Agenda and minutes

Health Overview & Scrutiny Committee - Tuesday 14 July 2020 10.00 am

Venue: Virtual Meeting - Web ex meeting. 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 100 KB


The minutes of the meeting held on 14 January 2020 were agreed as a correct record subject to the amendment of a typo at 7.1 where it should read: ’enabling active communities’



Public Representation pdf icon PDF 61 KB

The Health Overview and Scrutiny Committee is piloting an approach

whereby members of the public can make representations at committee



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


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


should be given by 4pm three clear working days before the date of the meeting.

The closing date for notification is 4pm on 8 July 2020.

Please email

If any individual has any particular requirements please include in the



4.1      The Committee welcomed Dr David Willingham who was a Cheltenham Borough Councillor to make his representation as detailed below:


I am making this public representation to HOSC in respect of my continued concern about the reported Covid?19 death rate in the “Alstone and St Mark's” Middle-layer Super Output Area (MSOA) which has the formal designation of “Cheltenham 007”.

Online mapping published by the Office of National Statistics, suggests that as of 31st May 2020, there have been thirty-two (32) Covid?19 related deaths in this MSOA.  My further analysis of dataset from which this mapping visualisation was derived, shows that this is the highest number of Covid?19 deaths for any MSOA in not just Gloucestershire, but the whole Southwest region, and equal fourth highest number of Covid?19 deaths in the whole of England and Wales.  My analysis also shows that in April 2020, Covid?19 was the leading cause of deaths (59%) in this MSOA.


Dialogue with the Director of Public Health for Gloucestershire County Council has suggested that “This MSOA has 9 care homes with 264 beds. This is much higher than the MSOA average of 3 care home with 80 beds. When cross-referenced with our local registration data there is a high match between areas with a high number of care homes and deaths we are aware of in care homes.” 

The communities that I represent, the bereaved families of the deceased, and families with relatives in care homes deserve both answers and reassurance. 

I am therefore making this public representation to request the HOSC investigate what factors led to the high death rate in the Alstone and St Mark’s MSOA, and if, as suggested, the majority of deaths were in care homes, what the causal factors that lead to this tragically high death-rate were.


If there were systemic failures at any level, whether national, regional or local, then it is imperative that these are quickly identified so that remediation can occur.  This feeds into the second part of my request which is to ensure that in the event of resurgence of Covid?19 as lockdown measures are eased, the community that I represent, can be confident that there is sufficient understanding and preparedness that there will not be a repeat of the conditions that led to the high localised mortality rate.


My focus as a Borough Councillor is predominantly on the ward I serve and represent, as it has suffered the worst impact of this virus.  However, I recognise that it is clearly in the best interests of the county if other MSOAs in Gloucestershire with statistically significant elevated Covid?19 mortality rates also have similar investigations performed.


I trust that HOSC will agree that it is in the public interest for this to be investigated in as open and transparent way possible, so that the communities that I represent can understand what happened, and also get a reassurance that the understanding gained from this investigation is being used to inform the  ...  view the full minutes text for item 4.


Covid-19 Temporary Service Changes pdf icon PDF 1 MB

To provide the Committee with details of the temporary service changes that have taken place and update on plans for the future.


Members will note proformas outlining the plans relating to:


·         General Surgery

·         MIIUs


5.1      The Committee received a report to update members regarding the Covid-19 incident response and proposals for the temporary substantial variation and development of Health Services in Gloucestershire that were required to meet the ongoing operational requirements. The Committee was asked for further support for changes with details provided in line with the locally agreed Memorandum of Understanding. Ellen Rule introduced the report.


5.2      This related to two service changes, the temporary reconfiguration of Emergency General Surgery to Gloucestershire Royal Hospital from Cheltenham General Hospital (temporary change enacted on 1 April 2020 and the temporary closure of The Vale, Dilke & Tewkesbury Minor Injury Units (enacted on 22 March 2020). Members had been notified of the initial temporary changes by email at the time.


5.3      The Committee understood the two-phase incident response where it was necessary to radically reprioritise and reshape services.  Phase 1 had been about moving at pace to ensure services were safe, with short term actions taken so that Covid-19 patients were handled safely.  Now the Trust was in phase 2 where Covid-19 was still in circulation but the rate of infection had changed and the degree to which the Country was ‘locked-down’ had changed. It was noted that throughout this a number of factors have arisen that have and continue to significantly affect productivity of health and care services; these include the need for increased levels of infection prevention and control in all services, the challenge presented in caring for those safely in the shielded and vulnerable categories and continuing higher levels of staff sickness. In addition the Trust was modelling scenarios with regards to potential winter pressures and a potential second peak to ensure services were in a safe place to respond.


5.4      The changes proposed would be up for review in September 2020 with HOSC meeting on the 15th September.


5.5      The Committee recognised that there was some overlap between the emergency service changes enacted in response to Covid-19 and the Fit for the Future proposals due to be brought to public consultation later in the year. This presented a complex message to the public and stakeholders.


5.6      An extensive public engagement had been carried out in relation for Fit for the Future in late 2019 and it was proposed that the programme would be re-established in the autumn. There would be clarity around the changes that had been enacted as part of the temporary incident response and ensuring that no presumption existed regarding the medium to long-term proposals.


5.7      Winter planning proposals had not been completed and that would come to Committee in September.


5.8      Simon Lanceley Director of Strategy, provided members with a run through of the pro-forma for Emergency General Surgery emergency service change. He explained that as a result of centralisation of emergency surgery services, five of the extreme risks have been reduced. He highlighted the patient benefits and case study outlined within the pro-forma and emphasised how these actions removed the rota challenges.


5.9      In response to a member  ...  view the full minutes text for item 5.


Fit for the Future Update

Verbal Update to the Committee.


6.1      Members noted the timeline outlined within the previous item for Fit for the Future and confirmed that they would receive the pre-consultation business case proposals at the meeting on 15 September 2020.


6.2      It was explained that the Trust was working on the detail during July before meeting NHS England improvement in August and then in September launching the consultation with public boards and HOSC. In November there would be a Citizens Jury and then implementation would be planned for the new year (subject to consideration of outcome of consultation and any Citizens’ Jury recommendations). While it was recognised that the short term challenges around Covid-19 needed to be considered, it was still felt that long term planning and consultation on those plans were needed. Throughout the process there would be opportunity for reflection and consideration of current challenges and how that might change long term plans.


6.3      One member asked how the consultation would be publicised and carried out. It was explained that members would receive a detailed consultation plan, but it was acknowledged that traditional methods were unlikely to be relied upon in the current circumstances. The consultation would include online discussion forums, short surveys, polls and conversations with training being carried out on the systems and processes to support this. Members understood that the CCG had been working closely with Gloucestershire County Council with the recent allocation of grants and funding through the Digital Innovation Fund.



Gloucestershire Clinical Commissioning Group Performance Report pdf icon PDF 3 MB


7.1      Mary Hutton presented the performance report explaining that there was some updated information. This included a recent rise in Emergency Department activity but still below pre-covid levels as well as a 4.9% reduction in category 1 ambulance calls. There was also a focus on discharge.


7.2      In relation to cancer referrals, these had been well below the previous year’s levels for May and June but for July was back up to 100%.


7.3      In response to a question on ambulance response times in rural areas, it was explained that there had been new investment to provide more vehicles on the ground in 2020 as well as an investment in first responders. This was not an area the CCG was taking lightly.


7.4      There was some discussion around pathology services particular in Cirencester and members was reminded that phlebotomy services across the county were being delivered through GP surgeries in their own practices which should allow them to be more responsive. There would be no changes to the timeline and process for obtaining results.


7.5      In response to questions on waiting time at Gloucestershire Royal compared to Cheltenham, it was stated that Gloucestershire Royal Hospital performance during the pandemic was very strong and comparable to the previous year. One member expressed concern and stated that the poor performance in Gloucester was striking.



One Gloucestershire ICS Lead Report pdf icon PDF 739 KB


8.1      The Committee noted the report.


8.2      It was explained that a survey had been issued for those that had been volunteering during the Covid-19 pandemic asking for their experiences and asking if they would like to volunteer again. One member emphasised the importance of utilising the experience in this area.



GCCG Clinical Chair/ Accountable Officer Report pdf icon PDF 234 KB


9.1      The Committee noted the report.


9.2      One member noted the actions that had been taken to support care homes and asked whether there were any national systemic failures in this areas that had been identified and fed back to Government. In response it was explained tat issues had been identified of staff moving between care home and the need for PPE training and that all that learning was being fed back into the national work. It was also explained that a number of care homes had staff that did not have good use of the English language and that they had been unable to interpret guidance. One member called on the need for greater regulation of care homes.


9.3      Members were asked to fill in the survey within the papers on Covid-19 and pass the link on more widely.


9.4      One member asked a question about the previous mention that locally the Public Health team did not have access to the patient details of local cases of Covid-19 to enable outbreak management. This was confirmed as correct by the Director of Public Health. Instead, she worked closely with the South West Public Health England Team who did have access to this data to manage outbreaks. There was also  a question on spare capacity at local testing sites. With regards to testing, there was spare capacity due to the relatively low numbers of Covid-19 in the County. This spare capacity was available should there be a second peak, but the Public Health team was also in discussions with regards to how this resource could be best utilised.