Agenda and minutes

To note any apologies for absence.

Apologies were received from Cllrs Julia Gooch (FODDC).

Cllrs Gemma Madle and Adrian Bamford joined the meeting via remote access.

Chair, Cllr Andrew Gravells, paid tribute to Ingrid Barker, (Chief Executive of the Gloucestershire NHS Health and Care Foundation Trust), on her forthcoming retirement from the Trust.

To note any declarations of interest.

To confirm the minutes of the joint meeting of the Adult Social Care and Communities Scrutiny Committee and the Health, Overview and Scrutiny Committee meeting held on 11 January 2024.

To note any outstanding actions from this and any previous meetings.

The minutes of the joint meeting held on 11 January 2024 and summary of actions were confirmed as an accurate record of that meeting.

Responding to an action from the meeting relating to a visit to the BeeZee Bodies Delivery Programme at Coney Hill and offers to encourage and promote healthy lifestyles in local communities, particularly in the Barton and Tredworth areas of Gloucester, it was confirmed that a 16-week face to face programme had commenced in January 2024 to address the low take up of numbers/families of work relating to the BeeZee Bodies Programme in these areas.

Members were invited to contact jo.moore@gloucestershire.gov.uk if interested (as a small group of members) to undertake a visit to the BeeZee Bodies delivery programme at Coney Hill, Gloucester, on a mutually agreed date later in the year.

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 making a representation follows the Gloucestershire County Council Constitution rules for making representations 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 12 March 2024 to jo.moore@gloucestershire.gov.uk before 4.00 pm on Wednesday 6 March 2024.        

No public representations were submitted for consideration at this meeting.

To receive an update on the delivery of maternity services in the county, including an overview of current issues and media reports.

5.1 Members engaged an in-depth discussion on the delivery of Maternity Services for the County, including the responses to the Panorama television documentary ‘Midwives under Pressure’ broadcast by the BBC on 29 January 2024, and the focus on Cheltenham General Hospital in the reporting of national maternity challenges.

5.2 Contributing to the discussion/responding to questions were representatives from the Gloucestershire NHS Hospitals Foundation Trust.

Key information presented at the meeting included: -

5.3 The BBC Panorama documentary broadcast on Monday 29 January 2024, focused on maternity services provided by the Gloucestershire NHS Hospital Foundation Trust. The programme included details of three very tragic deaths of a mother and two babies in NHS Gloucestershire Hospitals, in addition to exploring the national and local challenges in recruitment and staffing. The documentary also focused on the impact on staff, where some staff felt unable to speak up about safety concerns or felt they had not been listened to, particularly in relation to the two baby deaths in 2019 and 2020.

5.4 NHS representatives stated that the maternity services in Gloucestershire were undergoing significant transformation and that, as a Trust, NHS Gloucestershire Hospitals FT was determined to learn from past experiences and address any issues where mistakes were made.

5.5 The cases highlighted by the BBC documentary occurred between 2019 to 2021. Each case was independently investigated. Members were reassured that, as a result of the investigations and subsequent Care Quality Commission’s (CQC) inspections, significant improvements had been made to the delivery of NHS Gloucestershire maternity services.

5.6 Acknowledging that the Panorama programme had been very distressing, it was noted that the Trust had apologised for its failings and the trauma experienced by those individuals who had suffered such tragic losses. It was also noted that the Trust had made extensive changes and improvements over the past 18 months as part of the wider journey of improvement currently underway.

5.7 Some of the key changes included: 

1)    A new and expanded senior leadership team.

2)    An increased number of midwives and doctors.

3)    Work with staff to focus on patient safety, learning and continuous improvement.

4)    Introduction of a new consultant midwife role to strengthen midwifery oversight of midwifery-led care.

5)    An ongoing recruitment and retention programme to reduce vacancies and turnover of staff.

6)    Introduction of a ‘Place of birth risk assessment’ to prevent delays in accessing urgent care, if required.

7)    Three daily safety briefings to review staffing, workload and labour inductions (ensuring concerns are addressed immediately).

8)    Revisions to the internal Freedom to Speak Up Service.

9)    A range of other support offered to staff, including wellbeing and psychological services and safety champions.

5.8 The changes are being driven by staff, working in conjunction with families and communities. It is hoped this will encourage everyone to speak out and ensure the best and safest care is provided.

5.9 In terms of staffing levels and investment in NHS Gloucestershire midwifery services, it was confirmed that, since April 2020, the Trust had invested  ...  view the full minutes text for item 5.

To review the performance of the NHS Gloucestershire Urgent and Emergency Care Winter Sustainability Plan 2023-24.

To aid the discussion, members are asked to reflect on the information report published with the agenda, and the minutes of the Health Overview and Scrutiny committee meeting held on 10 October 2023. To view the documents relating to this meeting, please visit the Gloucestershire County Council website at the link here.

To view the report for this item, please refer to the agenda published on the Gloucestershire County Council webpage at the link here.

6.1 The committee received an overview of the priorities and plans set out for the delivery of Urgent and Emergency Care in Gloucestershire during the Winter of 2023/24. Please refer to the report published with the agenda for more details at the link here

6.2 The committee was asked to review and evaluate the NHS Gloucestershire Winter Assurance Plan 2023/24 presented to the committee in October 2023. To view the presentation pack published with the agenda for that meeting, please refer to the link here

6.3 Members were informed that the NHS Gloucestershire Winter Assurance Plan for 2023/24 had been developed in response to the ‘usual’ anticipated winter challenges, in addition to 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.

6.4 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 Southwest Ambulance Service NHS Foundation Trust and Private Sector Providers.

6.5 Forming part of the discussion, members received an update on the performance of the Southwest Ambulance NHS Foundation Trust (SWASFT) by the newly appointed Chief Executive Officer of the Trust, John Martin. Prior to the meeting, members considered district level data relating to the average Ambulance Category 1 and Category 2 response times for Gloucestershire during the period 2021 to 2024, including average response times recorded in January 2024. Members attention was also drawn to agenda item 8 and pages 40 to 44 of the agenda pack.

6.6 Responding to questions, the Chief Executive acknowledged concerns about ambulance response times for the county and to barriers to performance in rural areas. He also responded to questions about the availability and the sharing of equipment and other resources.

6.7 Committee Chair, Cllr Andrew Gravells, referred to the merits of arranging combined meetings between the various County Health Overview and Scrutiny Committees located in the Southwest and the Southwest Ambulance Service FT. Cllr Gravells reiterated the value of joint working with neighbouring trusts. 

6.8 Seeking a view on the anticipated performance of the SW Ambulance Service FT in the next 6 to 12 months, Cllr Gravells suggested adding an item to the committee work plan/agreeing a date for a full update from SWASFT to the new committee in early 2025. Action by – Democratic Services/SWASFT

Operations Manager, Nic Wright, and Dr Bob Hodges to present an overview of the work, including current issues, impacting on the Gloucestershire Local Medial Committee (LMC).

7.1 At the invitation of Operations Manager, Nicola Wright, members received a presentation on behalf of the Gloucestershire Local Medical Committee (LMC). Local GP, Dr Bob Hodges, attended the meeting to support the presentation and to respond to questions on the work of the committee based in Gloucestershire.

7.2 Established circa 1911, a Local Medical Committee is ‘a democratic body elected by and comprising local GPs. Under Section 97 of the NHS Act 2006, each committee is designated as the local representative committee for all medical practitioners who, under a general medical services contract, provide primary medical services in the area for which that committee is formed.

7.3 The committee is an independent body, representing the interests of all General Practitioners. Free from political constraint, the committee provides a source of advice and support for GPs in matters affecting their professional lives and activities. In consultation with medical defence organisations, the British Medical Association, and solicitors, the LMC is able to offer advice to GP’s should they need to seek help on any professional matter.

7.4 The committee also acts as the representative body for the canvassing of views from local GPs prior to consideration by the NHS Integrated Care Board, NHS England and other bodies.

7.5 As a professional body, the committee is responsible for ensuring the quality of GP work and the upholding of standards of professional practice. The LMC shares responsibility with NHS England and with regulatory and educational bodies to ensure local GPs conduct themselves appropriately, remain competent, are fit to practice, and do not expose patients to unnecessary risk.

7.6 The LMC strives to ensure local GPs, whose performance or conduct may have fallen below the required standards, are treated fairly, and are given the opportunity to correct any deficiencies.

7.7 Elected representatives in Gloucestershire comprise: 4 Gloucester GPs;

2 Forest of Dean GPs; 2 Cotswold GPs; 4 GPs for Stroud and Berkeley Vale;

1 Tewkesbury GP; 4 Cheltenham GPs; 2 GPs to represent freelance/locum GPs and several co-opted members, representing practice managers and GP trainees. Representatives are elected every four years. The LMC office is managed by a full time Operations Manager, with administrative support.

7.8 As an independent organisation, the LMC is funded by statutory and voluntary levy by all Gloucestershire GP Practices, (currently 46 pence per patient), and from by national levy, (currently 4 pence per patient). The national levy contributes to the GP Defence Fund (GPDF) to provide support to the British Medical Association and to aid any local GP Practices undergoing legal cases.

7.9 HOSC members welcomed the presentation, including confirmation of the encouraging working relationship between the LMC and the Gloucestershire ICB. Noting data relating to GP access in Gloucestershire, members were able to consider new information on the challenges to local GPs and the impact of the growing population in Gloucestershire. Members also noted the work in place to attract new GPs to the county. Information on ring fenced funding prioritised to support NHS recruitment to be presented  ...  view the full minutes text for item 7.

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

8.1 The committee noted the Gloucestershire Integrated Care System, (ICS), Performance Report detailing 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: -

8.2 Cllr Paul Hodgkinson expressed concern about the performance of some core NHS Gloucestershire performance targets, including those relating to Cancer Treatment Waiting Times. After the meeting, Cllr Hodgkinson submitted a Motion, (Motion 935 - NHS Cancer Treatment Waiting Times), for consideration at the Gloucestershire Full Council meeting on 20 March 2024 based on his concerns.

8.3 At the Council Meeting, members had resolved that: -

1)    A full briefing would be presented to the Council by the Gloucestershire Health Overview Scrutiny Committee, after the committee had conducted a review of cancer treatment waiting times in Gloucestershire, (to be brought back to Council within six months of the motion being proposed).

2)    The Leader of Council to write to the Chief Executive of the NHS Gloucestershire Integrated Care Board, highlighting the Council’s concerns on cancer treatment waiting times in both Gloucestershire and across England, and asking the ICB to take action to address this.

To listen to the full debate at the council meeting please open the link here.

8.4 In response to concerns about the under-performing of some performance targets, including neurological targets, NHS Gloucestershire acknowledged that the current position was challenging, but not unique to Gloucestershire. Where performance targets failed to meet the required targets, contingency recovery plans were introduced. The committee requested progress reports on the recovery plans, and it was agreed to provide updates as part of the performance reporting process to the committee at future meetings. Action by – NHS Gloucestershire

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.

John Martin, Chief Executive of the South-Western Ambulance Service NHS Foundation Trust, will join the meeting to give an overview on the current performance of the service and to respond to questions.

9.1 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.

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

Highlights referred to by the report included: -

9.3 The new Gloucestershire Diagnostic Centre opened in February 2024 and welcoming patients for diagnostic tests. The new £15m facility is located at the new Quayside building in Gloucester, offering more than 80,000 additional diagnostic appointments each year and allowing patients in Gloucestershire to access potentially lifesaving checks more quickly, without having to visit hospital. A wide range of diagnostic tests including X-Rays, MRI, CT, ultrasound, ECHO and DEXA scanning will be available when the centre becomes fully operational.

9.4 The Gloucestershire Dementia Strategy was considered by the NHS Gloucestershire Programme Development Group (PDG) in December

2023, and has received the support of system partners. The Strategy aims to promote dementia positive communities and enable the delivery of a personalised proactive approach to provide support and care at local community or neighbourhood level to help prevent, slow or reduce the impact of dementia. A comprehensive Dementia Needs Assessment has been completed and a series of workshops held involving participants from health, social care, public health, community, and VCSE (voluntary, community and social enterprise) organisations. The Strategy will be presented to the ICB for governance approval.

9.5 The Gloucestershire Local Area Partnership had its OFSTED and Care Quality Commission (CQC) Special Education Needs and Disabilities (SEND) inspection from 27 November to 15 Dec 2023. OFSTED and CQC carry out joint inspections of local areas at the request of the Secretary of State for Education under Section 20(1)(a) of the Children Act 2004. The purpose of inspection is to provide an independent, external evaluation of the effectiveness of the local area partnership’s arrangements for children and young people with SEND. The inspection report was published on 6 February 2024. Committee members were invited to study the report and to submit any comments on the areas identified for approvement. Action by – HOSC

9.6 Cheltenham Primary Care Network (PCN) won a top award, (Primary Care Network of the Year), for its joined-up work to proactively care for a diverse range of patients across Cheltenham.

9.7 Members were asked to encourage people across the county aged 40 and over to take up the offer of a blood pressure check in an effort to reduce heart attacks and stroke. One Gloucestershire’s Information Bus and the Outreach Vaccination and Health Team offered blood pressure checks in a variety of locations in January 2024. The latest initiative to build on visits to other parts of the county in the Autumn of 2023. Members enquired about the role of Pharmacists in offering blood pressure checks and were advised to visit the NHS Pharmacy First Service and  ...  view the full minutes text for item 9.

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

21 May 2024

16 July 2024

15 October 2024

26 November 2024

The dates of future meetings and the committee work plan were noted.

The following items were considered and agreed as possible items to include on the committee work plan: -

1. Children and Adults Mental Health Services (CAMHS) Scrutiny Review

At the Gloucestershire County Council Corporate Overview and Scrutiny Committee meeting on 6 December 2023, the committee agreed that a proposal by Cllr Andrew Gravells, (Chair of HOSC), and Cllr Andrew Miller, (Chair of Children and Families Scrutiny Committee), for the members of both committees to consider the establishment of a joint (HOSC/C&FSC) scrutiny and finish task group in response to concerns about the delivery of Children and Adults Mental Health Services (CAMHS), including CAMHS appointment waiting times, be deferred pending the outcome of the Gloucestershire SEND Inspection in 2023/24. 

At the Children and Families Scrutiny Committee meeting on 7 March 2024, Cllr Andrew Gravells requested information on the county’s investment into the delivery of Children and Adults Mental Health Services (CAMHS) prior to members considering the following proposals at this meeting.

At the meeting, it was suggested that a briefing note and task group review scoping document be considered under the committee work plan item for consideration/discussion at the HOSC meeting on 21 May 2024 (this will allow the new membership of the committee to consider how they wish to take the item forward/including consideration of the proposal for a task group review). HOSC district representatives with an interest in the issue to be invited to attend relevant task group meetings (at the invitation of the Chair) following the May council elections. Chair of Gloucestershire Health and Care Foundation Trust noted the suggestion and advised that the review be scoped as a broader Special Education Needs and Disabilities (SEND) review to look at issues across the whole system pathway. Action by – NHS Gloucestershire GHCFT/Democratic Services

2. Maternity Services Update (including invitation to external independent investigation boards) – 21 May 2024

3. GP Access – this item was suggested after the HOSC meeting on 12 March 2024 meeting for consideration at the HOSC meeting on 21 May 2024.

4. Frailty Issues – overview to be included in the 21 May meeting ICB Update Report

5. Deaf and hard of hearing accessibility to services – update to be included in the 21 May meeting ICB Update Report

6. Combined HOSC (SW Region) and SWAST discussion – to consider the arrangements for inviting representatives from other HOSCs within the SW region to participate in a Teams discussion with SWAST.

7. Committee Work Plan Review – 21 May 2024/16 July 2024

It was noted that the next meeting of the committee, on 21 May 2024, would be the first meeting of the new committee membership following district local elections and following the appointment of district representatives on the Health Overview and Scrutiny Committee at local council annual general meetings.