Agenda and minutes

To note any apologies for absence.

Apologies were noted from Ingrid Barker and Angela Potter, (Gloucestershire Health Care NHS Foundation Trust), Professor Mark Pietroni, (Gloucestershire Hospitals NHS Foundation Trust), and from Nikki Richardson, (Healthwatch Gloucestershire).

Cllrs Julia Gooch and Susan Williams and Becky Parish (NHS Gloucestershire) joined the meeting via remote access.

To report any declarations of interest.

No declarations of interest were made at the meeting.

To confirm the minutes of the meeting held on 11 July 2023 (attached). Members to review the progress of actions from this meeting.

The minutes of the meeting held on 11 July 2023 were confirmed as a true and accurate record of that meeting.

The action log from the previous meeting was noted. It was confirmed that any outstanding actions would be monitored and reported at the next meeting.

At each meeting of the Health Overview and Scrutiny Committee, up to 20 minutes is set aside for members of the public, (including non-committee members), to make representation at the meeting. The process for making 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 initial representation.

Please submit any representations for the committee meeting on 10 October 2023 to jo.moore@gloucestershire.gov.uk before 4.00 pm on Wednesday 4 October 2023.               .

No public representations were made at the meeting.

To consider proposals set out in the NHS Gloucestershire Winter Sustainability Plan 2023/24.

Included in the presentation will be an update on the work of Newton Europe, as commissioned by NHS Gloucestershire and Gloucestershire County Council.

The committee received an overview of the priorities and plans set out for the delivery of Urgent and Emergency Care in Gloucestershire across the Winter months of 2023 and early Spring 2024.

The committee was asked to consider: -

a)    The NHS Gloucestershire Winter Sustainability Plan 2023/24.

b)    A briefing paper on the ‘Working as One’ programme, including an update on current progress in delivering transformation in Urgent and Emergency Care services across the One Gloucestershire Health and Care System.

The committee will be asked to review and evaluate the performance of the Winter Assurance Plan at the committee meeting in March 2024.

To view the presentation pack published with the agenda for the meeting, please refer to the link here

Members were informed that the NHS Gloucestershire Winter Assurance Plan for 2023/24 had been developed in response to the ‘usual’ anticipated winter challenges, as well as planning for seasonal flu, the ongoing impact of Covid 19 and continuing industrial action and workforce challenges experienced across the Gloucestershire Health and Social Care Network.

The plan was produced in collaboration with system partners, including Adult Social Care, Gloucestershire Hospitals NHS Foundation Trust, Primary Care, Voluntary Care Sector providers, Gloucestershire Health and Care NHS Foundation Trust, (community physical and mental health), the South West Ambulance Service NHS Foundation Trust and Private Sector Providers.

Asked to identify key changes from previous years, the committee was advised of the key challenges, (high-impact interventions), anticipated to impact on the health and care system, and the actions being proposed to address the challenges.

Proposed interventions included: -

a)    Same Day Emergency Care: proposals included reducing variations in Same Day Emergency Care provision and providing guidance on operating a variety of services for at least 12 hours per day, 7 days per week.

b)    Frailty: proposals included include reducing variations in acute frailty service provision and improving recognition of cases that might benefit from specific frailty services.

c)    Inpatient flow and length of stay: proposals included include reducing variations in inpatient care, (including mental health), and length of stay for key Urgent and Emergency Care pathways, conditions and cohorts by implementing in-hospital efficiencies and bringing forward discharge processes.

d)    Community bed productivity and flow: proposals included includereducing variations in inpatient care and length of stay, including mental health, by implementing in-hospital efficiencies and bringing forward discharge processes.

e)    Care transfer hubs: proposals included include implementing a standard operating procedure and minimum standards for care transfer hubs to reduce variation and maximise access to community rehabilitation and prevent re admission to a hospital bed.

f)     Intermediate care demand and capacity: proposed actions include supporting the operationalisation of ongoing demand and capacity planning, including improved use of data to improve access to and quality of intermediate care, including community rehabilitation services.

g)    Virtual wards: proposed actions includestandardising and improving care across all virtual ward services to improve the level of care to prevent admission to hospital and help with discharge.

h)    Urgent Community Response: proposed actions include  ...  view the full minutes text for item 5.

To receive an update on the performance of the Gloucestershire Integrated Care System (GICS) against NHS constitutional and other agreed standards.

The committee noted the Gloucestershire Integrated Care System, (ICS), Performance Report relating to the performance of the NHS Gloucestershire Integrated Care Board. The report included information on performance, quality and workforce. The report was taken as read at the meeting.

To view the contents of the report please refer to the link on the Gloucestershire County Council website at the link here.

Key achievements reported at the meeting included: -

      i.        The urgent and emergency care programme had achieved the majority of planned commitments with reductions in the numbers of long stay patients in acute hospitals and good performance against the 2 hour urgent care community response target.

    ii.        Diagnostic performance for the NHS Gloucestershire ICB was ranked first nationally.

   iii.        Despite the challenges of industrial action, the elective recovery fund (ERF) position for Quarter 1 2023/24 was on plan.

   iv.        Total primary care activity remained above plan, and urgent provision continued to benchmark well nationally.

    v.        Primary Care services had undergone necessary changes in order to meet demand. Emphasis was placed on the need to reduce pressures in Primary Care.

   vi.        Cancer performance targets were good, with 96.8% of patients seen within 2 weeks of referral on a cancer pathway.

Key information noted at the meeting included: -

      i.        Ongoing industrial action continued to impact on the system, with mitigation work taking some of the focus away from other areas of work, including urgent and emergency care transformation work.

    ii.        A consequence of the industrial action had resulted in a significant number of cancellations of elective procedures and appointments. Although this had not caused the elective recovery fund position to fall, it was, nevertheless, impacting on the system’s ability to attract additional funding.

   iii.        Industrial action was also constraining options for patients likely to breach the 78 week wait for elective treatment.

   iv.        Hot weather in early September had impacted on performance, particularly in relation to the performance of the South West Ambulance Service NHS Foundation Trust. Increased demand had been reported across all systems within the South West, impacting on Category 2 response times and handover delay performance.

Member Questions

Responding to concerns about Children’s and Adolescent Mental Health Services (CAMHS), the Chair suggested that a scrutiny task and finish working group be established to consider issues relating to Children’s Mental Health. Noting current waiting times for hospital appointments, specific focus to be made on waiting times for children obtaining hospital appointments.

Representatives from the Gloucestershire Health and Care NHS Foundation Trust confirmed that progress was being made to reduce waiting times for CAMHS appointments, but that these remained high due to workforce challenges and recruitment issues. It was noted that significant work to support children’s mental health services was being undertaken in local schools and in partnership with other service partners.

Speaking in support of the proposal to establish a scrutiny task and finish group, one member raised concerns about the provision of services available to children and families outside of term time and where children  ...  view the full minutes text for item 6.

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

The following updates will be included within this report: -

a)    Maternity Services Update

b)    Frailty Project Update

c)    NHS Long Term Workforce Plan (please refer to the NHSE Information Link here for more details). An ‘introductory’ paragraph to be included in the ICB update report to inform members about the NHSE publication (30 June 2023) of the ‘first comprehensive workforce plan for the NHS’. This will be followed by a more detailed update (as a standalone item) at the 28 November 2023 meeting.

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.

One member enquired about the recent closure of the GL1 Leisure Centre and Oxstalls Sports Complex in Gloucester, and the impact on local communities. It was clarified that, whilst the County Council was not involved in the decision-making, it was aware of actions being taken by the City Council to manage the situation, including arranging alternative locations for leisure activities provided by NHS Gloucestershire.

In response to the update on the delivery of Maternity Services in Gloucestershire, Cllr Dilys Neill enquired into the transfer of patients out of county and cross county anti-natal services. An update on the issue to be included in the Gloucestershire Update Report for consideration by the committee at the next meeting. Action: Gloucestershire Hospitals NHS Foundation Trust

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

28 November 2023

11 January 2024 (Joint Meeting with ASCC)

The committee work plan was noted and agreed.

Issues suggested as items to include on the committee work plan (for consideration at future meetings) included: -

1.    NHS South West Ambulance Service (Category 1) Response Times (to include in the NHS Integrated Care Board Report to the committee at the next meeting;

2.    Drug and Alcohol Rehabilitation Services – the committee was advised that this issue had been considered at the Adult Social Care and Communities Scrutiny Committee meeting on 16 May 2023, supplemented by regular updates to the committee at future meetings. To view the report and minutes from the ASCC meeting on 16 May 2023, please refer to the link here

3.    Referencing recent updates on the delivery of Maternity Services, (including the update at item 3.1.5 of the update report provided at this meeting), Chief Executive of the Gloucestershire Hospitals NHS FT informed members that further updates would be provided.

4.    Raising concerns about the issues of trips and falls in the over 65 cohort and links to physical frailty, a member enquired what preventative action was being taken to reduce the number of falls in relation to people’s balance and improving risk awareness when in the home and the community. It was confirmed that this was a key focus of work included in the Health and Wellbeing Board Strategy, for which a detailed presentation would be provided to this committee and the Adult Social Care and Communities Scrutiny Committee at a joint scrutiny committee meeting on 11 January 2024. Action: Director of Public Health

5.    Referring to the work of the committee in relaying information to local communities, a councillor enquired what measures were taken to encourage members to share key messages with the public. It was suggested that a briefing on the sharing of information be provided to the committee after the meeting. Action: NHS Gloucestershire