Agenda and minutes

To note any apologies for absence

Apologies for absence were received from Cllr Rob Vines. Cllr Vines was represented by Cllr Susan Williams.

Cllr Adrian Bamford was introduced to the meeting as the new Cheltenham Borough Council co-opted member, (replacing Cllr Dilys Barrell).

Cllr Ray Padilla, co-opted member from Gloucester City Council announced that this would be his last meeting before taking on a cabinet role at the City Council. Cllr Padilla was thanked for his work on the committee during the past year.

The Chair welcomed Deborah Evans as the new Chair of Gloucestershire Hospitals NHS Foundation Trust (GHT).

To confirm any declarations of interest at the meeting.

Cllr Ray Padilla, (co-opted member from Gloucester City Council), declared a personal interest in non-specific items for discussion at the meeting. The declaration was made in relation to Cllr Padilla’s role as a NHS Staff Nurse at Gloucestershire Royal Hospital.

To confirm the minutes of the joint meeting held with the members of the Adult Care and Communities Scrutiny Committee on 8 March 2022 (attached).

The minutes of the joint meeting held with the Adult Social Care and Communities Scrutiny Committee on 8 March 2022 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), to acknowledge the response to their representation.

The notification deadline to make representation at the committee meeting on 17 May 2022 is 4.00 pm on Thursday 12 May 2022.

No public representations were made at the meeting.

To receive an update on GP Practices in Gloucestershire, include a review of numbers of GP’s and vacancies across the County.

Helen Goodey from the NHS Gloucestershire Clinical Commissioning Group (CCG) and Dr Lauren Halden, (GP from Hucclecote Surgery), gave a detailed presentation on the role of the CCG to support the recruitment and retention of clinical and non-clinical roles within local GP Practices.

Key points raised during the presentation included: -

1)    Considerable support is provided to Gloucestershire practices and primary care networks, (PCNs), in relation to the recruitment, retention and education of staff working in Primary Care.

2)    Before, and increasingly so since the COVID-19 Pandemic, GP numbers have been challenged nationally. A range of factors may have contributed to this, including: significant increases in workload, changing patient demographics, negative media portrayal of General Practice, complaints, a desire; and need for a more balanced home and work life and increased administrative burden.

3)    Whilst Gloucestershire’s GP workforce was slightly above the national average, (May 2022), GPs may often leave, move or change roles, resulting in an ongoing focus on recruitment and retention. In addition to ongoing engagement with GP Practices and PCNs, the CCG’s Primary Care Workforce team consistently reviews GP workforce numbers on a regular basis using both nationally available data and the Primary Care Training Hub’s annual Workforce Survey.

4)    Noting the latest GP Workforce position for each of the six localities for Gloucestershire, it was noted that Gloucester Inner City practices were experiencing significant challenges in both numbers of GPs and vacant GP sessions. A number of initiatives had been introduced by the CCG’s Primary Care Workforce and Training Hub Team to support the retention and growth of GP numbers within Gloucester Inner City. Some of the initiatives had been set up specifically designed to address recruitment for Inner City practices. Other initiatives were available to all practices, including those within the Inner City. The outcomes of an annual workforce survey and progress report would be shared with the committee later in the year (2022/23)..

5)    Gloucestershire CCG has been at the forefront of offering successful and wide-ranging GP fellowships, providing GPs with the opportunity to develop personal skills and make a difference to the lives of the patient populations they serve. This joint initiative has promoted Inner City practices as a good place to work, offering GPs the opportunity to work with a vibrant and culturally diverse patient population.

6)    A new GP specialism fellowship provided GPs with an opportunity to work in a ‘forward thinking’ training practice in the heart of Gloucester City, directly supporting the provision of healthcare for patients in the area. In partnership with GHAC, (Gloucester Health Access Centre), the CCG was seeking to recruit two salaried GP roles to undertake clinical sessions with the added benefits of a fully-funded Special Interest GP fellowship, (up to 2 sessions per week for 12 months), as well as a Continuing Professional Development bursary. The roles will be supported by a GP mentor from GHAC for the fellowship, alongside dedicated GP fellowship advisors from the Primary Care training hub. The roles will offer  ...  view the full minutes text for item 5.

To receive an update on the One Gloucestershire Integrated Care System Fit for the Future (FFTF) Programme. Following the discussion at the meeting, the intention will be to launch public, patient and staff engagement to explore ideas on how other specialist hospital services can be developed, (Phase 2 of the FFTF Programme).

Ellen Rule, Director of Transformation and Service Redesign, gave an update on the One Gloucestershire Fit for the Future (FFTF) programme.

Members attention was drawn to FFTF 1, which had looked at a number of specialist hospital services and the development of the ‘Centres of Excellence’ approach. The proposals included in FFTF 1 had focused on bringing together some of specialist services at Cheltenham General Hospital (CGH) and some at Gloucestershire Royal Hospital (GRH), in an effort to improve patient care through the way the two hospitals worked together. The services included; Acute Medicine, General Surgery, Image Guided Interventional Surgery, Gastroenterology inpatient services and Trauma and Orthopaedic inpatient services.

Five of the seven FFTF 1 service changes, (Emergency General Surgery, Gastroenterology inpatient services, Trauma and Orthopaedic inpatient services and Vascular surgery), had been implemented, with the remaining two, (Acute Medicine and Image Guided Interventional Surgery), due for completion in 2023.

Introducing ideas relating to the next stage of the FFTF programme, it was explained that, following today’s discussion, One Gloucestershire would launch a public, patient and staff engagement exercise to explore ideas on how several other services might develop in the future as part of FFTF2. The ideas relating to some of these services would be broader, covering the continued development of the ‘Centres of Excellence’ approach at CGH and GRH, and a wider journey of care for people who needed services or support in their own home, in GP surgeries or in the community. The key focus would be to consider how best to care for people at every stage of their illness or injury.

The public engagement to cover the following areas: -

1)    Benign Gynaecology - day cases. Gynaecology is the medical speciality (area) dealing with the health of the female reproductive system and benign means non-cancerous. The service also provides surgical procedures, such as hysterectomies.

2)    Diabetes and Endocrinology - inpatient care for people with Diabetes and Endocrine conditions. Endocrine conditions are where a person’s endocrine system (that produces the body’s hormones) does not work correctly, causing hormonal imbalances in the body.

3)    Frailty/Care of the Elderly - hospital and community services. Frailty is where the ability to cope with physical trauma or illness and psychological stress is reduced, impacting on the ability to recover after illness. 

4)    Non-interventional cardiology - inpatient care for cardiology patients, not requiring interventional cardiology i.e. not requiring special imaging tests or surgery. Cardiology is the treatment of disorders of the heart and blood vessels.

5)    Respiratory care - inpatient respiratory care, including the respiratory high care service. Respiratory Services provide treatment for breathing problems, including the lower airway (trachea), the lungs, the chest wall and the ventilatory control system.

6)    Stroke care - acute inpatient stroke services. A stroke is a serious medical condition that happens when the blood supply to part of the brain is cut off.

The ideas did not include outpatient services, which would continue to be available at multiple sites.

It was explained that the aims  ...  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.

The performance report was noted. It was acknowledged that, overall, current performance data did not reflect the position One Gloucestershire would want to be in. Emerging from the pandemic there were significant challenges ahead and considerable pressures on a number of services within the system, most notably, ambulance response times and hospital admissions and discharges. It was suggested that the Southwest Ambulance Service Foundation Trust be invited to give an update at the next meeting and this was agreed.

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

NHS Partners include: -

NHS Gloucestershire Clinical Commissioning Group (GCCG)

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)

Ellen Rule, Director of Transformation and Service Redesign, summarised key activities being undertaken to deliver health and social care services within Gloucestershire.

Highlighting some of the positive outcomes being reported by the Clinical Programme Groups, (CPGs), and an update on current campaigns, members were also advised of the ongoing focus on tackling inequalities. 

Work was on track towards the further integration of health and care services and the statutory transition of the Integrated Care System (ICS). The Health and Care Bill 2021-22 had received Royal Assent on 28 April 2022. This would enable the Integrated Care System (ICS) to become a formal partnership arrangement on 1 July 2022, made up of an Integrated Care Board (ICB) and Integrated Care Partnership (ICP). Work was ongoing to support the safe closure of the Clinical Commissioning Group by the end of June 2022 and the establishment of the Integrated Care Board and wider Integrated Care System.

It was announced that Tracey Cox had joined the ICB for a six-month secondment from 11 April 2022 as designate Interim Director of People, Culture and Engagement. Tracey had come from the post of Chief Executive of Bath & North East Somerset, Swindon and Wiltshire (BSW) CCG, having led the merger of the three former CCGs in 2020.

The report was noted.

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

Ellen Rule, introduced the Clinical Chair and Accountable Officer Report.

Included in the report was confirmation of the appointments to the NHS Gloucestershire Integrated Care Board (NHS Gloucestershire) including Non-Executive Directors and Executive Directors.

Executive appointments include:

Dr Marion Andrews-Evans, Chief Nursing Officer

Dr Paul Atkinson, Chief Clinical Information Officer

Tracey Cox, Interim Director of People, Culture Engagement

Cath Leech, Chief Financial Officer

Ellen Rule, Deputy CEO/Director of Strategy and Transformation

Dr Andy Seymour, Chief Medical Officer

Mark Walkingshaw, Director of Operational Planning & Performance.

Kim Forey, Director of Integrated Commissioning (joint post with Gloucestershire County Council)

Helen Goodey, Director of Primary Care & Place (joint post with Gloucestershire Health and Care NHS Foundation Trust).

More information on the Executive Directors can be viewed here

Non-Executive appointments include:

Joanna Coast, System Resources

Jane Cummings, System Quality

Colin Greaves, Primary Care & Direct Commissioning

Clive Lewis, Remuneration

Julie Soutter, Audit

More information on the Non-Executive Directors can be viewed here

In response to pressures on urgent and emergency care (UEC) services across England the Care Quality Commission (CQC) undertook a series of coordinated nationwide inspections within local areas, including a review of Gloucestershire UEC in November and December 2021.

Members’ attention was drawn to the following statement made by One Gloucestershire NHS partners (NHS Gloucestershire Clinical Commissioning Group, Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire Health and Care NHS Foundation Trust and South Western Ambulance Service NHS Foundation Trust) in response to the CQC review publication focusing on urgent and emergency care in the county in March 2022: -

We have greatly valued our involvement in the CQC urgent and emergency care system review which was about recognising what is working well in Gloucestershire, identifying how we can make improvements and providing learning for other areas. This review which took place from late Autumn 2021 was against the backdrop of considerable and on-going pressures being experienced locally and across the country, resulting from seasonal pressures, the COVID-19 pandemic and workforce challenges.

We were encouraged to see acknowledgment of the strong One Gloucestershire partnership working in evidence and our determination to provide the best possible advice, care and treatment for everyone who uses our services. It’s this spirit of partnership working that will ensure further improvements are made, acknowledging that many of the challenges facing urgent and emergency care can only be overcome by working together and are a shared responsibility.

One Gloucestershire health and care partners are working more closely than ever before to ensure the journey in and out of hospital is as smooth as it can be. A whole raft of measures (summarised below) have been put in place to improve access, help ensure people are able to leave hospital when safe to do so with ongoing care support if needed and improve ambulance handover arrangements at the hospital front door. These issues are inextricably linked.

We acknowledge the need to continue to simplify access to services, join them up further and help staff and patients better understand the services available and  ...  view the full minutes text for item 9.

To note the dates of future meetings (below) and to suggest items to include on the committee work plan.

12 July 2022

25 October 2022

06 December 2022

The following items were added to the committee work plan for consideration at the committee meeting on 12 July 2022.

1)    A presentation from the South West Ambulance Service

2)    A presentation from NHS England on NHS Dentistry

Cllr Helen Fenton requested that the committee consider including NHS Hysteroscopy to the committee work plan. Cllr Fenton to provide details on the scope and objectives of the review for consideration by the committee at the next meeting (under the work plan item).