Agenda and minutes

Joint Meeting with Adult Social Care and Communities Scrutiny Committee, Health Overview & Scrutiny Committee - Tuesday 8 March 2022 9.30 am

Venue: Committee Room - Shire Hall, Gloucester. View directions

Contact: Jo Moore (DSU) 

Items
No. Item

1.

Apologies

To note any apologies for absence

Minutes:

Apologies were received from Cllr Alan Preest (Gloucestershire County Council) and from Cllr Jill Smith (Tewkesbury Borough Council). Cllr Andrew Miller represented Cllr Preest at the meeting. Cllr Smith was represented by Cllr Keja Berliner on behalf of Tewkesbury Borough Council.

2.

Declarations of Interest

To confirm any declarations of interest at the meeting.

Minutes:

No declarations of interest were made at the meeting.

3.

Minutes of the meetings pdf icon PDF 122 KB

To agree the minutes of the previous committee meetings: -

 

a)         Health Overview and Scrutiny Committee meeting held on 11 January 2022 – Cllr Andrew Gravells

 

b)         Adult Social Care and Communities Scrutiny Committee meeting held on 25 January 2022 – Cllr Stephen Hirst

Additional documents:

Minutes:

The minutes of meetings held on 11 January 2022, (Heath Overview and Scrutiny Committee), and 25 January 2022, (Adult Social Care and Communities Scrutiny Committee), were confirmed and agreed as a correct record of those meetings.

4.

Public Representations

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 representation at the meeting.

 

Any person who lives or works in the county, or is affected by the work of the County Council, may make written representation on any matter that relates to an 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 representation may address the committee, (3 minutes per representative), to ask a question on the response provided to the written representation.

 

The notification deadline to make representation at the joint committee meeting on 8 March 2022 is 4.00 pm on Thursday 3 March 2022.

Minutes:

No public representations were made at the meeting.

5.

Gloucestershire Urgent and Emergency Care Winter Sustainability Plan 2021-22 pdf icon PDF 761 KB

To review the performance of the Gloucestershire Urgent and Emergency Care Winter Sustainability Plan 2021-22.

 

To aid the discussion for this item, members are encouraged to note the minutes and the report published with the agenda for the joint committee meeting held on 12 October 2021. To view the documents relating to this meeting, please open the link published on the Gloucestershire County Council website here

Minutes:

Following on from the joint meeting of the Health Overview and Scrutiny Committee and Adult Social Care and Communities Scrutiny Committee held in October 2021, the members of both committees received an in-depth overview of the outcomes and performance of the Gloucestershire Urgent and Emergency Care Winter Sustainability Plan 2021-22. To view the documents relating to the plan, (presented to both committees on 12 October 2021), please refer to the link published on the Gloucestershire County Council website here

 

To view the slide-show presentation presented at this meeting, please refer to the link here

 

In considering the update, members noted an outline of the key aims included in the plan. The key aims were to: -

 

1)    Ensure the resilience of all key services.

2)    Maintain patient flow across acute, community and social care.

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

4)    Continue to maintain strong service delivery in Primary and Community Care.

5)    Expand and improve mental health services and services for people with Learning Disabilities/Autism.

6)    Continue to meet Covid-19 requirements and guidelines.

7)    Take action to mitigate key staffing pressures.

8)    Support the health and wellbeing of our health and social care staff.

9)    Seasonal Flu vaccination programme and delivery of the Covid-19 vaccination and booster programmes.

10)Deliver NHS111 First and maximise the contribution of clinical triage and assessment.

11)Maximise ‘Hear and Treat’ and ‘See and Treat’ within the Ambulance service.

12)Minimise Ambulance handover delays.

13)Continue to expand the use and support provided by the Voluntary Sector.

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

 

It was explained that, from its onset, the plan had met with significant challenges. The main challenges included; the ongoing impact of Covid-19; hospital discharge delays; ambulance handover delays; workforce pressures in delivering health and social care services; impact of pressures on Emergency Department performance; high numbers of patients in hospital (non-emergency areas); NHS 111/Out of Hours and Primary Care activities increase.

 

On a more positive note, members were advised of those service areas that had worked well. These included: -

 

1)    Cinapsis – the ‘Cinapsis Smart Referrals System’ is a clinical communications platform to provide GPs, Paramedics, NHS 111 call handlers and Optometrists with immediate access to specialist advice and guidance. For more information, please refer to the link here

2)    Community Assessment Treatment Unit (CATU)

3)    Additional Bed Capacity – Adult Social Care

4)    Recruitment Retention Fund

5)    Adult Social Care support in Acute Trust 

6)    Voluntary Sector discharge support 

7)    Improved visibility and reporting of Criteria to Reside and No Criteria to Reside-GHFT

8)    Executive led Discharge Improvement Board-GHFT

9)    New medical Same Day Emergency Care (SDEC) area-GHFT.

 

Members were advised of the aspects of the plan, (in relation to the delivery of services), likely to be delivered using a different approach in 2022/23. These included: -

 

1)    Focussing  ...  view the full minutes text for item 5.

6.

Child Measurement Programme pdf icon PDF 220 KB

A briefing on the Gloucestershire Child Measurement Programme, including actions taken in response to below average, (weight management), targets for Year 6 pupils.

Additional documents:

Minutes:

Members received an in-depth briefing on the Gloucestershire Child Measurement Programme, including an overview of actions taken in response to the below average, (weight management), targets for Year 6 pupils.

 

To view the full briefing, please refer to the link here

 

To view the slideshow presentation presented at the meeting, please refer to the link here

 

The general discussion at the meeting focused on the gravity and seriousness of the consequences of childhood obesity on older generations and the escalation at which the matter was impacting on delivering NHS services. The recent pandemic had almost certainly had a significant impact on the weight management of children and people of all ages.  

 

Noting proposed next steps and actions to be taken to resolve the impact of childhood obesity in Gloucestershire, the members of both committees agreed it would be essential to work together to monitor and review the actions, and to emphasise the seriousness and impact of obesity on the health and wellbeing of all age groups.

 

Next steps to be taken (locally) would be to: -

 

1)    Drive forward system level action on health inequalities and the wider

determinants of health (with links to the county’s levelling up commitments)

2)    Identify capacity to develop a ‘whole systems approach’ to obesity prevention

3)    Support/develop food environment and physical activity programmes

(with links to climate change, air quality and sustainability agendas)

4)    Complete the community-based children and families weight management pilot and evaluation

5)    Commission substantive children and families weight management support

6)    Work with NHSE&I and ICS colleagues to develop and test an end-to-end integrated weight management pathway for children and young people.

 

Responding to in-depth questioning from members of both committees, it was agreed that it would be important to continue the work with parents in tackling this sensitive issue. Education, better understanding and encouragement in providing a healthy, balanced diet to children and young people would be key to overcoming some of the issues. One member commented on the challenges of eating healthily on a limited budget and advocated the need to target parents on the importance of combining a balanced diet with physical activity and exercise. It was agreed a sensitive approach would need to be applied when communicating with parents on matters that would undoubtedly create distress and resistance.  

 

Acknowledging the complexities of the issue, it was confirmed that the matter was being addressed using a targeted approach and with a variety of universal activities. Two local pilot schemes were currently underway, one in the Forest of Dean District and two in Gloucester City. A significant amount of work was being carried out in schools and as a result of the council’s commissioning of a family hub model.

 

The report was noted, with a request for further updates to be provided throughout the year. It was agreed that the issue was reflected in the remit of more than one scrutiny committee but probably best considered at a meeting of the Adult Social Care and Scrutiny Committee,  ...  view the full minutes text for item 6.

7.

Information Reports (Health) pdf icon PDF 2 MB

To note the following (HOSC) information reports: -

 

a)    NHS Gloucestershire Clinical Commissioning Group (GCCG) Performance Report

 

b)    One Gloucestershire Integrated Care System Report (ICS)

 

c)    NHS GCCG Clinical Chair and Accountable Officers Report

 

The reports will be taken as read at the meeting. Members will have an opportunity to ask questions at the meeting, or alternatively, submit questions in advance of the meeting, for which the written responses will be attached to the minutes.

Additional documents:

Minutes:

The following (HOSC) information reports were circulated with the agenda and taken as read at the meeting: -

 

1)    NHS Gloucestershire Clinical Commissioning Group (GCCG) Performance Report

 

2)    One Gloucestershire Integrated Care System Report (ICS)

 

3)    NHS GCCG Clinical Chair and Accountable Officers Report 

 

Members received a detailed update on the progression of the Integrated Care System (ICS) Transition and on the roll out of the Gloucestershire vaccination programme.

 

Subject to the progression of the Health and Care Bill 2021-22, it was confirmed that arrangements were underway to enable the ICS become a formal partnership arrangement by 1 July 2022, made up of an Integrated Care Board, (known as NHS Gloucestershire), and the Integrated Care Partnership, (known as the One Gloucestershire Health and Wellbeing Partnership). Work was also underway to support the safe closure of the Gloucestershire Clinical Commissioning Group by the end of June 2022 and establishment of the Integrated Care Board (ICB) and the wider Integrated Care System, including work to establish the committee arrangements for the ICB.

 

On 1 February 2022, an initial engagement exercise, involving community partners, local people and communities had commenced to develop One Gloucestershire ICS priorities. The outcomes of the exercise will be used to inform and develop the One Gloucestershire Working with People and Communities Strategy.

 

The engagement will focus on three key questions: -

 

1.    How to get involved;

2.    What issues need to be considered for inclusion in the new ICS strategy;

3.    What top 3 areas need to be considered to improve health and wellbeing in Gloucestershire

 

Please refer to the following link for details of the engagement: https://getinvolved.glos.nhs.uk/ics-gloucestershire  

 

Other updates considered at the meeting included confirmation that the County Council had coordinated a national adult social care survey for people receiving care and support services both in the community and in care homes. The survey commenced in January and run to the end of March 2022. The results of the survey would be fed into national and local understanding of how services affected people’s lives and how to ensure the right services were available to those that needed them.

 

A new campaign ‘There’s no place like home’ had been launched to help care for patients at home. The campaign, supported by Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire CCG and the County Council, aims to raise awareness of the benefits of recovering at home as soon as patients are safe and well enough to leave hospital. For more information please visit https://www.gloshopsitals.nhs.uk/your-visit/staying-us/theres-no-place-like-home/

 

Another campaign, the Gloucestershire Wellbeing Line, had launched on 17 January 2022, to raise awareness of the mental health and wellbeing support for health and care staff within Gloucestershire. The Wellbeing Line had received setup funding from NHS England and Improvement and will be run by Gloucestershire Health and Care NHS Foundation Trust on behalf of other system partners.

 

The information reports were noted.

8.

COVID-19 Temporary Service Changes: Memorandum of Understanding Update pdf icon PDF 309 KB

Health Overview and Scrutiny Committee (HOSC) members to note updates on COVID-19 temporary service changes endorsed by the committee during 2020/21.

Minutes:

Members were advised of several proposed extensions to the temporary service changes introduced in 2020/21.

To view the full report, please refer to the link here

It was explained that, in early 2020, the Gloucestershire Integrated Care System (ICS) and partners had needed to respond quickly to the developing COVID-19 Pandemic, and had subsequently, with the support of the Health, Overview and Scrutiny Committee, introduced several temporary service changes. The majority of the service changes had now ended, with the exception of the services listed below,

GHNHSFT

  1. High Care Respiratory – to remain at GRH.
  2. Hyper-Acute and Acute Stroke & Rehabilitation – to remain at CGH.
  3. Medical Day Unit – to remain at CGH.

GHCFT

  1. Reverse the temporary emergency change and return the Vale Community Stroke Rehabilitation bed numbers to their original configuration (#14), at a time when this can be safely achieved. This will require a time-limited extension of the temporary service change (with a completion target date of end of June 2022).
  2. Dilke MIIU – to remain closed until all social distancing measures can be removed.
  3. Stroud MIIU – to reopen in pre-Pandemic state in May 2022 following refurbishment programme.

It was clarified that the changes had originally been put in place in response to the unprecedented challenges of the COVID-19 pandemic, with some of the recent changes also linked to winter pressures and staffing considerations.

The majority of changes had ended in August 2021, with the exception of a small number of services where the NHS had felt there had been the potential to provide continuing benefits to patient care and to help manage current challenges (see below). Members were advised that the current plans were seen to represent a pragmatic and carefully considered response to the current challenges impacting on local services.

The key challenge was to ensure a realistic balance in delivering the very best care as the county emerged from the pandemic, whilst at the same time, working with local people and communities to consider where more permanent changes might add real benefits in the longer term.

In relation to the provision of stroke services, it was confirmed that the intention was to extend the acute stroke service temporary changes, including retaining the *Hyper Acute Stroke Unit (HASU) at Cheltenham General Hospital.

This service change was originally made in early February 2022. The proposal was to extend this service change to March 2023. The ASU would also remain at Cheltenham General Hospital as a temporary change until March 2023. This had originally been put in place in August 2020 as part of the local NHS’ response to the first wave of COVID-19. This ASU change had coincided with improvements in the Trust’s rating for stroke services as part of a national assessment programme (a B rating compared to the previous C rating). It was hoped the extension of the temporary arrangements would give the NHS more time to monitor the full impact of the changes for patient care and carry out a full evaluation to  ...  view the full minutes text for item 8.

9.

Information Reports (Adult Social Care and Communities) pdf icon PDF 821 KB

a)    ASCC Quarter 3 Performance Report 2021/22 - to consider performance data in relation to the delivery of services within the remit and context of the Adult Social Care and Communities Scrutiny Committee.

 

b)    Chief Fire Officer Report - an update on matters relating to the delivery of services within the portfolio of services delivered by the Chief Fire Officer, (Gloucestershire Fire and Rescue Service), and within the remit of the Gloucestershire County Council Adult Social Care and Communities Scrutiny Committee, (Trading Standards, Civil Protection and Coroners Services).

 

c)    Adult Social Care Report - An update from the Executive Director of Adult Social Care and Public Health, (Gloucestershire County Council), on matters relating to adult social care.

 

d)    Public Health Report -An update from the Executive Director of Adult Social Care and Public Health, (Gloucestershire County Council), on matters relating to public health. A Covid-19 intelligence summary update will be circulated prior to the meeting to provide members with the latest data and information on the response to the Covid-19 Pandemic.

 

All of the above reports will be taken as read at the meeting.

 

Members will have an opportunity to ask questions under each item, (the responses to questions submitted in writing before the meeting will be published with the minutes of the meeting).

Additional documents:

Minutes:

Members noted the following Adult Social Care and Communities information reports, (circulated with the agenda and taken as read at the meeting).

 

1)    ASCC Quarter 3 Performance Report 2021/22 – members were asked to note performance data in relation to the delivery of services within the remit and context of the Adult Social Care and Communities Scrutiny Committee.

 

2)    Chief Fire Officer Report – members received an update on matters relating to the delivery of services within the portfolio of services delivered by the Chief Fire Officer, (Gloucestershire Fire and Rescue Service), and within the remit of the Gloucestershire County Council Adult Social Care and Communities Scrutiny Committee, (Trading Standards, Civil Protection and Coroners Services).

 

3)    Adult Social Care Report – members received an update from the Executive Director of Adult Social Care and Public Health, (Gloucestershire County Council), on matters relating to adult social care.

 

4)    Public Health Report – members received an update from the Executive Director of Adult Social Care and Public Health, (Gloucestershire County Council), on matters relating to public health. A Covid-19 intelligence summary update was circulated prior to the meeting to provide members with the latest data and information on the response to the Covid-19 Pandemic.