Agenda and minutes

Health Overview & Scrutiny Committee - Tuesday 19 November 2019 10.00 am

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

No. Item


Apologies for absence


See above.



Declarations of Interest


No additional declarations were made.



Minutes of the previous meeting pdf icon PDF 168 KB

To agree the minutes of the meeting on 10 September 2019.


The minutes of the meeting on 10 September were agreed subject to the following amendment.


To include, Ingrid Barker, Angela Potter, and John Campbell to the attendees list.



Public Representation pdf icon PDF 37 KB

The Health Overview and Scrutiny Committee is piloting an approach whereby members of the public can make representations at committee meetings.

At each meeting of the Health Scrutiny Committee there shall be up to 20 minutes set aside for representations (3 minutes allocated per member of the public).


Any person who lives or works in the county, or is affected by the work of the County Council, may make a presentation on any matter which relates to any item on the Health Overview and Scrutiny agenda for that meeting.


Notification of your intention to attend the meeting and make a representation should be given by 4pm three clear working days before the date of the meeting.


The closing date for notification is 4pm on 13 November 2019.

Please email


If any individual has any particular requirements please include in the email.


Cllr Iain Dobie had submitted the following questions:



The Royal College of Psychiatrists has called for an end to the “shameful practice” of sending psychiatric patients hundreds of miles from home to be treated. The RCP is calling for hundreds of extra beds to be created in order to avoid the consequent distress of being separated from friends and families. Bristol, North Somerset and South Gloucestershire are named as regularly sending patients out of area.


- What are the figures (current and for the past 3 years) for Gloucestershire sending psychiatric patients - adults and children - out of area?


- What plans are there to create alternative residential treatment options in area - perhaps through cooperation with neighbouring health authorities?


It was explained that in 2018/19 there had been 20 placements and in the previous year (2017/18) there had been 27. A detailed response would be circulated outside of the meeting.



Improving Access to Psychological Therapies (IAPT) pdf icon PDF 722 KB

Members to consider the documents around Children and Young People’s Mental Health.


Presentation on IAPT – TO FOLLOW

Additional documents:


5.1      The Committee received a presentation and Members noted the additional papers that had been provided outlining Children and Young People’s Mental Health Support and the TIC+ Impact Report. The Committee understood there would be a workshop with Children and Families Scrutiny Committee members in March/April 2020 that would allow a more in depth look at this subject.


5.2      The presentation outlined that the IAPT programme was a national programme that had commenced in 2008. Nationally over 1 million adults and older adults accessed support each year and the NHS Long Term Plan committed to increase this to 1.9 million by 2023/24.The focus was on addressing the psychological needs of hard to reach or vulnerable groups of people.


5.3      The Committee received performance information which showed the increase in referrals and access. Since 2014/15 access had grown from 10% to 16.7% with the target for the end of 2019/20 at 20.5%.There was over performance against timeliness targets. The percentage of patients waiting longer than 90 days was at 27%.


5.4      The programme offered  a stepped approach with step one as self-help, for example, through the website and by signposting to services; step 2 was providing guided and assisted self-help; step 3 was high intensity intervention and support ; step 4 was compassionate resilience course.


5.5      Members understood that people with long term conditions were two or three times more likely to experience mental health problems than the general population.


5.6      The starting point was to develop an integrated approach to PR and cardiac, rehab and embed IAPT clinicians into existing public health pathways. It was important to increase identification of common mental health problems within physical health settings and promote closer work and skills across the services. The programme would look to offer informal support, supervision and training around mental health comorbidity. In addition, triage would be offered and review of people who required NICE recommended psychological treatments and to develop a full stepped care psychological service for people with co-morbidity in the physical health setting. 65% of patients could go through the lower intensity interventions.   


5.7      The team were looking at pilots funded by NHS England elsewhere to learn from best practice.


5.8      One member asked who did the diagnosis and referral with these cases. It was explained that those processes were being developed, because there was an understanding that many people would not self-refer.


5.9      It was clarified that where two conditions were presented at the same time this was referred to as co-morbidity.


5.10    It was suggested that some individuals with a physical condition did not identify or acknowledge they might also have a treatable mental health problem. One member asked whether individuals who might not access the service initially and enter later were likely to be ‘picked up’ by other organisations. It was stated that the team could not say confidently that every patient trying to access a service was being tracked. The aim was to make it as accessible as possible as part of a  ...  view the full minutes text for item 5.


The power of technology to improve the quality of NHS services

Members to receive a presentation.


6.1      Dr Paul Atkinson introduced the report outlining the delivery goals which centred around delivering a modern flexible infrastructure; provide a holistic view of the citizen’s direct care needs; joined up intelligence; provide streamlined systems and tools and offering people and their circle of care consistent and usable digital access.       


6.2      There was consideration of what patients need and want; members were shown a flow chart that demonstrated how a patient’s desire for advice to check symptoms and access the right medical help and medications led them directly to a GP practice, when the more appropriate route would to triage the patient to the most appropriate type of care.


6.3      Digital tools would be used to empower citizens to manage their health and wellbeing because it was better, simpler and because more people wanted to access services this way. For this to work there needed to be a point where people felt that the online journey was desirable.


6.4      Members received details of the Digital First/Online Services available such as the NHS app, patient’s online accounts and appointment and record access. Members were informed that 18% of repeat prescriptions in Gloucestershire were through electronic prescribing with the aim to raise this to 25%.


6.5      There was detail provided of the way in which information was shared such as through ‘Cinapsis’ that allowed GPs to talk to specialists. There was an average 19 seconds waiting times for GPs to access a specialist.


6.6      Members noted the data on the monthly views of the JUYI system which had been launched on 30 August 2018 with 200 users. The user feedback had been good.


6.7      One member commented that the figures around digital access were still relatively low compared to other organisations and suggested that it was still a very paper based system on the ground. In response it was explained that funding and willingness of central government was a factor in this but mainly it was ‘legacy’ with old equipment needing replacing. Digital options did not work for all of our patients and it was felt that we should be careful not to aim too high. It was suggested that if a percentage of the working age population could be moved away from face to face towards self care and more efficient means, that would create capacity for those that did not have digital technology. In Gloucestershire in Oct 2019 there had been 47,000 prescription requests.


6.8      One member asked how much patient information had been digitalised. In addition he asked were there still barriers in moving those records to a digital system? It was explained that this varied across organisations. Primary Care had been largely digital for a decade, but the historical library was on paper and any move to a new surgery would require paper copies to be transferred. There was a national programme to digitalise those paper records.


6.9      With regards to electronic prescriptions, some members suggested that there were issues with stock levels of medication so  ...  view the full minutes text for item 6.


Memorandum of Understanding pdf icon PDF 155 KB




This MoU has been prepared to enable the Committee to be clear as to what constitutes a substantial variation or development in a health service and to clarify the role of scrutiny.


Scrutiny plays a key role in holding NHS Commissioners and NHS Trusts to account, scrutinising local NHS services and ensuring NHS Commissioners and Trusts involve, engage and/ or consult lawfully and appropriately with local people. This role includes determining whether a service change constitutes a ‘substantial variation’ and determining requirements placed upon an NHS body if an issue is a ‘substantial variation’.


This document is to be agreed by the local NHS Commissioners (NHS Gloucestershire Clinical Commissioning Group/ NHS England) trusts (2Gether NHS Foundation Trust and Gloucestershire Care Services NHS trust (from October 2019: Gloucestershire Health and Care NHS Foundation Trusts, Gloucestershire Hospitals NHS Foundation Trust, South West Ambulance Service NHS Foundation trust) and the Gloucestershire County Council Health Overview and Scrutiny Committee and then reviewed again in 12 months, or following any material change to guidance or legislation.



7.1      Members noted the draft Memorandum of Understanding that had been drawn up  to enable the Committee to be clear as to what constituted a substantial variation or development in a health service and to clarify the role of scrutiny. The document included definitions around service changes such as ‘Emergency/ Temporary’. 


7.2      Members had a further opportunity to comment on the draft by email and discussions would continue with partners. Cllr Carole Allaway Martin as Chair of the Committee would sign it off on behalf of the Committee once all parties were happy. The Committee would receive the final version as an information item in the new year.


7.3      One member commented that it was important that timescales were agreed in relation to service change and that this should be done on a case by case basis. It was felt that a document such as this was essential as a guideline to how the Committee considered these items.



Gloucestershire Clinical Commissioning Group Performance Report pdf icon PDF 2 MB


8.1      The Committee noted the report with Mary Hutton updating members on the areas of improvement. It was explained that there were significant peaks and troughs in demand.


8.2      Members noted the 4 hour A&E target which had seen reduced performance, still compared well nationally. Members were informed of the Urgent Care Summit with actions from it to look in more detail at the areas of demand. Members noted the further investment in the Emergency Department and Psychiatric Liaison Service.


8.3      Further work was required regarding the performance relating to Cancer and in particular the 62 day target regarding GP referrals, screening and consultant upgrade. Members expressed concern at the continual poor performance in this area. In response it was explained that the focus had been on ensuring that the targets around two week assessments had been made as 90% of patients would be reassured at that stage that they did not have cancer and this target had now been achieved for three consecutive months, the first since 2015.. The focus was now on the 62 day pathway and urology was the challenge here but significant work was underway to address this. She would provide a briefing to members and feed back for January 2020 on what work was being undertaken in this area.
ACTION                     Deborah Lee


8.4      One member referred to media reports relating to changes to laboratory work in Cheltenham General Hospital with cytology now being delivered elsewhere. The member was concerned that this was a further ‘bit by bit eroding; of Cheltenham General. In response it was clarified that this was one service within the laboratory that was commissioned by NHS England and moved as part of a national commissioning process. This was establishing fewer, ‘specialist’, centres doing a higher volume of work to achieve better outcomes. This was not related to any other plans or proposals for Cheltenham General and the laboratory at CGH remained open.



8.5      One member noted the national concerns around A & E waiting times and asked what was the reason for these issues. In response it was reiterated that there was a national picture of increased demand on A & E services and the causes were not well understood at this stage. In terms of managing demand the focus was on encouraging patients to use the most appropriate services. Although Gloucestershire’s performance relative to recent time was not strong it was still one of the stronger performers nationally. 


8.6      One member requested an update with regards to radiology and community x-ray. It was explained that there had been some successful recruitment and greater flexible use of staff had allowed an increase in hours to some extent. Despite this they were not able to run a full service, this was a national issue and there was no quick solution..


8.7      In relation to ‘Planned Care – Diagnostics’ it was explained that non-obstetric ultrasound remained an area of concern for GP Care who had flagged their continuing financial pressure. An update would be provided  ...  view the full minutes text for item 8.


One Gloucestershire ICS Lead Report pdf icon PDF 816 KB


9.1      Members noted the report. Mary Hutton provided the Committee with details of the Enabling Active Communities programme and the Community Wellbeing Service.


9.2      In relation to Clinical Programme Approach, the Committee noted that a Chronic Obstructive Pulmonary Disease Self Management Plan was to be evaluated in the Hospital, community and 13 GP practices with the trial phase having commenced in September 2019. The new National Diabetes Prevention Programme (NDPP) provider, ICS, Health and Wellbeing Board started on 1 August 2019 and was working well with nearly 400 referrals made to date. The 10 Year Diabetes Strategy had been finalised and would be submitted for approval to Diabetes Clinical Programme Group in November 2019.


9.3      One member raised the Fit for the Future engagement and noted the comments made by the Secretary of State. He asked what information had been provided to the Secretary of State to provide assurances around the future of Cheltenham A & E. He requested detail around what proposals would be consulted on. Officers noted that the Committee meeting was being held during the pre-election period and so there would be no response to questions of this nature at this time. The Chair reminded members that the Committee would be considering the outcome of the engagement process at its meeting in January 2020 and there would be time for further questions at that stage.


9.4      The Committee recognised that the ICS lead Report contained a lot of information that would benefit from Public Health statistics to further inform members regarding outcomes. Members reflected that this split in the reporting was in part due to the change in committee remits following the Scrutiny review and that Public Health information was received by Adult Social Care and Communities Scrutiny Committee. If members had specific requests for information this could still be provided and where there were scrutiny items that that warranted it, joint meetings with the other committees could be arranged.



9.5      One member commented on the Joint Estate Strategy and sought reassurance that partners were included in discussions around any surplus sites to make the best use for the public sector. In response it was explained that there was a One Gloucestershire Estate Group and the membership of that group could be provided.
ACTION         Mary Hutton



GCCG Clinical Chair/ Accountable Officer Report pdf icon PDF 176 KB

Includes an update on Gastroenterology.

Additional documents:


The report was noted.