Agenda and minutes

To note any apologies for absence.

Committee Chair, Cllr Andrew Gravells, opened the meeting by paying respect to the life and work of County Councillor, Philip Awford, and former County Councillor, Ray Theodoulou. A minutes silence was held in recognition of the recent sad deaths of the two Councillors. 

Apologies were noted from Cllr Helen Molyneux, (representing Forest of Dean District Council) and from Cllr Kathy Williams, Cabinet Member: Adult Social Care Delivery.

To report any declarations of interest.

No declarations of interest were made at the meeting.

To confirm the minutes of the Gloucestershire Health Overview and Scrutiny Committee meetings held on: -

6 December 2022

31 January 2023

The minutes of the meetings held on 6 December 2022 and 31 January 2023 were confirmed as an accurate record of those meetings.

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 follows 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 agenda for that meeting’.

For meetings of the Health, Overview and Scrutiny Committee, 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 the 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 the written response to the original representation.

Please submit any representations for the committee meeting on 14 March 2023 to jo.moore@gloucestershire.gov.uk before 4.00 pm on Wednesday 8 March 2023.

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The following representations were received in advance of the meeting.

1. Keith Smith: Agenda item 5: Out of Hours (Practice Plus Group) Service

In view of the sustained and significant flaws the Care Quality Commission has identified in Practice Plus Group's operation of 'Out of Hours' GP services throughout the county, does the Health Overview and Scrutiny Committee share my own views?

That:

a) Those at NHS Gloucestershire, the contractor - be it those on its CMB (Contract Management Board), charged with a tactical role of governance, but apparently oblivious to performance indicators; or those with strategic oversight, of sufficiency, safety and cost-effectiveness of our healthcare provision, on its ICB (Integrated Care Board) - have shown themselves incapable of bringing a solution to bear. And should either be reconsidering their positions - or having them reconsidered for them.

b) NHS Gloucestershire's extended, benign tolerance of a private partner (the aforesaid PPG) whose level of performance (in terms, for example, of staffing levels) has been not just below standard, but legal requirements, also, should forthwith give way to cancellation of the contract, and transfer to a different service provider

c) Somewhere here there is a case for referral of the Practice Plus Group to Health and Safety. Who will act?

2. Ela Pathak-Sen: Representation made in relation to item 5 of the agenda: Out of Hours (Practice Plus Group) Service Report.

Given the most recent CQC report on the Gloucestershire Out of Hours service, how aware were the commissioners and Health Overview and Scrutiny Committee about the issues identified by the CQC, especially since  similar issues were raised in the 2021 inspection? What actions were taken?

Is it time for the Out of Hours service to come back under the direct management of the NHS and truly integrate with all out of hours urgent and emergency services across the county?  

Inviting members to comment, the Chair informed the Committee that the representations had been published on the council website and circulated to members in advance of the meeting. Neither of the persons making representation were present at the meeting, and therefore no supplementary questions were asked on this occasion. Members were informed that written responses to the representations would be provided after the meeting. The responses would be emailed to the persons making representation and recorded in the minutes of the meeting. No further discussion was made at the meeting.

An update from NHS Gloucestershire on the recent Care Quality Commission (CQC) Inspection of the Practice Plus Group (Out of Hours) Service and actions proposed in response to the publication of the inspection report. Representatives from the CQC will join the meeting via remote access to respond to questions on this item.

Having evaluated the performance of the NHS 111 and GP Out of Hours Service during the past 6 months, including a visit by lead members to the Practice Plus Group Call Centre at Stoke Gifford, Bristol, in November 2022, the committee received an update on the recent Care Quality Commission (CQC) Inspection of the Practice Plus Group (Out of Hours) Service. Dawn Bateman from the Care Quality Commission (CQC) and Sue Brooks and Steve Hinch from the Practice Plus Group joined/attended the meeting to respond to questions.

Committee Chair, Cllr Andrew Gravells, referred to the ‘requiring improvement’ classification by the Care Quality Commission (CQC) in relation to services provided by the Practice Plus (Out of Hours). Member’s attention was drawn to the fact that the CQC rating had been classified as ‘requiring improvement’, prior to the Covid-19, (coronavirus), pandemic and had been classified as this classification for several years. The current Out of Hours service inspection report, (17 March 2023), also reported a ‘requiring improvement’ rating for the service.

Acknowledging the committee’s concerns, lead officers from NHS Gloucestershire gave a detailed overview on the performance of the Out of Hours service, (OOH), as provided by the Practice Plus Group (PPG), including an update on the actions implemented in response to the CQC report dated 22 November 2022. It was noted that recent CQC inspections had rated the Gloucestershire NHS 111 service as outstanding and the GP Out of Hours Service as requiring improvement.

Please refer to the links below to view the respective CQC reports: -

CQC report relating to the PPG operated Gloucestershire GP Out of Hours (OOH) services https://www.cqc.org.uk/location/1-5503278574

CQC report for the PPG operated South West NHS 111 services (providing NHS 111 services for Gloucestershire) https://api.cqc.org.uk/public/v1/reports/a799bade-f35c-43ef-80ba-fdc7a867662b?20220316080207

NHS Officers agreed it was not acceptable to rationalise that the NHS 111 CQC outstanding rating could diminish the Out of Hours (PPG) ‘requiring improvement’ rating.

Referencing concerns about leadership of the GP Out of Hours service, it was confirmed that the PPG had developed an action plan to demonstrate the work undertaken to date and plans for future improvement. The Deputy Chief Nursing Officer for the NHS Gloucestershire Integrated Care Board, (ICB), had recently taken on the ICB leadership role for quality oversight of the PPG contract and had met with the PPG GP Clinical Lead to review the quality and clinical elements of the action plan. Members were informed that the ICB would continue to work with, and support, the PPG’s clinical team during the final stages of producing the PPG action plan, which was due to be submitted to the CQC later that day, (14 March 2023).

Having noted the slideshow presentation presented at the meeting, NHS Gloucestershire acknowledged the challenges of providing NHS GP Out of Hours services but nevertheless agreed that it was essential to make the necessary improvements to the service in order to meet the levels of activity required, achieve performance targets and improve patient experiences.

Members were given strong reassurances that the ICB  ...  view the full minutes text for item 5.

To review performance against the Gloucestershire Urgent and Emergency Care Winter Sustainability Plan 2022-23

To aid the discussion at the meeting, members are encouraged to note the information report published with the agenda and the minutes of the joint committee meeting held on 18 October 2022 in relation to this item. To view the documents for this meeting, please refer to the link on the Gloucestershire County Council here

Presenting Officers: Eve Olivant and Mary Hutton from NHS Gloucestershire

The committee received a detailed update on the delivery and performance of the NHS Gloucestershire Urgent and Emergency Care Winter Sustainability Plan 2022-23

To aid the discussion, prior to the meeting, members were advised to refer to the information published with the agenda and the minutes of the joint committee meeting held on 18 October 2022. To view the documents considered at this meeting, please refer to the link on the Gloucestershire County Council here.

Eve Olivant and Mary Hutton from NHS Gloucestershire introduced the item before responding to questions. The slide show presentation presented at the meeting can be viewed at the link here

Members were informed that, on 27 February 2023, operational and clinical leads from across the NHS Integrated Care System had come together to give candid and constructive feedback on how the Winter Sustainability and Surge Management Plan 2022/23 had responded to the challenges of delivering accident and emergency services during the winter period and to consider what might have been done to improve the quality of patients’ experiences and outcomes.

Considerations included: -

Ø  What went well?

Ø  What could have been done better?

Ø  Lessons learnt?

Ø  What needed to be taken into consideration when developing planning improvement and transformation plans?

Ø  Feedback from partners

It was reported that, in late April, NHS Gloucestershire would be arranging a workshop involving executives and operational leaders from across the system to consider outputs from the review exercise conducted in February to align with system wide transformation plans, using a year on year approach. It was hoped the review would create the foundation on which NHS Gloucestershire could build goals and develop priorities and plans for the future of urgent and emergency care in Gloucestershire.

Members acknowledged the huge pressures impacting on the Urgent and Emergency Care system during the winter months, including the large spike in December. In recent months, the care system had been affected by industrial action, which was on ongoing.

The majority of questions addressed at the meeting related to ambulance response times, Covid-19 related issues and hospital admissions in the South-West, (higher than the national average for England). Responding to members concerns, NHS Gloucestershire stated that, improvements in the system had begun to emerge, and that more benefits were anticipated in the longer term.

Responding to questions on the Covid-19 Booster programme, Executive Director of Adult Social Care, Wellbeing and Communities at Gloucestershire County Council, advised that the Covid-19 vaccination and booster programme had been developed to prevent complications from the virus and had been a huge success. The vaccine, however, would not prevent a person from getting the virus. Successive vaccines/stages would be on the advice/instruction of the government (Department of Health).

Referring to the delivery of services by the South-West Ambulance Service and NHS 111 service during the winter months, a member asked whether the committee would be able to revisit the consultants’ (Newton Europe) reports relating to these areas. The request was noted. Action by – NHS Gloucestershire  ...  view the full minutes text for item 6.

A verbal update on the extension of temporary service changes to maternity services provided at the Cheltenham General Hospital (AVETA) Birthing Unit and at the Stroud Hospital Birth Unit.

For background details on the extension of temporary service changes, please refer to Appendix 1 of the NHS Gloucestershire Integrated Care Board (ICB) Report, presented at the Health Overview and Scrutiny Committee meeting on 31 January 2023. This is a historic document and was considered by the committee on 31 January 2023. Document attached for information.

At the request of the Chair, the committee received a verbal update on the decision to extend temporary service changes to maternity services provided at the Stroud Maternity Unit (SMU) and the Aveta Birthing Unit at Cheltenham General Hospital (CGH).

For details of the changes, please refer to the attached appendix, (Appendix 1 of the NHS Gloucestershire Integrated Care Board (ICB) report, presented to the Health Overview and Scrutiny Committee at its meeting on 31 January 2023). Please note: this is a historic document and was considered by the committee on 31 January 2023.

Deborah Lee, Chief Executive, Gloucestershire Hospitals NHS Foundation Trust and Lisa Stephens, Director of Midwifery, referred to the decision to close temporarily the Aveta Birthing Unit at Cheltenham General Hospital in April 2022 and six post-natal beds located at the Stroud Maternity Unit in October 2022. It was confirmed that the decision had been reviewed in early January 2023, where it had been agreed that the services would remain temporarily closed. The decision would be reviewed again in April 2023, (based on progress made on midwifery recruitment, sickness and absence levels). A Memorandum of Understanding (MOU) considered at the HOSC meeting on 31 January 2023 had been noted and agreed.

Members were informed that, current staffing levels continued to fluctuate, impacted by sickness and maternity leave. Since the previous update, however, a consultant midwife had been appointed in early March. Staff recruitment and retention remained a challenge, with 25 midwifery vacancies reported. A recruitment event was planned, involving a potential 31 candidates. It was hoped significant opportunities would develop from this and other such events, but that it was important to avoid a yo-yo effect and the consequences of such from the opening and closing of services. It was essential that, once re-opened, the services remained open. The Hospitals Trust intended to explore a range of staffing models/options appraisals in early May to maintain the stability of the services.

Responding to questions and an appeal to keep the Stroud Maternity Unit open, one member requested that consideration be given to offering new mums the opportunity to remain at the hospital for at least 6 to 12 hours after giving birth, and benefit from the support of the midwife.

The update was noted.

To receive an update on the performance of the Gloucestershire Integrated Care System (GICS) in parallel with 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.

The report was taken as read.

Key points referred to by the report included: -

a)    The Newton Europe Urgent Care diagnostic was now informing Urgent and Emergency Care operational planning for 2023/24. 

b)    As of 30 January 2023, 73.6% of those eligible for an Autumn Covid-19 Booster in Gloucestershire had received their booster dose. Guidance issued the previous week had stipulated the 12 February 2023 as a ‘hard stop’ for Autumn Booster vaccinations. Gloucestershire was currently engaged in a final push to convince those still eligible but yet to have their Autumn Booster to come forward. Following 12 February, a much reduced delivery network would continue to operate in Gloucestershire, supported by outreach teams to try to drive primary course (first or second) vaccination uptake rates in ‘hard to reach’ cohorts, particularly in areas of relative deprivation.

c)    In accordance with the Health and Care Act 2022, the Integrated Care Board (ICB), along with partner NHS trusts and NHS foundation trusts, is required to prepare a 5-year joint forward plan (JFP), prior to the start of each financial year. The plan is currently in the process of being updated prior to publication in June 2023.

Members enquired if Newton Europe would be invited to present their final findings to the committee at a future meeting. It was confirmed that the Newton commissioned piece of work had now completed and that a further piece of work was under consideration. It was unlikely Newton would present to the committee until later in the year.

The Gloucestershire Integrated Care System (GICS) Performance report was noted.

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 responsible for the day-to-day commissioning and provision of NHS services in Gloucestershire.

The NHS Gloucestershire Integrated Care Board, (ICB), report was taken as read at the meeting. 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.

Mary Hutton, Chief Executive of the NHS Gloucestershire ICB, referred to the Memorandum of Understanding Proforma at Appendix 1 of the report and asked members to note the contents of the document, detailing proposed continuation of changes to the Medical Day Unit at Cheltenham General Hospital. 

It was confirmed that a continuation of the temporary service change to the Medical Day Unit had been agreed with HOSC in March 2022, (to continue until March 2023), with the intention of undertaking a range of activities and engagement to determine the long-term plans for the location of the unit, including patient and staff involvement. Unfortunately, due to operational and logistical pressures, it had not been possible to complete this process.

The committee noted and supported the proposal for a nine-month extension, (April to Dec 2023), to the temporary service change relating to the Medical Day Unit at Cheltenham General Hospital, (prior to decisions being taken regarding the permanent location of the service).

Ingrid Barker, Chair of the Gloucestershire Health and Care NHS Foundation Trust paid tribute to Paul Roberts, Chief Executive of the Trust, prior to his retirement in April 2023. Ingrid referred to the huge contribution Paul had made to the NHS during his 35 years of employment, (28 years as a Chief Executive).

Ingrid’s tribute: -

Arriving in Gloucestershire five years ago, Paul has made a huge difference to the Gloucestershire Health and Care NHS Foundation Trust and has led the organisation through a merger and a pandemic. In the most difficult of times, Paul has created an organisation with strong values and a positive culture. This was recognised in the very good CQC report last summer and in an independent ‘well led review’ in 2022. It’s also evidenced in our staff survey results, which are now the best of any Trust in the South West. Paul’s commitment to tackling inequalities is profound, in line with his values of compassion and fairness. He will be greatly missed. I know you will want to join me in thanking him for his contribution. 

Unfortunately, Paul was unable to attend the meeting. The committee commended Paul’s work and his contributions to the Gloucestershire Health Overview and Scrutiny Committee.

The NHS Gloucestershire Integrated Care Board, (ICB), report was noted.

To note the dates of future meetings (below) and review items included on the committee work plan (attached).

23 May 2023

11 July 2023

10 October 2023

28 November 2023

The committee noted the dates of future meetings: -

23 May 2023

11 July 2023

10 October 2023

28 November 2023

The committee work plan was noted, with a request from one member of the committee that members engage in discussions prior to updates to the work plan, rather than retrospectively. The request was noted.

Chair, Cllr Andrew Gravells, thanked everyone for their clear responses to some serious questions, in particular, to the questions on the item relating to NHS Gloucestershire Out Of Hours Service.