Agenda and minutes

To note any apologies for absence.

Apologies were received from Cllr Helen Fenton, (representing Stroud District Council), Cllr Helen Molyneux, (representing Forest of Dean District Council), Cllr Stephan Fifield (GCC), and Cllr Linda Cohen (GCC).

Cllr Terry Hale substituted for Cllr Fifield. Cllr Suzanne Williams substituted for Cllr Cohen. There were no other substitutions.

Apologies were also received from Angela Potter, (Gloucestershire Health and Care NHS Foundation Trust).

To report any declarations of interest at the meeting.

Cllr Stephen Andrews, (Cotswold District Council representative), declared a non-prejudicial interest in the items on the agenda relating to his work as a volunteer first responder with SWAST, (Southwest Ambulance Service NHS Foundation Trust).

To confirm the minutes of the meeting held on 13 July 2021 (attached).

The minutes of the meeting held on 13 July 2021 were agreed and confirmed as a correct record of that meeting.

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 representations.

Any person who lives or works in the county, or is affected by the work of the County Council, may make a written 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 submit a representation is required three clear working days before the date of the meeting, (excluding the day of the meeting). If in attendance at the meeting, the person making the representation may address the committee, (3 minutes per representative), in acknowledgement of the response to their representation.

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

No representations were made at the meeting.

Cllr Andrew Gravells, (Chair), proposed that the process for considering public representations at Health Overview and Scrutiny Meetings be reviewed at a future meeting.

An update from the South Western Ambulance Service NHS Foundation Trust (SWASFT).

Members are invited to submit any written questions relating to this item prior to the meeting (please submit any questions by 4.00pm on Wednesday 6 October 2021).

Representatives from the South West Ambulance Service NHS Foundation Trust (SWASFT) updated the committee on current activities, issues and performance. Stephanie Bonser, Kevin Dickens and Rhys Hancock gave a detailed introduction to the report before responding to questions.

The committee noted ambulance incident numbers, (including Category 1 and 2 ambulance response times), for the South West region during the period August 2020 to September 2021. Category 1 refers to the triage category for ambulance emergency response times for the most seriously unwell patients in the region, including those in cardiac arrest. Category 2 refers to the triage category for patients with a more clinically stable condition but still require an emergency response. At the time of the meeting, the Category 1 mean response time target for the purpose of performance standards was 7 minutes. The Category 2 mean response time target was 18 minutes.

Members were informed that the Trust had experienced significantly higher than normal activity levels during the period following the easing of Covid-19 lockdown measures in May 2021. Weekly incidents had been recorded at over 20,000 incidents for the 18 consecutive weeks between 3 May and 5 September 2021. An increase in tourism activity across the region, particularly over the summer months, had been a notable factor in the increased number of emergency incidents.

Referring to detailed graphs included in the report, it was noted that the Category 1 performance for the South West had been broadly in line with the national target, with the majority of patients receiving a response within 10 minutes. Category 2 performance, however, remained a significant challenge with performance levels falling below the national target.

One of the key factors influencing performance since the easing of government lockdown measures had been the unprecedented demand on the ambulance service experienced during August and September 2021. By means of explanation, it was noted that, over the previous 2 years, there had only been 2 weeks during which the Trust had experienced above 20,000 incidents in one week, both of which had fallen over the Christmas and New Year period in 2019, when activity is traditionally expected to be higher than normal.

In terms of activity illustrated by Clinical Commissioning Group area, (recorded as comparisons between data recorded in September 2019 and corresponding weeks in 2020), it was reported that each area had experienced a significant increase, with Gloucestershire showing an increase of almost 24%. This was further highlighted by data recorded for Gloucestershire in September 2021 and reports of an average of 2383 incidents per week, again a significant increase.

Another significant factor affecting performance was the impact of handover delays at hospital emergency departments. Increased pressure points in the system continued to have a direct impact on the resources available to respond to the number of emergency calls received. Capacity challenges and flow within hospitals continued to impact on their ability to accept ambulance patients in a timely manner, with the national handover standard being 15 minutes. SWAST continued to  ...  view the full minutes text for item 5.

A presentation on the Gloucestershire NHS Urgent and Emergency Winter Sustainability Plan 2021-22.

Members are invited to submit any written questions relating to this item prior to the meeting (please submit questions by 4.00pm on Wednesday 6 October 2021).

Jeannette Hudson, Deputy Director of Commissioning: Urgent and Emergency Care for the Gloucestershire Clinical Commissioning Group, gave an update on the Gloucestershire NHS Urgent and Emergency Care Winter Sustainability Plan (2021-22).

The purpose of the plan is to ensure that the Gloucestershire Health and Social Care System is able to provide resilient health and social care services throughout the year, with a particular focus upon the winter months.

The Gloucestershire Winter Sustainability Plan 2021/22 has been developed this year against the challenges created by the ongoing impact of the Covid-19 Pandemic, in addition to the normal anticipated winter challenges of planning for Seasonal Flu and Respiratory Syncytial Virus (RSV) and the significant workforce challenges across Health and Social Care.

The current plan was developed by working closely with system partners across the Integrated Care System, including Gloucestershire Clinical Commissioning Group, (GCCG), Gloucestershire County Council (GCC) Adult Social Care Services, Gloucestershire Hospitals NHS Foundation Trust (GHT), Primary Care, E-Zec Medical, (Patient Transport Provider), Gloucestershire Health and Care NHS Foundation Trust (GHC), South Western Ambulance Service NHS Foundation Trust (SWAST) and other private sector providers.

The key aims of the Gloucestershire plan, include:

a)    Ensuring the resilience of all key services.

b)    Maintaining patient flow across acute, community and social care.

c)    Continuing dual focus upon ‘Front Door’ attendance/admission avoidance and ‘Back Door’ flow.

d)    Continuing to maintain strong service delivery in Primary and Community Care.

e)    Expanding and improving mental health services and services for people with Learning Disabilities/Autism.

f)     Continuing to meet Covid-19 requirements and guidelines.

g)    Taking action to mitigate key staffing pressures.

h)   Supporting the health and wellbeing of health and social care staff.

i)     Implementing the seasonal flu vaccination programme alongside delivery of the Covid-19 vaccination and booster programmes.

j)      Delivering ‘NHS111 First’ and maximising the contribution of clinical triage and assessment.

k)    Maximising ‘Hear and Treat’ and ‘See and Treat’ initiatives within the Ambulance service.

l)     Minimising Ambulance handover delays.

m)  Continuing to expand the use and support provided by the Voluntary Sector.

n)   Continuing to work closely in partnership with Gloucestershire Adult Social Care services to ensure that those who are medically fit for discharge are not delayed in leaving hospital.

Outlining some of key lessons learned in response to the Covid-19 Pandemic, members were advised of the key risks and anticipated issues likely to affect the delivery of services during the winter months. These included: - 

1)    Situations where demand exceeds capacity: to be mitigated by system-wide demand and capacity planning and agreed system schemes/investments.

2)    Workforce pressures across Health and Social Care: to be mitigated by additional workforce investments, mutual aid and targeted recruitment campaigns.

3)    Risks related to increased Covid-19 cases: including the challenges presented with increased patients, changes to guidance and the challenges of around IPC (Social distancing, PPE, additional cleaning). Such risks impact on capacity within health and social care and within the workforce.

4)    Difficulties in maintaining operational performance standards: situations where  ...  view the full minutes text for item 6.

An update on the Gloucestershire Hospitals NHS Foundation Trust (GHT) Estate.

Appendix 1: Building the Future at Our Hospitals

Simon Lanceley, from Gloucestershire Hospitals NHS Foundation Trust, (GHT) gave an update on the £100m investment on transforming services and providing better patient care at Cheltenham General and Gloucestershire Royal Hospitals. Building works on the £44.5m programme started in August (2021) and are due to be completed in Summer 2023. Other improvement works, totalling £55.5m across both sites will run in parallel. 

The investment will enable GHT to provide the next generation of care at Cheltenham General and Gloucestershire Royal Hospitals and establish ground-breaking specialist services across both sites. At Cheltenham General Hospital, the focus will be on planned care modelled on the outstanding services already provided by the hospital’s cancer service, in particular, the Oncology Department. At Gloucestershire Royal Hospital, the focus will be to establish specialist services with a focus on urgent and emergency care.

Green funding will assist in reducing carbon emissions at both sites and help make both hospitals more sustainable for the future. Members welcomed the decision to include a range of green technologies as part of the investment, including heating system upgrade and pipe insulation, installation of solar panels on roofs and installation of a new battery storage system to the hospitals’ electrical distribution network.

Improvements at Cheltenham General Hospital include:

1)    Two new operating theatres opposite the Oncology Centre providing capacity to treat an additional 3,000 patients a year

2)    A new purpose-built Day Surgery Unit enabling a greater number of day case operations

3)    Extensive refurbishment of the Radiology Department and installation of new CT scanners, MRI scanner and greatly enhanced patient environment meaning emergency patients accessing the town’s A&E will benefit from faster, more accurate and better diagnostic tests such as X-rays and MRI scans

4)    A new CT scanner and improved patient area in radiotherapy enhancing further the Oncology Department’s outstanding reputation

5)    The establishment of a new Interventional Radiology room (spoke) to provide specialist support to Urology and Oncology services.

Improvements at Gloucestershire Royal Hospital include:

1)    A significant extension and redesign of the Emergency Department to improve patient flow along with improved Mental Health provision

2)    The extension of the Acute Medicine Initial Assessment (AMIA) area which provides an improved same day emergency care provision

3)    The extension of the Acute Medical Assessment Unit.  This will increase the bed space by 17 beds and enable the centralisation of acute medicine at GRH

4)    The conversion of non-clinical space within Gallery Wing to create a new 24 bed ward

5)    Establishing surgical robotics across oesophagus, stomach and gall bladder patients (upper gastrointestinal tract) with a multi-speciality programme commencing shortly

6)    The establishment of a pioneering hub to house image guided interventional surgery which will make Gloucestershire amongst the best in the country for providing the full range of interventional radiology (using Imaging equipment (X-rays and Ultrasound)) to guide surgical procedures across a range of specialities).

Detailing the financial background to the investment, it was explained that a significant proportion of the funding, £39.5m,  ...  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 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.

An update from the One Gloucestershire Integrated Care System (ICS) Partnership.

NHS Partners include: -

NHS Gloucestershire Clinical Commissioning Group (CCG)

Primary Care (GP) Providers

Gloucestershire Health and Care NHS Foundation Trust (GHC) Gloucestershire Hospitals NHS Foundation Trust (GHT)

South West Ambulance Service NHS Foundation Trust (SWASFT)

Committee members are invited to note and comment on the following documents: -

Appendix 1: Memorandum of Understanding: Minor Injury and Illness Units Continuation of Temporary Service Change

Appendix 2: Memorandum of Understanding: Lung Function and Sleep Services

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 noted the progress being made in working towards the further integration of health services, (subject to the progression of the Health and Care Bill 2021-22), to enable the Integrated Care System to commit to a formal partnership in April 2022.

Guidance released in August 2021 proposed the legal establishment of an Integrated Care Board (ICB), including the development of a list of statutory CCG functions to be conferred on the Integrated Care Board and enable the development of the Constitution. It was announced that Dame Gill Morgan had been named, (by NHS England|), as Chair designate for the Gloucestershire Integrated Care Board. The Board will be responsible for the day to day running of the NHS, locally and for developing a plan to meet the healthcare needs of Gloucestershire. Work will be undertaken to ensure the smooth closure of the CCG, in parallel with establishing the ICB from 1 April 2022.

The committee was asked to consider Appendix 1 of the report, (Memorandum of Understanding Pro-forma), relating to the proposed continuation of temporary service change to Minor Injury and Illness Units.

County wide Minor Injury & Illness Units (MIIU) were reviewed as an Emergency (temporary) Service Change on 1st April 2020, (as part of GHC’s response to the first phase of the COVID-19 Pandemic), and again in September 2020. Appendix 1 proposed that the current status of MIIU opening hours and model of delivery, (hybrid of walk-ins and bookable appointments), remain in place, support by the provision of a clinical MIIU telephone triage.

The committee noted the Memorandum of Understanding at Appendix 1 to the report and agreed and confirmed the proposed continuation of temporary service changes to Minor Injury and Illness Units.

The committee also considered Appendix 2 to the report, (Memorandum of Understanding Pro-forma), relating to a proposed service variation to Lung Function and Sleep Services.

The Lung Function and Sleep Service (LF&SS) provides investigation, monitoring and testing for respiratory diseases, (problems with the upper airway, the lungs, the chest wall and the ventilatory control system); non-invasive ventilation, (the use of breathing support administered through a full face or nasal mask) and identification and treatment for sleep disordered breathing conditions. In addition, the service delivers investigation, testing and assessment of the digestive or gastrointestinal (GI) system.

Members were advised of the proposal to provide the majority of outpatient diagnostic testing at CGH and an inpatient service, supporting other patients staying overnight at the hospital that require Lung Function diagnostic testing, at GRH. The service at Gloucester would help support lung cancer patients when attending GRH for Endobronchial Ultrasound investigations in Endoscopy.

The committee noted the Memorandum  ...  view the full minutes text for item 9.

To note the NHS Gloucestershire Clinical Commissioning Group (GCCG) Clinical Chair and Accountable Officers Information Report (October 2021).

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

To note the dates of future meetings and suggest items of interest to add to the committee work plan.

2021

16 November (this meeting will be held on 30 November 2021)

2022

11 January

8 March (a joint meeting with the Adult Social Care and Communities Scrutiny Committee)

17 May

12 July

13 September

15 November

The committee noted the dates of future meetings.

16 November 2021 (this meeting was rescheduled and will now be held on 30 November 2021)

11 January 2022

8 March 2022 (joint meeting with the Adult Social Care and Communities Scrutiny Committee to review the Winter Plan)

17 May 2022

12 July 2022

13 September 2022

15 November 2022

Ingrid Barker, Chair of Gloucestershire Health and Care NHS Foundation Trust, advised members of the date of the Gloucestershire Health and Care NHS Foundation Trust’s Annual Meeting with HOSC as 28 October 2021 at 10.00am. The meeting will be a remote access meeting.