Agenda and minutes

To note any apologies for absence

Apologies were noted from Cllr Jill Smith, (representing Tewkesbury Borough Council), Cllr Adrian Bamford, (representing Cheltenham Borough Council), and Cllr Helen Molyneux, (representing Forest of Dean District Council). Cllr Linda Cohen joined the meeting via remote access.

Other apologies included Deborah Lee, (Gloucestershire NHS Hospitals Foundation Trust), Ingrid Barker, (Gloucestershire Health and Care Foundation Trust), and Nikki Richardson from Healthwatch Gloucestershire.

To note any declarations of interest

No declarations of interest were made at the meeting.

To confirm the minutes of the meeting held on 6 December 2022

The minutes of the meeting held on 6 December 2022 were noted (subject to approval at the meeting on 14 March 2023).

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 to 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 a reply to the original representation.

The notification deadline to make representation at the committee meeting on 31 January 2023 is 4.00 pm on Wednesday 25 January 2023.

No public questions were received in advance of the meeting.

A presentation on recent developments in the delivery of Ophthalmology Services by NHS Gloucestershire.

Presenting Officers: Kerry O’Hara and Dr Graham Mennie from NHS Gloucestershire and Alun Davies from the Sight Loss Council.

The committee received a presentation from the NHS Gloucestershire Eye Health Clinical Programme Group (CPG) on the delivery of Ophthalmology (Eye Care) Services. Presenting officers, Kerry O’Hara and Dr Graham Mennie from NHS Gloucestershire and Alun Davies from the Sight Loss Council joined the meeting remotely.

Members were informed that the focus of the Eye Health CPG was to provide a holistic approach to the development of eye health services in the county Running in conjunction with the charity ‘Vision Care for Homeless People’ (VCHP) and staffed entirely by a volunteer rota of community optometrists and optician supported staff from across Gloucestershire, the aim of the CPG was to ensure patients received the best possible experience by prioritising service user involvement and service quality, improving delivery of service and by utilising public health intelligence to reduce any variations in service.

Overall, homeless people were known to have higher eye care needs than the general population. This was likely a result of homeless people not being entitled to free eye tests and from avoiding high street opticians due to the costs associated with purchasing spectacles.

Outlining some of the evidence base emerging from the work of the CPG, it was reported that the majority of people who had attended the clinic had not accessed a sight test for over 10 years. 81% of those seen by the clinic had needed spectacles, for which the clinic had been able to provide free of charge. 14% of people attending the clinic had needed onward referrals into secondary care eye care services. The Ophthalmology Department at the Gloucestershire NHS Foundation Trust was able to support the charity by making urgent referrals into the service.

NHS Gloucestershire had also commissioned the Royal National Institute of Blind People (RNIB) to provide Eye Care Liaison Officer (ECLO) support to elderly patients at Gloucester and Cheltenham hospitals. Of the patients seen to date, 27% had needed additional support from either, the provision of spectacles, emotional support, or aids and adaptations for onward referral. To ensure patients discharge was supported, the Gloucestershire Hospitals NHS Foundation Trust, (GHNHSFT), had made urgent provision to provide spectacles to inpatients in addition to offering to treat patients in the relevant clinic.

Reporting on digital developments in ophthalmology, in conjunction with issues relating to the recording of information by community optometrists and GPs, it was reported that Gloucestershire was the first area in the country to provide support to community optometrists by allowing access to hospital eye images, data and referral information. It was explained that work to combine and share personal records was managed collaboratively between the NHS Gloucestershire ICB, the Ophthalmology Department at GHNHSFT and the Local Optical Committee (LOC). It was reported that only 2 practices in the county did not have access to the system, and that one of the practices was due to be connected shortly.

Members were informed of a reduction in hospital referrals for patients who could be treated in the community. Access to information and essential  ...  view the full minutes text for item 5.

A report on the development of Gloucestershire Integrated Care Strategy.

Mary Hutton, Chief Executive of the NHS Gloucestershire Integrated Care Board (ICB), outlined recent developments in the delivery of health services following the establishment of the Gloucestershire Health and Wellbeing Partnership in July 2022, and presented an overview of the recently published One Gloucestershire Integrated Care System (ICS) Interim Integrated Care Strategy. 

The Chief Executive referred to the Health and Care Act 2022 and to the significant changes brought about by the Act to the structures and governance of local NHS bodies, including changes to the way local Health bodies work with Local Government. She explained that, under the new Act, the Gloucestershire Integrated Care System was formalised into a legal entity, comprising two equally important and complementary components, the Integrated Care Board (ICB), and the Integrated Care Partnership (ICP).

In Gloucestershire, the ICP will be known as the One Gloucestershire Health and Wellbeing Partnership. The Partnership will bring together health care services, (including GP providers, community and hospital services, emergency 999 care and mental health and learning disability services), social care, public health and other public, voluntary and community sector partners to collaboratively achieve better health and wellbeing outcomes for Gloucestershire.

Following the introduction of the new Act, the Department of Health and Social Care (DHSC) tasked Integrated Care Partnerships with the development of Integrated Care Strategies from which ICPs were required to achieve system wide priorities to improve the health, care and wellbeing of the county and reduce any disparities that might exist. At the first formal meeting of the Partnership, in December 2022, the ICP considered and agreed the interim Integrated Care Strategy for Gloucestershire. The development of the strategy followed extensive public engagement and wide-ranging discussions with wider stakeholders across the county.

It was explained that 2023 would be a transitional period for the new integrated care system. As an interim strategy, it would be necessary to refresh the strategy as the Partnership developed and progressed. One important consideration for Gloucestershire was that the strategy would build on the work that already been put in place across the county. It was acknowledged that Gloucestershire benefited from having had a successful Integrated Care System in place for several years, (prior to the formation of the ICP), an arrangement that would help pave the way in strengthening the collaborative working relationship between the County Council and NHS partners.

The membership of the ICP is drawn from a wide range of partner organisations, including representatives from each of the 6 districts and from each locality partnership. Working towards the vision of making Gloucestershire the healthiest place to live and work, members were asked to note the three overarching pillars of action, (ambitions for the forthcoming 12 month and 5 year periods), set out within the strategy and the 3 unifying themes of Employment, Smoking and Blood Pressure. It was explained that the 3 unifying themes had been set following discussions at engagement sessions held in the months prior to the inaugural meeting of the ICP in December 2022. The  ...  view the full minutes text for item 6.

An update on the performance of the Gloucestershire Integrated Care System (GICS) in comparison to NHS constitutional and other agreed standards.

Mary Hutton, Chief Executive of the Gloucestershire Integrated Care Board, (ICB), presented the ICS Performance Report relating to performance of the NHS Gloucestershire ICB for January 2023. The report includes information on performance, quality and workforce.

Key areas of focus highlighted by the report included the significant increase in pressure across the majority of Urgent and Emergency Care Services during late December, resulting in a deterioration in waiting times and other performance measures associated with capacity. Infection from Covid and flu symptoms increased significantly across the system, with challenges arising from hospital infection control, closure of nursing/residential homes and staff sickness. It was noted that the rates of infection now appeared to be declining.

Concerns relating to the Aspen Centre and a member request for an interim update on the work being undertaken by Newton Europe were noted, supplemented with the offer of addressing the concerns outside of the meeting. It was explained that the work of Newton Europe was continuing and that whatever information could be provided at the next meeting would be included in the ICB information report.

It was confirmed that ambulance handover and response times had been significantly under pressure during December, with increasing time lost to handover and longer Cat 2 response times. Remedial action plans were focussing on reducing delays from the triaging of ambulance calls to ensure that the most serious incidents received a quick response. Latest ambulance response times indicated improvements in response times and continued to be steady.

An elective recovery task and finish group had been set up to support the ongoing review of elective activity, (including identifying areas requiring further attention).

Maternity services in Gloucestershire continued to implement improvement plans. A serious incident surrounding antenatal screening had been declared and an action plan developed to address the concerns that had been raised. Members welcomed the good news that Gloucestershire Hospitals Maternity Services had been rated very positively among 121 acute NHS trusts that had taken part in the Care Quality Commission (CQC) 2022 National Maternity Survey.

One area of concern raised at the meeting related to the Gloucestershire GP Out of Hours Service and a letter from the Care Quality Commission (CQC). When asked about the contents of the letter, it was explained that the letter had only just been received by NHS Gloucestershire and that a copy would be sent to the Chair of the Committee as quickly as possible. Chair and Vice Chair of the Committee, Cllr Andrew Gravells and Cllr David Drew, reiterated concerns about the outcomes of CQC Reports relating to the delivery of Gloucestershire Health and Care Services and asked that regular updates be provided to the committee. It was noted that a full review of the NHS Gloucestershire Winter Sustainability Plan 2022/23 would be presented at the HOSC meeting on 14 March 2023, during which, several of the key issues raised at the committee today would be referred to. Action by – Mary Hutton, (Chief Executive of the ICB)

Responding to concerns about  ...  view the full minutes text for item 7.

A report from the NHS Gloucestershire Integrated Care Board (ICB), known collectively as NHS Gloucestershire. The report to include updates from Integrated Care System (ICS) partners with responsibility for overseeing the day-to-day commissioning and provision of NHS services in Gloucestershire.

The Committee is asked to note Appendix 1 of the report, detailing an extension of changes to maternity services at the Cheltenham General (AVETA) Birthing Unit and at the Stroud Hospital Birth Unit.

The NHS Gloucestershire Integrated Care Board, (ICB), report was taken as read. The report included updates from Integrated Care System (ICS) Partners with responsibility for overseeing the day-to-day commissioning and provision of NHS services in Gloucestershire.

Following on from the previous item, it was noted that maternity services in the county had received outstanding feedback in the Care Quality Commission (CQC) 2022 National Maternity Survey, published on 11 January 2023. The Trust had been rated highly among the 121 acute NHS trusts that had taken part in the survey. It was acknowledged that, given the considerable challenges to maternity services in Gloucestershire during the past year, the Trust and its partners were delighted with the results.

Reflecting on the need to ensure safe provision of the county’s maternity services and the proposal to extend a number of temporary service changes, (as set out below), for a further 3 months, the Trust reiterated its previous assurances about its long-term commitment to the future of both Stroud Maternity Unit and the Cheltenham Aveta Birthing Pool. 

Outlining the proposals, (as set out in detail in the Memorandum of Understanding Proforma and attached to the agenda at Appendix 1), members were asked to note and agree the Memorandum of Understanding.

The document was noted, with a request that a full update be provided at the next meeting.

Details of the changes, based on the following proposals, included: -

1)    Due to on-going midwifery staffing challenges, it was proposed that the temporary closure of the Cheltenham General (AVETA) Birth Unit for labour and birth be extended until April 2023; and that the

2)    Temporary closure of postnatal beds at the Stroud Birth Unit be also extended;

3)    At the AVETA Birthing Unit, all other services to remain open, including planned antenatal care;

4)    Stroud Maternity Birthing Unit to remain open for births, and postnatal care for families in the first 6 to 12 hours post birth to continue, after which families to be discharged home. If a mother or baby born at Stroud Hospital needed postnatal care, and required on-going in hospital monitoring, this would need to be accommodated at the Maternity Ward at the Gloucestershire Royal Hospital.

5)    The community midwifery service in Stroud to also remain unchanged. Women to be offered home visits or the opportunity to attend a postnatal clinic run by midwives in the postnatal period.  Breastfeeding parent support will also be available at the Unit.

Addressing concerns about the need to extend the temporary service changes to maternity services for a further 3 months, the Chair of the Committee, Cllr Andrew Gravells, requested a full report on the county’s maternity services at the next committee meeting. Although it was explained that the outcomes of a review of the service would not be available until the May meeting, it was agreed that the committee would receive an update on maternity services at the committee meeting on 14 March 2023, followed by a review of data and reports at the May meeting.  ...  view the full minutes text for item 8.

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

14 March 2023

23 May 2023

11 July 2023

10 October 2023

28 November 2023

The committee noted the dates of future meetings, including: -

14 March 2023

23 May 2023

11 July 2023

10 October 2023

28 November 2023

Committee Chair, Cllr Andrew Gravells, summarised the items put forward at the meeting as items for consideration at future meetings as: -

1.    Maternity Services Update – 14 March 2023

2.    Out of Hours (Practice Plus) Service Briefing – 14 March 2023

3.    CQC Report Update – 14 March 2023

It was noted that the main topic for discussion at the 14 March 2023 meeting would be a review of the NHS Gloucestershire Winter Sustainability Plan 2022/23. The members of the Adult Social Care and Communities Scrutiny Committee to be invited to join the meeting via remote access to ask questions on this item.

Cllr Paul Hodgkinson suggested the following topics as items for consideration at future meetings: -

1.    Obesity

2.    NHS Workforce Issues

3.    Sexual Health Issues

It was noted that some of the items overlapped with items considered by the other scrutiny committees.