Agenda and minutes

Health Overview & Scrutiny Committee - Monday 22 March 2021 10.30 am

Items
No. Item

1.

Apologies

To note any apologies for absence

Minutes:

Apologies were received from Cllr Helen Molyneux, (Forest of Dean District representative) and from Cllr Dilys Neill, (Cotswold District representative). Cllr Stephen Andrews substituted for Cllr Neill at the meeting.

2.

Declarations of Interest

To receive any declarations of interest in relation to the matters for consideration at the meeting. Please refer to the notes at the end of the agenda for guidance.

Minutes:

No declarations of interest were made at the meeting.

3.

Public Representations pdf icon PDF 115 KB

At each meeting, there shall be up to 20 minutes set aside for public representations, (3 minutes 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 an 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 22 March 2021 is 4.00 pm on Tuesday 16 March 2021.

 

To confirm your request to make a representation at this meeting, please email Jo  Moore at 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, could you please include in the email.

Minutes:

At the Health Overview and Scrutiny Committee (HOSC) meeting on 2 March 2021, members supported the request for an additional meeting to consider the outcomes of the CCG Governing Body decision on 18 March 2021 regarding proposals based on the Fit for the Future Consultation: Developing Specialist Hospital Services in Gloucestershire and Decision Making Business Case.

 

Julius Marstrand from REACH, (Restore Emergency At Cheltenham General Hospital), was invited to speak at the meeting, following a late request to make representation. Committee Chair, Cllr Stephen Hirst, confirmed that a dispensation would be granted for the representation to be made, (to allow members to consider the views of the REACH Campaign on proposed changes to specialist hospital services in the county)

 

Launched by the Cheltenham Chamber of Commerce, and supported by local businesses and stakeholders, the aim of the REACH Campaign is to achieve the following objective: -

 

“To reinstate a fully functioning, fully staffed A&E Department operating 24/7 at Cheltenham General Hospital, serving a population of at least 200,000 in Cheltenham, Tewkesbury Borough and the North Cotswolds, at the earliest possible opportunity.” 

 

In response to the continuing reduction in Covid-19 community transmission and falling hospital admissions, a media statement, (24 February 2021), was released by the One Gloucestershire Integrated Care System (ICS) confirming the intention to reinstate Cheltenham A&E to pre-Covid arrangements no later than 1 July 2021, (24/7 A&E – nurse led 8pm-8am). The statement is attached to the minutes of the meeting.

 

Representation made by Julius Marstrand (on behalf of REACH)

 

Public Consultation Process

 

REACH believes the ‘Fit for the Future’ consultation was deeply flawed because it only presented the public with a very one-sided view of the argument.  It did not provide adequate opportunities for alternative or opposing views to be presented to the public. If One Gloucestershire and the Hospital Trust had been so confident of the logic of their proposals they would not have provided such a one-sided public consultation in which legitimate opposition was effectively excluded from the main public consultation.

 

REACH did an excellent job of informing the public of some of the negative consequences of some of the proposed changes, on an absolutely minimal budget compared to the huge spending on the public consultation by One Gloucestershire and the Hospital Trust. This was not entirely due to the pandemic,  but it was certainly one of the major issues of attempting to hold a major public consultation in the middle of a pandemic.

 

Preparing Gloucestershire Hospitals for Future Pandemics

 

The other and far more important issue (raised by the pandemic) is that it is now very obvious the NHS was ill-prepared for a pandemic on this scale, with insufficient bed capacity and insufficient Intensive Care Capacity.

 

The proposed changes were determined in 2018/19 before the pandemic.  The proposals took no account of what has been has been learnt from the pandemic and include no provisions for pandemic-proofing Gloucestershire Hospitals.  The ability to separate the ‘Green’ (Covid-free)  ...  view the full minutes text for item 3.

4.

Fit for the Future pdf icon PDF 584 KB

The Gloucestershire Health Overview and Scrutiny Committee (HOSC) to consider the Output of the Fit for the Future Consultation and the decisions made at the NHS Gloucestershire Clinical Commissioning Group Governing Body meeting on Thursday 18 March 2021. The decisions were informed by the Decision Making Business Case (DMBC).

 

The DMBC sets out proposed resolutions for the medium and long term future of specialist hospital services, including:-

 

Ø  Acute Medicine (specifically acute medical take)

Ø  Emergency General Surgery

Ø  Gastroenterology inpatient services

Ø  Image Guided Interventional Surgery (IGIS) including Vascular Surgery

Ø  Trauma and Orthopaedic (T&O) inpatient services

 

The DMBC also includes a resolution for Planned General Surgery, proposing further work to define a new option to deliver: -

 

Ø  Planned high risk Upper Gastrointestinal (GI) and Lower Gastrointestinal (Colorectal) surgery at Gloucestershire Royal Hospital;

Ø  Planned complex and routine inpatient and day case surgery in both Upper and Lower GI (Colorectal) at Cheltenham General Hospital.

 

Should the resolution for Planned General Surgery be agreed, the public and NHS staff will be given the opportunity to inform the definition of a new option.

 

Consideration of the DMBC at the Governing Body meeting on 18 March 2021 follows the public and stakeholder consultation in 2020, enabling Gloucestershire Hospitals NHS Foundation Trust and GCCG to consider, in detail, an Output of Consultation Report; Citizens’ Jury reports and representations made by members of the public, staff and stakeholders.

 

The Governing Body papers, (including DMBC), plus meeting information are available at: www.gloucestershireccg.nhs.uk/category/board-meetings

 

Following a request by the Health Overview and Scrutiny Committee to further review the Fit for the Future consultation, the committee to receive a detailed presentation on the Fit For The Future consultation process, responses, and post consultation activity, including the outcomes of the discussion at the Governing Board meeting on 18 March 2021, before agreeing the committee response to the proposals, including any actions.

Additional documents:

Minutes:

At the Health Overview and Scrutiny Committee (HOSC) meeting on 2 March 2021, the committee agreed to a request from Cllr Martin Horwood for an additional meeting to be arranged to enable the committee to consider the decisions of the Clinical Commissioning Group (CCG) Governing Body meeting on 18 March 2021 regarding the outcomes of the Fit for the Future: Developing Specialist Hospital Services in Gloucestershire Consultation and Decision Making Business Case.

 

At the HOSC meeting on 2 March 2021, members reflected on the Fit for the Future update provided at the committee meeting on 12 January 2021 and expressed their disappointment at not being given an opportunity to discuss the outcomes of the consultation due to the proximity of the 12 January 2021 HOSC meeting and the end of the consultation period with the preparation of the Output of Consultation Report and Presentation, (shared shortly before the January HOSC meeting less that one week prior), and at not being able to scrutinise the details of the decision making business case, due for consideration by the CCG Governing Body at a meeting on 18 March 2021.

 

Expressing concern about possible inaccuracies in the reporting of the bed assurance test, Cllr Martin Horwood requested that the additional meeting be arranged to consider ‘serious unanswered questions’ relating to the proposed service changes, including questions relating to vascular surgery and centres of excellence.

 

Supporting the request for an additional meeting, members were reminded that, at the committee meeting on 12 January 2021, the committee had been asked to comment on the outputs and recommendations from the consultation and to submit any questions prior to consideration at the 2 March 2021 meeting.  No comments had been received from members. 

 

Having set the context of the meeting, Cllr Stephen Hirst, (as Chairman), explained that the purpose of the extraordinary meeting on 22 March 2021 was to provide the committee with a further opportunity to consider the outcomes of the consultation, in addition to commenting on the resolutions agreed by the CCG Governing Body on 18 March 2021, regarding the medium and long term future of specialist hospital services in Gloucestershire

 

The decisions at the Governing Body meeting were informed by the Fit for the Future Decision Making Business Case (DMBC), based on proposals relating to:-

 

Ø  Acute Medicine (specifically acute medical take)

Ø  Emergency General Surgery

Ø  Gastroenterology inpatient services

Ø  Image Guided Interventional Surgery (IGIS) including Vascular Surgery

Ø  Trauma and Orthopaedic (T&O) inpatient services

 

The DMBC also included a proposal relating to Planned General Surgery, with a proposal that further work be undertaken to define a new option for the delivery of : -

 

Ø  Planned high risk Upper Gastrointestinal (GI) and Lower Gastrointestinal (Colorectal) surgery at Gloucestershire Royal Hospital;

Ø  Planned complex and routine inpatient and day case surgery in both Upper and Lower GI (Colorectal) at Cheltenham General Hospital.

 

This proposal had given HOSC, the public and NHS staff a further  ...  view the full minutes text for item 4.

5.

Recommendations to the New Committee

The committee to note the outcomes of the further review of Fit for the Future consultation, (including any actions), and make suggestions for the new committee to consider, post the council elections in May 2021.

Minutes:

It was agreed a report, listing the issues raised at this and at previous meetings, in relation to Fit for the Future specialist service changes at Gloucestershire hospitals, would be considered by the new committee post the council elections in May 2021.

 

Action: A report on the Fit for the Future decision making process/resolutions from the NHS CCG Governing Body meeting on 18 March 2021 and concerns raised at the Health Overview and Scrutiny Committee meeting on 22 March 2021 to be presented for consideration by the members and representatives of the new committee and NHS CCG post the council election in May 2021. Action by: NHS CCG