Venue: Council Chamber - Shire Hall, Gloucester. View directions
Contact: Jo Moore
To note any apologies for absence.
Apologies were noted from Cllr Helen Molyneux (representing Forest of Dean District Council). Apologies were also noted from Mary Hutton and Paul Roberts from NHS Gloucestershire.
Chair, Cllr Andrew Gravells, welcomed Cllrs Paul Hodgkinson, Tim Harman and Collette Finnegan as new and returning members to the committee.
Declarations of Interest
To report any declarations of interest.
No declarations of interest were made at the meeting.
To confirm the minutes of the meeting held on 17 May 2022 (attached)
The minutes of the meeting held on 17 May 2022 were confirmed and agreed 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 representation at the meeting. The process for submitting a representation will follow Gloucestershire County Council Constitution rules for making representation at public meetings.
The Council’s Constitution states that ‘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 which relates to an item on the Health Overview and Scrutiny Committee agenda for that meeting’. Notification of the intention to make representation is required three clear working days before the date of the meeting, (excluding the day of the meeting). Where the person making representation attends the meeting in person, that individual will be invited to address the committee, (3 minutes per representative), to respond to the information provided in reply to the original representation.
The deadline for making representation at the committee meeting on 12 July 2022 is 4.00pm on Thursday 7 July 2022.
No public questions were considered at the meeting.
A short introduction to the One Gloucestershire Integrated Care System (ICS).
The Gloucestershire Integrated Care System received statutory status on 1 July 2022. The NHS Gloucestershire Integrated Care Board, (known as NHS Gloucestershire), was also established on this date, replacing the NHS Gloucestershire Clinical Commissioning Group. NHS Gloucestershire will be responsible for overseeing the day-to-day running of local NHS health and care services, including the commissioning of services.
NHS Gloucestershire will work closely with the Gloucestershire Integrated Care Partnership, (ICP), known as the One Gloucestershire Health and Wellbeing Partnership, bringing together health, social care, public health and other voluntary and community sector partners.
The committee received an update on the formation of the One Gloucestershire Integrated Care System (ICS).
Following the passing of the Health and Care Act 2022, significant changes to the structure and governance of local NHS bodies, including changes to the way local health bodies work with Local Government, were introduced. In accordance with the changes, the Gloucestershire Integrated Care System was established, receiving statutory status on 1 July 2022.
Prior to this, a significant amount of work had been involved in the development the NHS Gloucestershire Integrated Care Board, (to be known as NHS Gloucestershire). The Gloucestershire Integrated Care Board, (ICB), received formal status on 1 July 2022, replacing the NHS Gloucestershire Clinical Commissioning Group. NHS Gloucestershire will be responsible for overseeing the day-to-day running of local NHS health and care services, including the commissioning of services. Represented by Executive and Non-Executive Directors, as well as partner members from local NHS organisations, (NHS Trusts and Primary Care), local authorities and Gloucestershire County Council, the Board, (NHS Gloucestershire), will be responsible for deciding how NHS money is invested.
The NHS Integrated Care Board will work
closely with the Gloucestershire Integrated Care Partnership, (to
be known as the One Gloucestershire Health and Wellbeing
Partnership), bringing together health, social care, public health
and other voluntary and community sector partners. The ICP will be
aligned with Gloucestershire’s existing Health and Wellbeing
Board, with a
Statutory guidance issued by the Department of Health and Social Care in July 2022 on the scrutiny arrangements for the Integrated Care Partnership can be found at the link below:
Scrutiny of Integrated Care Partnerships falls under Health Scrutiny, and therefore within the remit of the Gloucestershire Health Overview and Scrutiny Committee. Guidance states: “It is important to note ICPs, as a joint committee between the ICB and partner local authorities, as well as other members agreed by the ICP locally, will be within the scope of HOSCs”.
Responding to questions, it was confirmed that regular reports from the NHS Gloucestershire ICB would be presented to the committee, in the form of a One Gloucestershire NHS Integrated Care System (ICS) Performance Report and a One Gloucestershire NHS Integrated Care Board (ICB) Update Report.
Enquiring into the impact of the changes on staff morale, it was explained that Gloucestershire was in a unique position in that it had benefited from having a successful Integrated Care System in place for several years, which had had paved the way for a co-operative and collaborative relationship between the Council and its NHS partners. The new formalised methods of working were not that new to the County and, as a result, not anticipated to have a such a significant impact on staff.
A full programme of communications and engagement had commenced in July and would continue throughout the rest ... view the full minutes text for item 5.
A presentation from Dr Matthew Dominey, (Consultant in Public Health: Screening and Immunisation Lead for NHS England and Improvement), on local screening and immunisation services in Gloucestershire.
Dr Matthew Dominey, (Consultant in Public Health: Screening and Immunisation Lead for NHS England and Improvement), gave a detailed update on the progress of screening and immunisation services in Gloucestershire.
To view the presentation please open the link here
It was reported that the COVID-19 pandemic had had a significant impact on all aspects of screening. Antenatal and new-born screening had continued throughout the pandemic due to the time critical requirement for screening to take place during pregnancy. Cervical screening had paused for a 12 week period at the start of the pandemic. All other screening programmes had ceased at varying points throughout 2020, resulting in backlogs of patient screening.
During the past 2 years, a significant amount of work had been undertaken to prioritise overdue appointments and ensure all programmes were in a position to recover as quickly as possible.
The current position (at the time of the meeting) was as follows:-
a) All antenatal screening programmes were fully recovered.
b) The bowel screening programme had recovered and would be extended to ensure people aged 50-59 were eligible for screening. People aged 56 had been invited in 2021/22 and people aged 58 would be invited in 2022/23.
c) There remained a backlog of women awaiting a breast screening invitation. Significant funding has since been invested to increase capacity and support recovery with the Gloucestershire programme. The programme was anticipated to recover by the end of July.
d) Invitations for cervical screening had been delayed for a short period of time but the programme had soon recovered. It was noted that challenges existed in secondary care due to staffing capacity.
e) The diabetic eye and abdominal aortic aneurysm screening programme had recovered to the extent that everyone eligible for screening had now been invited. There continued to be challenges for both programmes in secondary care. Urgent referrals continued to be prioritised.
The committee welcomed the report that all screening programmes, with the exception of breast screening, (anticipated to recover in July), had now fully recovered.
It was explained that the current position was not without its challenges but that Gloucestershire was in a better than average position nationally. The focus now was on reaching some of the more deprived areas in the county. Ongoing work with GP’s and ensuring effective communications was a priority.
The update was noted.
An update on the provision of NHS Dental Services in Gloucestershire from NHS England, (in response to questions raised at the May 2022 committee meeting).
Steve Sylvester, (Director of Primary Care and Specialised Commissioning), Jo Lawton and Mel Smoker from NHS England gave an update on the provision of NHS Dental Services in Gloucestershire.
It was confirmed that NHS England and NHS Improvement was responsible for the commissioning of dental services across England, having taken over the responsibility from primary care trusts following the reorganisation of the NHS in 2013. NHS England’s South West regional offices currently manage its contracts locally, with dental services in Gloucestershire provided in three settings: -
1. Primary care – incorporating orthodontics
2. Secondary care
3. Community services – incorporating special care
Dental practices are managed as independent businesses, operating under contracts with NHS England and NHS Improvement. Many also offer private dentistry. All contract holders employ their own staff and provide their own premises, with some premise costs reimbursed as part of the respective contracts. Dental contracts are commissioned in units of dental activity.
In noting the report, several members expressed their dismay at the seriousness of the situation and admitted that they had not been fully aware of the extent of the issues affecting the county and of the nationwide position.
To view the full report, please open the link here
Responding to questions, it was agreed to take away the requests and provide a response after the meeting. The following information was clarified by the Director of Public Health: -
The committee asked for more information on oral health, in particular with regard to early years and schools. This update was presented at the Adults Social Care and Communities Scrutiny Committee meeting on 5 July 2022: -
Gloucestershire County Council (GCC) is statutorily responsible for improving the oral health of its local population. Local authorities are expected to do this by providing or commissioning appropriate oral health promotion programmes to meet local need, and by providing or commissioning oral health surveys.
The development of an oral healthcare training package for care home staff is a key priority area within the oral health portfolio. The development of a training offer was originally discussed prior to the COVID-19 pandemic, but capacity in the adult social care system has changed significantly in this time. Individuals from Gloucestershire County Council’s Prevention, Communities & Wellbeing (PWC) Hub, Adults Integrated Commissioning, the Clinical Commissioning Group (CCG), Community Dental Service, Gloucestershire Hospitals NHS Foundation Trust and Gloucestershire Health and Care NHS Foundation Trust have therefore come together to develop a county-wide approach to oral healthcare training. This will involve a blended offer of both virtual and face-to-face training, alongside the development of resources that staff can refer to whenever required. The approach will be piloted in approximately 10 care homes across Gloucestershire, including both nursing and residential units, with a wider rollout informed by an evaluation of the pilot.
Responding to questions of supervised tooth-brushing, it has been clarified that NHS England is proposing the rollout of a supervised tooth-brushing programme across all local authorities in the South West. At the time of the meeting, ... view the full minutes text for item 7.
An update on the work of the South West Ambulance Service Foundation Trust.
Will Warrender, (Chief Executive), Steph Bonser, (County Commander) and Jessica Cunningham, (Executive Director of Operations), gave a detailed update on the work of the South West Ambulance Service Foundation Trust (SWASFT).
The report was taken as read at the meeting. To view the full report, please open the link here. Members were advised of a number of questions submitted by Cllr Stephen Andrews prior to the meeting. The questions were noted.
Following an in-depth discussion, members supported a proposal put forward by the Chair of the Committee, Cllr Andrew Gravells, to undertake a review of issues impacting on urgent and emergency care services in Gloucestershire.
On considering the proposal, members agreed that a workshop be arranged in early September to consider the issues raised at this meeting and in response to recent inspection reports relating to the outcomes of a Local Government Association (LGA) and NHS England Peer Review and a recently commissioned piece of work undertaken in partnership with Newton Europe to improve the experiences and care outcomes of the people of Gloucestershire.
It was reported that Newton Europe would commence its work in mid-July, with the aim of developing an integrated approach to the delivery of urgent and emergency care services in Gloucestershire and improving system flow, based on the needs of the person and carer. The work would encompass the physical health, mental health and social care needs of a person having undergone an urgent or emergency care experience.
The workshop to have the following objectives: -
1. To provide a briefing on the output from the recent LGA/NHSE peer review (urgent and emergency care) conducted in June and the next steps planned;
2. To enable HOSC members and the members of the Adult Social Care and Communities Scrutiny Committee to participate in a discussion with representatives from Newton Europe regarding their work. The discussion to provide an opportunity for members to input into this work directly;
3. Based on the information shared at the workshop, to set the scope on what members might wish to scrutinise at a joint scrutiny session in November.
It was later proposed that a joint scrutiny meeting, involving HOSC and Adult Social Care Scrutiny Committee members be held on 15 November 2022. The meeting would be a single item meeting to allow for a more detailed discussion and robust scrutiny of the issues raised at the workshop.
Invitations to attend the session in November to be sent to the following additional organisations: Primary Care, SWAST, NHS 111 and the Police and Crime Commissioner.
It was anticipated that Newton Europe would complete its work by mid-October and would be in a position to share its initial findings. This, coupled with the action plan from the LGA/NHSE’s Peer Review, would provide insight into the challenges facing urgent and emergency care and make proposals on how to address key issues. It was requested that officers provide written reports in advance of the meeting in November to cover the objectives agreed at ... view the full minutes text for item 8.
To receive an update on the performance of the Gloucestershire Clinical Commissioning Group (GCCG) against NHS constitutional and other agreed standards.
This report covers the last period of operation of the GCCG and will be replaced at future meetings with a report from the NHS Gloucestershire Integrated Care Board.
The committee received an update on the performance of the Gloucestershire Clinical Commissioning Group (GCCG) in relation to NHS constitutional and other agreed standards. It was noted that the report at this meeting covered the last period of operation of the GCCG and would be replaced at future meetings with a performance report provided by the NHS Gloucestershire Integrated Care Board.
Included in the update was an update on the Covid-19 & Influenza Autumn Vaccination Programmes
It was reported that the Joint Committee on Vaccination and Immunisation had recommended that the Autumn booster programme offer a further dose of Covid-19 vaccine to: -
Ø All adults aged 50 years and over
Ø All those aged 5 to 49 years in a clinical risk group, including pregnant women
Ø All those aged 5 to 49 years who are household contacts of people with immunosuppression
Ø All those aged 16 to 49 years who are carers
Ø All residents in a care home for older adults and staff working in care homes for older adults
Ø Frontline health and social care workers
The focus was likely to be on Health and Social Care Patients; Care Home Residents and people aged over 75.
In addition, all those over 50 will also be eligible for flu vaccination this year. The flu vaccine for over 50 year olds would be available later in the year, (likely to be November), as there were concerns about stock levels due to the lower uptake last year and therefore possibly less ordering (lower stock availability) by both practices and at national levels.
To view the full report, please refer to the link here.
The report was noted.
An update from the One Gloucestershire Integrated Care System (ICS)
This report covers the period up to 30 June 2022. The report will be replaced at future meetings with a single report prepared by the NHS Gloucestershire Integrated Care Board.
The committee received an update from the One Gloucestershire Integrated Care System (ICS) Partnership, (the ICP received formal recognition on 1 July 2022).
It was explained that the report at this meeting covered the period from the meeting in May up to 30 June 2022. The current reporting process would be replaced at future meetings with a single report prepared by the NHS Gloucestershire Integrated Care Board.
To view the full report, please refer to the link here.
The report was noted.
To note the NHS Gloucestershire Clinical Commissioning Group (GCCG) Clinical Chair and Accountable Officer’s Information Report.
This report covers the last period of operation of the GCCG and will be replaced at future meetings with a single report prepared by the NHS Gloucestershire Integrated Care Board.
The committee noted the NHS Gloucestershire Clinical Commissioning Group (GCCG) Clinical Chair and Accountable Officer’s Information Report.
It was explained that the report covered the last period of operation of the GCCG and would be replaced at future meetings with a single report prepared by the NHS Gloucestershire Integrated Care Board.
To view the full report, please refer to the link here.
To note the dates of future meetings (below) and to suggest items to include on the committee work plan.
25 October 2022 (replacing the meeting scheduled for 13 September 2022)
6 December 2022 (replacing the meeting scheduled for 8 November 2022)
The dates of future meetings were noted.
The following suggestions were made at the meeting as items for scrutiny at future meetings: -
1. Dietary healthcare - access to services
2. Dentistry Update
3. Familiarisation visits to SWAST
4. Information on the NHS 111 service