’s Report and the ICS Lead Report.


The report considered at this meeting included an update on the progress to date of implementation of the FFTF proposals approved by the GCCG in March 2021. It was noted that implementation of the proposals would be phased and not fully implemented until 2022/2023.


The committee was informed that the following service changes had been approved by the CCG Governing Body at a meeting on 18 March 2021.


1)    Formalise ‘Pilot’ Configuration for Gastroenterology inpatient services at CGH

2)    Formalise ‘Pilot’ Configuration for Trauma at GRH and Orthopaedics at CGH

3)    Centralise Emergency General Surgery at GRH

4)    An Image Guided Interventional Surgery ‘Hub’ at GRH and ‘Spoke’ at CGH

5)    Centralise Vascular Surgery at GRH

6)    Centralise Acute Medicine (Acute Medical Take) at GRH

7)    Planned General Surgery. (This recommendation relates to further work on defining a new option to deliver: a) Planned High Risk Upper Gastrointestinal (GI) and Lower Gastrointestinal (Colorectal) surgery at Gloucestershire Royal Hospital and b) Planned complex and routine inpatient and day case surgery in both Upper and Lower GI (Colorectal) at Cheltenham General Hospital).


FFTF Pre-Consultation (PCBC) and Decision-Making business cases (DMBC), including the relevant appendices, can be viewed here


The new members of the committee were advised that FFTF proposals had been considered by the former committee on several occasions, culminating in some members raising concerns on issues for which further information had been requested. Notable discussions had taken place at HOSC meetings held in October 2020, January 2021 and March 2021. (A summary of the discussions, including updates on specific issues, can be found at pages 2 to 4 of the report relating to this item).


The purpose of the update at this meeting was to provide the new  ...  view the full minutes text for item 7.


NHS Gloucestershire Clinical Commissioning Group (GCCG) Performance Report pdf icon PDF 2 MB

To consider an overview of performance by the Gloucestershire Clinical Commissioning Group (GCCG) against NHS constitutional and other agreed standards.


To include an update on ambulance response times during the COVID-19 Pandemic.



The committee received an overview on the performance of the local NHS based on a range of national priorities and other agreed local standards. The report included an update on ambulance response times in Gloucestershire by the South West Ambulance Service Foundation Trust (SWAST), including the impact of the COVID-19 Pandemic.


The update included the following information: -


a)    Recovery of NHS service activity and performance following the COVID-19 pandemic was underway. Urgent care services, in particular, were experiencing additional pressures/demand in comparison to the demands on services experienced during periods of national lockdown;


b)    Performance remained strong in respect of delivering cancer services in Gloucestershire and was showing good recovery in comparison with other CCG areas in the South West Region in respect of elective services. Notable areas of recovery and performance included; local imaging investigative (diagnostic) services and the reduction of patients waiting over 52 weeks for treatment;


c)    Demand for all healthcare in Gloucestershire, (in response to COVID-19 pressures from increased transmission of the ‘delta variant’), was likely to impact on the recovery process from the pandemic for the remainder of the year;


d)    NHS England/Improvement Oversight assessments published in November 2020 rated the overall performance of the NHS Gloucestershire Clinical Commissioning Group (CCG) 2019/2020 as ‘good’ based on the assessment of the following performance indicators: i) new service models; ii) preventing ill health and reducing inequalities; iii) quality of care and outcomes; iv) leadership and workforce and v) finance and use of resources.


e)    Performance against key standards continued to follow national trends, with the exception of Accident and Emergency (A&E) and Ambulance (Category 1) response times. (The Gloucestershire response time was reported as 7.8 minutes against a national response time of 7 minutes. The response time had risen again in May 2021 to 8 minutes).


f)     The committee enquired into possible explanations for the high demand in urgent care and the pressures being experienced by SWASFT. It was suggested that a possible explanation for the high demand in urgent care was the increased volume of people taking holidays locally and in the UK, (due to the pandemic), which in turn, was impacting on the high demand for ambulance services. In spite of the efforts to clear the backlog of work, urgent care services continued to be experiencing significant pressures. It was hoped, an audit due to be undertaken later in the week would provide a better understanding of the increased number of people requiring urgent care.


It was confirmed that the Gloucestershire Vaccination Programme continued to be very successful and had reached a high proportion of the local population.


One member of the committee reflected on the increasing pressures on SWASFT and the use of first responders and volunteers in rural areas. It was suggested a focus on effective communications to encourage the recruitment of both first responders and volunteers would be helpful to maintain sufficient levels of assistance and support. A detailed report on ambulance response times  ...  view the full minutes text for item 8.


One Gloucestershire Integrated Care System Report pdf icon PDF 202 KB

To receive an update from the One Gloucestershire Integrated Care System (ICS) Partnership.


The NHS Partners of One Gloucestershire 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 response to the Covid-19 emergency. 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. 


Members received an update on the COVID-19 Vaccination Programme, where it was reported that, at the beginning of June 2021, over 700,000 doses of the vaccine had been given to Gloucestershire residents, including over 200,000 second doses since commencement of the rollout  in December 2020. It was confirmed that all priority groups had been invited for their first vaccination, with those at greatest risk invited for second doses. Excellent progress was being made in the delivery of the second phase of the programme, including the younger cohorts.


Information on the community vaccination programme for Gloucestershire can be accessed at the NHS COVID-19 portal here


During May 2021, the Gloucestershire COVID-19 Vaccine Equity Group, in partnership with Inclusion Gloucestershire and the Gloucestershire Deaf Association, had delivered a virtual skills sharing session for COVID-19 vaccinators. A report on the work and progress of this group to be made at a future meeting. Action by – NHS CCG


The report was noted.


GCCG Clinical Chair/Accountable Officer Report pdf icon PDF 233 KB

To note the NHS Gloucestershire Clinical Commissioning Group (GCCG) Clinical Chair and Accountable Officers’ Report.



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


Key information highlighted by the report included: -


a)    Primary Care Appointments


Following on from questions relating to GP appointments asked earlier in the meeting, the committee noted data released by NHS Digital in relation to recent press attention on increased activities in GP practices. The report confirmed that, during the most recent 12 month period, (up to and including activity in April 2021), there had been a 6% increase in activity in comparison to the previous 12 month period from May 2019 to April 2020. Nationally, 392 appointments per thousand patients had been recorded in April 2021, (265 in April 2020 and 399 in April 2019).


Data relating to Gloucestershire reported 437 appointments per thousand patients, in comparison to 290 appointments per thousand in April 2020 and 418 in April 2019. A significant drop in appointments in April 2020 reflected the impact of the first COVID-19 lockdown. Taking account of activity in 2019, the latest figures represented an upward trend.


It was noted that 61% of all appointments in Gloucestershire during April 2021 had been face-to-face, (55% nationally). This figure reflected huge efforts by local GP practices to deliver the COVID-19 vaccination programme, in addition to providing urgent and routine care.


b)   Care Quality Commission (CQC) for General Practice, mergers and changes to Primary Care Networks


From April 2021, the Care Quality Commission (CQC) had resumed its inspections of independent primary care providers. Inspections will be specific ‘focused inspections’ looking at three key areas/questions, (safe, effective and well-led), plus any other areas identified as concerns from previous inspections.


In February 2021, the CQC made an unannounced inspection of the Urgent and Emergency Care Unit (UEC) at Gloucestershire Royal Hospital. It was confirmed that, whilst the hospital had retained an overall ‘Good’ rating, the UEC service had been rated as ‘Requiring Improvement’. The CQC report included a number of positive observations, relating to staff and the needs of patients. As a result of the inspection, the Gloucestershire Hospitals NHS Foundation Trust (GHT) was continually assessing and making changes to the way Emergency Departments were run. A number of measures had been introduced which were already making a positive impact.


These included:-


                      i.        Eliminating corridor care within emergency departments/ creating more space;

                    ii.        Improving ambulance drop off times by establishing additional drop off points;

                   iii.        Responding to walk-in patients more rapidly;

                   iv.        Ensuring patients are seen by the most appropriate doctor/by-passing the Emergency Department, if appropriate.


The impact of the new measures were encouraging, including improvements to the average wait time of a patient in an ambulance. The Trust had been commended by NHS Improvement (NHSI) for addressing the areas under question and for making significant improvements. It was noted, however, that significant challenges remained in respect of improvements to the four hour wait time  ...  view the full minutes text for item 10.


Work Plan pdf icon PDF 97 KB

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



13 July

14 September (to move to October for consideration of the Winter Plan)

16 November



11 January

8 March

17 May

12 July

13 September

15 November


Members were advised that issues relating to the committee work plan would be considered by the NHS Reference Group. Please see attached the terms of reference for the group.


It was explained that the NHS Reference Group provides a forum for early, informal and confidential ‘no surprises’ discussions between the NHS Gloucestershire Clinical Commissioning Group (GCCG), NHS provider organisations, (Gloucestershire Hospitals NHS Foundation Trust and Gloucestershire Health and Care NHS Foundation Trust), Primary care service providers, (GP services only), and representatives of the Gloucestershire Health Overview and Scrutiny Committee (HOSC) and Healthwatch Gloucestershire, about potential service developments or changes. 


The key functions of the group are to:-


1)    Act as an informal confidential forum for discussing possible service developments at an early stage prior to the normal impact assessment process;

2)    Provide a ‘sense check’ on possible service developments from an Elected Member/Community perspective;

3)    Discuss plans for communication and engagement prior to publication of service development or change proposals;

4)    Provide feedback to help influence the focus of impact assessments to support the process for determining whether a proposed change constitutes a ‘substantial variation’.


Chair, Cllr Andrew Gravells, plus the following representatives, (representing the main political groups and district members of the committee), have been invited to attend future reference group meetings: - Cllrs David Drew, David Brown and Stephen Andrews.


The committee noted the dates of future HOSC meetings and suggested the following topics as items for consideration: -


12 October 2021


a)    Gloucestershire NHS Winter Sustainability and Surge Management Plan 2021/22


The committee agreed that the date of the scheduled HOSC meeting on 14 September 2021 to be changed to 12 October 2021 to allow members to consider NHS Winter Plan Proposals. Members of the Gloucestershire County Council Adult Social Care and Communities Scrutiny Committee to be invited to submit any questions on the Gloucestershire NHS Winter Sustainability and Surge Management Plan 2021/22 prior to the meeting.


b)    SWAST Annual Presentation


16 November 2021


Possible agenda items at the 16 November 2021 meeting to include:-


1)    Mental Health Presentation


11 January 2022


Possible agenda items at the 11 January 2022 meeting to include


1)    Vaccination Update (update to be included in the ICS report)


8 March 2022


The 8 March 2022 meeting to be held as a joint meeting with the GCC Adult Social Care and Communities Scrutiny Committee to: -


1)    Gloucestershire NHS Winter Sustainability and Surge Management Plan 2021/22 Review


2)    ICS Legislation/Development Update



17 May 2022


12 July 2022


13 September 2022


15 November 2022 (possible joint meeting with the GCC Adult Social Care and Communities Scrutiny Committee)


Updates on the NHS Fit for the Future Programme to be included in the regular NHS update reports to the committee.