Agenda and minutes

Health Overview & Scrutiny Committee - Tuesday 28 November 2023 10.00 am

Venue: Council Chamber - Shire Hall, Gloucester. View directions

Contact: Joanne Moore  Email: jo.moore@gloucestershire.gov.uk

Items
No. Item

1.

Apologies

To note any apologies for absence.

Minutes:

Apologies for absence were received from Cllr Stephen Hirst (Gloucestershire County Council) and from Cllr Dr Collette Finnegan (Gloucester City Council).

 

No substitutions were made at the meeting.

 

To view/listen to a recording of the meeting, please visit the Gloucestershire County Council website at the link here

2.

Declarations of Interest

To report any declarations of interest.

Minutes:

Cllr Julia Gooch (Forest of Dean District Council) declared a non-prejudicial (personal) interest in item 6 of the agenda. Cllr Gooch’s daughter is a Support Officer with the Proud to Care Team at Gloucestershire County Council.

 

Cllr Gooch also advised of a non-prejudicial (personal) interest in relation to her son’s employment as a Biomedical Scientist with NHS Gloucestershire.

3.

Minutes pdf icon PDF 111 KB

To agree and confirm the minutes of the meeting held on 10 October 2023.

 

To review the progress of any outstanding actions.

Minutes:

The minutes of the meeting held on 10 October 2023 were confirmed and agreed as a correct record of that meeting.

 

Comments raised in relation to outstanding actions from that and from earlier meetings included: -

 

1.    Improving Access to Psychological Therapies (IAPT) Access. Acknowledging the responses to questions submitted at the HOSC meeting in July, Cllr Helen Fenton stated that the recovery rates quoted in the response reflected a much longer recovery period than had been anticipated and enquired what was being done to address this? Chief Executive of the Gloucestershire Health and Care FT agreed the recovery rates were longer than would have been liked, but that, in response to the huge increase in demand for services, investment had been made to support an intense recruitment programme, which would hopefully help to improve the position.

 

2.    Members noted an update on an action relating to a request to the Adult Social Care and Communities Scrutiny Committee (ASCC) to consider a scrutiny item on Acute Psychiatric Inpatient Discharges. Members were informed that, at the ASCC meeting on 14 November 2023, the committee had agreed to consider the request as part of a Health and Adult Social Care Market Position Statement Report/Presentation to ASCC in July 2024. The matter to be considered as a broader ‘in-house provision’ topic, with officers from the in-house provision team invited to the meeting to contribute to the presentation. During the discussion, it was suggested that a site visit might be useful for members to visit one of the council’s in-house locations, and this was agreed. Cllr David Drew enquired if HOSC members would be invited to attend the site visit, and it was confirmed that HOSC members would be welcome to attend. Action by – Democratic Services

4.

Public Representations

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 28 November 2023 to jo.moore@gloucestershire.gov.uk before 4.00 pm on Wednesday 22 November 2023.

Minutes:

No public representations were made at this meeting.

5.

Primary Care Updates pdf icon PDF 854 KB

A presentation on the delivery of GP Medical, Community Pharmacy, Optometry and Dentistry (POD) Services in Gloucestershire.

Minutes:

Presenting Officers Jo White and Helen Edwards from NHS Gloucestershire gave a detailed presentation on the delivery of GP Medical, Community Pharmacy, Optometry and Dentistry (POD) Services in Gloucestershire.

 

To view the presentation, please refer to the link here

 

In spite of the challenges of recruitment and retention, General Practice Data reported the majority of patients (59%) in Gloucestershire as satisfied with the general practice appointment they had received against 57% reported nationally. 

 

Key information reported at the meeting included: -

 

General Practice Access:

 

a)    A total of 27% (80,000) more appointments had been offered in General Practice in September 2023 compared to September 2019.

b)    Over the past 6 months, the average increase in the number of appointments offered had been 23.5% compared to the same period in 2019, an increase of over 67,000 appointments a month.

c)    Gloucestershire General Practices were seeing more patients as face to face appointments than in the early part of 2019, (above the national average during and since the Covid-19 Pandemic).

d)    Comparisons made between the six month period during April to September 2019 and the same period in 2023 reflected an average monthly increase of over 5,500 GP face to face appointments in Gloucestershire.

 

Primary Dental Services

 

a)    NHS Dental access for adults in Gloucestershire in 2021/22, (recorded as a percentage), was 29%. This was against an average of 35.5% for the South West.

b)    Measures taken to improve access to dental appointments included: -  seeking expressions of interest from General Dental Practitioners (GDPs) to offer out of hours urgent appointments on Saturday mornings and in early evenings; commissioning in hours urgent appointments at the start and end of existing sessions; flexible commissioning to retain primary care providers in core areas; re-directing new referrals for Intermediate Minor Oral Surgery (IMOS) Service from Secondary Care to the Community Dental Service (CDS), where clinically appropriate.

c)    Plans were also in place to establish a Primary Care Dental Centre of Excellence, increasing access and enabling dental workforce development.

d)    In terms of workforce activities, several appointments had been made,  or in the process of being made, including a Dental Strategy Clinical Lead, 2 new Dental Advisor posts.

e)    Plans were also underway to develop and extend local apprenticeship and trainee offers in conjunction with local providers, including the University of Gloucestershire, Gloucester College, South Gloucestershire and Stroud College. 

f)     Work was ongoing to promote the NHS England work experience programme in local schools and building a relationship with Local Dental Committee.

g)    Dentistry had been included in the NHS ICB workforce planning campaign.

h)    Work in conjunction with Gloucestershire County Council (GCC) Public Health colleagues included; the commissioning of a dedicated Oral Health Training Team; offering oral health training to staff working in residential/nursing homes and other vulnerable groups; developing a service model for enhanced dental health in care; supporting the implementation of a supervised teeth-brushing campaign for the county, and implementation of ‘First Dental Steps’, with training for Health Visitors.

 

Community Pharmacy

 

a)  ...  view the full minutes text for item 5.

6.

NHS Gloucestershire Health and Care Workforce Plan 2023 pdf icon PDF 1020 KB

An overview of workforce challenges the health and care sector is experiencing across Gloucestershire. To refer to the NHS Workforce Plan, please refer to the NHSE Information Link here.

Minutes:

Tracey Cox, Director of People, Culture and Engagement for NHS Gloucestershire, presented an overview of the workforce challenges presented to the health and care sector for Gloucestershire.

 

To view the information presented at the meeting, please refer to the agenda published on the Gloucestershire County Council website at the link here. 

 

Members attention was drawn to the NHS Long Term Workforce Plan published on 30 June 2023, outlining ambitions set out in a 15-year plan from which to address predicted workforce shortages the NHS is likely to experience if no action is taken. To view the plan, please refer to the link here.

 

Running in parallel is the Skills for Care Plan announced in October 2023, focussing on workforce shortages within the Adult Social Care Sector, and the Integrated Care System (ICS) One Gloucestershire People Strategy, setting out proposals from which the ICS aim to attract and retain more staff to work in Gloucestershire. To view the strategy, please refer to the link here.

 

Other initiatives referred to at the meeting included; Health and Wellbeing Support for Staff; Recruitment initiatives, including international recruitment activity and engagement work with schools on considering careers in health and care.

 

Outlining current national and local data, members were informed that Primary Care was a particular area of challenge. In response, specific focus by the Integrated Care Board’s Primary Care Training Hub aimed at supporting GP Practices and Primary Care Networks across Gloucestershire. It was noted that workforce challenges continued to be impacted on by the recovery from the Covid Pandemic, low employee satisfaction and an ageing staff profile in some service areas, including Primary Care and Social Care. A particular challenge in 2023 had been the impact of industrial action.

 

Questions and comments made at the meeting included:

 

1.    Several members raised concerns about pay and high staff vacancy rates;

 

2.    Whilst pay is considered a factor in the recruitment and retention of staff, it is not the biggest factor;

 

3.    There is huge potential for the retention of staff from good quality training;

 

4.    Accommodation and housing provision to be included as considerations for retaining and attracting NHS staff to Gloucestershire; 

 

5.    It was suggested NHS officers engage with District Authorities/Housing Teams to consider what support might be available to address housing and accommodation issues for NHS staff;

 

6.    A member requested a breakdown of the schools and students involved in the ‘We Want You – WWY’ Project. Targeting pupils in years 8 and 9 of 19 selected schools, the purpose of the project is to promote ‘NHS One Gloucestershire’ as a key employer young people from across the county might consider working for, and to increase the uptake and awareness of higher education programmes at the University of Gloucestershire. Action by – NHS Gloucestershire

 

7.    Several members stressed the importance of better signposting and raising awareness with patients on where to seek treatment and in which service area in order to avoid placing increased pressures on Primary Care.  

 

The  ...  view the full minutes text for item 6.

7.

Gloucestershire Integrated Care System (GICS) Performance Report pdf icon PDF 711 KB

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

 

Minutes:

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 messages highlighted at the meeting included: -

 

1.    Additional funding had been awarded to the Integrated Care Board (ICB), including £40k towards the NHS Family Care Leavers Covenant Programme, a nationally sponsored initiative aimed at increasing the number of care experienced people employed by the NHS;

 

2.    Other bids included funding aimed at reducing Health and Care Support Worker vacancies and funding for Mental Health Training;

 

3.    Overall, performance targets for Gloucestershire was reported as stable in comparison to a decline in the national position;

 

4.    Ambulance Category 2 response time performance in October was reported at 70.9 minutes (a deterioration from the September performance target of 46.7 minutes);

 

5.    Average Ambulance Category 1 response times in October was reported at 11.0 minutes, ranging from 14.1 minutes in the Cotswolds to 7.8 minutes in the Gloucester localities; 5582 hours had been lost in handover delays during October, (an average 186 hours per day). It was noted that, since October, Category 1 and 2 performance response times had improved. Work was ongoing between the ICB and SWASTFT to address current issues. Members requested an update from the NHS South-West Ambulance Service Foundation Trust in the New Year, and this was noted; Action by - SWASTFT

 

6.    In September 2023, performance against the 2 week wait and 28 day Faster Diagnosis standards were missed for the first time in 2023/24. It was explained that the deterioration was a result of staffing issues and turnaround times for diagnosis tests. Recovery plans had been put in place.

 

Questions and comments raised at the meeting included: -

 

Responding to concerns about Category 1 and 2 ambulance response times, it was suggested that, pending an update to the committee in the New Year, a Teams meeting with a senior representative from SWAST be arranged with lead members. Action by NHS Gloucestershire/Democratic Services

 

A member enquired about recent concerns regarding the standards of care at Berkeley House. Members were advised that the concerns were being addressed and that details of the outcomes from an inspection of the facility would be shared with the committee, when published. Action by – Gloucestershire Health and Care Foundation Trust.

 

A member referenced the demand for repeat prescriptions via the Out of Hours Service and was pleased that work was underway to support Primary Care with this issue.

 

The report was noted.

8.

NHS Gloucestershire Integrated Care Board (ICB) Report pdf icon PDF 881 KB

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.

Minutes:

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.

 

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

 

Key messages highlighted at the meeting included: -

 

Members attention was drawn to the Gloucestershire Integrated Care Board Annual Assessment High-Level Summary for 2022-23 at Appendix 1 of the report. Conclusions from the report confirmed that the Gloucestershire ICB was working in compliance within its statutory duties.

 

The assessment demonstrated that the ICB remained in a strong position in terms of system leadership and had improved its approach to prevention and patient care. However, another outcome from the assessment was that the system was underachieving on its efficiency target, for which progress would be necessary in 2024. Progress was also required to improve dementia diagnosis rates in line with the 2023-24 operational plan. 

 

At Appendix 2 of the report, members were asked to consider a Memorandum of Understanding, (MOU), relating to a proposed service variation to the Medical Day Unit Service, a nurse led service previously provided at Gloucestershire Royal Hospital and at Cheltenham General Hospital. In response to the Covid Pandemic, the service had been moved to Cheltenham General Hospital as a temporary service change.

 

The MOU at this meeting proposed that the Medical Day Unit remain at Cheltenham General Hospital and that the temporary arrangement be extended for a further 6 to 9 months. The committee supported the proposal, and it was agreed to extend the temporary arrangement for a period of up to 9 months only, before moving to a permanent location in Quarter 2 of 2024-25.

 

Members welcomed the announcement of the opening of a new £15m Gloucestershire Community Diagnostic Centre at Quayside House, Gloucester in 2024 and the support the centre will provide to reduce the number of diagnostic appointments at Gloucestershire Royal and Cheltenham General Hospitals. Members supported a proposal from the Chair of the Committee, Cllr Andrew Gravells, that members undertake a site visit to the centre in the Spring. Action by - GHCFT/Democratic Services  

 

The report was noted.

9.

Work Plan pdf icon PDF 101 KB

To note the dates of future meetings and to review and update the committee work plan.

 

Next meeting: Thursday 11 January 2024 (a joint meeting with the members of the Adult Social Care and Communities Scrutiny Committee).

Minutes:

Members noted and agreed the combined work plan for the meetings of the Health Overview and Scrutiny Committee and the Adult Social Care and Communities Scrutiny Committee.

 

Items suggested for inclusion on the work plan included: -

 

1.    Update on the delivery of Maternity Services – to form part of the update to the committee at the January meeting

 

2.    Update on the Practice Plus Group Out of Hours GP Service - to form part of the update to the committee at the March meeting

 

3.    Gloucestershire Health and Wellbeing Board Pharmaceutical Needs Assessment Update

 

The date of the next meeting is 11 January 2024.

 

Members were reminded that this meeting would be a joint meeting of the Health Overview and Scrutiny Committee and the Adult Social Care and Communities Scrutiny Committee. In addition to HOSC performance and update reports, the following items to be considered at the meeting: -

 

  1. Gloucestershire Health and Wellbeing Strategy Update (incorporating actions in response to ‘Gloucestershire County Council Motion 881 - Tackling Inequalities, Poverty and Deprivation’ and the request for regular updates to HOSC on Health and Wellbeing Board Strategic Priorities). Obesity and Action on Adverse Childhood Experiences (ACEs) to form part of the presentation.

 

  1. Review of outcomes from the Gloucestershire Build Back Better Conference and Levelling Up Grant Reports announced in the Autumn.

 

  1. Work Plan (the combined work plan for both committees to be circulated in advance of the meeting, with an invitation to members to submit any suggestions/proposals/comments via email to jo.moore@gloucestershire.gov.uk for noting at the meeting).

 

The request for information on the ‘general physical activity programme’ (all ages) to be considered under the Gloucestershire Health and Wellbeing Strategy Update. 

 

The request for an item on falls and slips prevention’ to be presented as a briefing note circulated to HOSC/ASCC members in advance of the March scrutiny meetings.

 

Dates of future meetings: -

12 March 2024

21 May 2024

16 July 2024

15 October 2024

26 November 2024