Agenda and minutes

Health Overview & Scrutiny Committee - Tuesday 15 September 2020 10.00 am

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

Items
No. Item

1.

Apologies for Absence

Minutes:

Apologies for absence were noted from Cllrs Helen Molyneux, Brian Oosthuysen, Nigel Robbins, Pam Tracey, Robert Vines and Suzanne Williams.

2.

Declarations of Interest

Minutes:

No declarations of interest were made at the meeting.

3.

Minutes of the previous meeting pdf icon PDF 115 KB

Minutes:

The minutes of the committee meeting held on 14 July 2020 were confirmed as an accurate record of that meeting.

 

A member expressed concern about not being able to ask questions at the meeting on issues relating to the COVID-19 emergency, mental health issues and the NHS response to the emergency. Referring to the limitations of the agenda due to the revised remit of the committee, (following a decision by the county council to split the remit of the Health Scrutiny Committee from that of the Adult Social Care and Communities Committee), it was requested that the committee be given an opportunity to ask questions on wider health issues at future meetings.

 

Chair, Cllr Brian Robinson, noted the request and agreed to accept questions on issues relating to the COVID-19 emergency covered by some of the other items of the agenda. He also referred to the agenda items that had been considered at the Adult Social Care and Communities Committee meeting on 8 September 2020, for which members were able to access the papers on the GCC website and view the discussion via YouTube.

 

It was agreed that the agenda and papers from each of the Health Overview and Scrutiny Committee and Adult Social Care and Communities Committee would be circulated to the members of both committees in advance of future meetings.

 

In response to a question submitted by another member of the committee, (after the meeting), in relation to the changes made to the remit of the committee following the GCC scrutiny review in 2019, it has since been confirmed that a review of the current arrangements will be undertaken by the GCC Democratic Services Team in the next few months. The views of both committees will be taken into consideration as part of the review and reported back to the committee at a future meeting. 

 

In the meantime, should committee members wish to reflect on any particular aspects of the discussion at any GCC committee meeting, they are able to view/listen to the live recordings of all meetings via YouTube.

 

To view/listen to the discussion at the Adult Social Care and Communities Committee meeting on 8 September 2020, please refer to the link here

 

To view/listen to the discussion at this meeting, please refer to the link here

4.

Public Representation

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  9 September 2020.

Please email jo.moore@gloucestershire.gov.uk

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

Minutes:

Phlebotomy Services in the South Cotswolds

 

One public representation was made at the meeting.

 

The following statement was submitted by Marco Taylor in response to concerns relating to the closure of the Phlebotomy Service at Cirencester Hospital and the possible impact of this decision on the most vulnerable members of the community.

 

Statement (taken as read at the meeting)

 

‘I would like to raise with the Committee the significant negative impacts already being caused by the closure of the Phlebotomy service at Cirencester hospital and appeal for their assistance in holding the Clinical Commissioning Group (CCG) to account for this un-consulted and damaging change and secure the reinstatement of accessible blood testing in Cirencester as soon as possible.

 

Six weeks’ notice was provided of the service’s closure, with no community engagement or consultation, and the minutes from the last Committee stated that: “There would be no changes to the timeline and process for obtaining results”. However, the proposal in March’s Committee report provided no details of how service levels would be monitored and what action would be taken if the prior quality of service could not be sustained.

 

Typical wait times of a fortnight for a blood test appointment are being reported locally (compared to next or even same day access via the online system introduced in the last month of hospital-based service’s operation) and having had a blood test at the hospital just prior to the service’s closure, I was told by my surgery wait times for test results would in future be five days (compared to the typical 48 hours I have experienced before). The hospital-based service was highly rated and valued by the local community and certainly my personal experiences of the service were much better than nurse-provided services at my GP service in the town (for my daughter’s recent pre-school vaccination there was a six week wait).

 

The changes totally ignore the needs of those requiring a blood test related to hospital treatment, who, now have no option other than to travel to Gloucester hospital, in addition to the many people who will not be able to wait three weeks for test results. The proposal in the March Committee agenda pack also alleged that the service at Cirencester hospital was unable to provide tests for those under the care of a consultant or aged six or below, which I do not believe was true. This particularly discriminates against those without access to a car, (who typically are the more vulnerable members of society), as there is no direct bus service between Gloucester hospital and Cirencester, let alone the surrounding rural communities our hospital serves.

 

An Equality Impact Assessment (EQIA) would have identified these risks and required the CCG to put in place appropriate mitigations prior to making such a change, as far as I can tell none of these activities have taken place.

This letter, in last week’s local newspaper, The Wilts & Glos Standard [1]illustrates the significant hardship being imposed on the  ...  view the full minutes text for item 4.

5.

Winter planning pdf icon PDF 1 MB

Minutes:

Maria Metherall, Senior Nurse: Urgent and Emergency Care for the NHS Gloucestershire Clinical Commissioning Group, gave a detailed presentation on the Gloucestershire Winter Sustainability and Surge Management Plan 2020/21.

 

5.1 Outlining some of the challenges presented by the COVID-19 Emergency to the winter planning process, in particular to the arrangements for providing face to face consultations to patients, members were advised that a key challenge would be how to deliver the plan in a timely manner.

 

5.2 Members were informed that, unlike previous years, the plan would need to ensure a resilient system for the delivery of services over the winter period, including responding to potential changes in the levels of COVID-19, in addition to considering the impacts of the pandemic upon available capacities. This would need to be set against the backdrop of the need to recover and sustain levels of planned activity and pressures experienced across many parts of the health and social care system.

 

5.3 It was explained that, due to there being so many unknowns, it was unlikely the plan would be able to cover all possibilities and would be developed to focus on 4 key scenarios. These included: -

 

a)    Baseline position – normal levels of demand and situation as per previous winters (no COVID-19)

b)    COVID-19 (maintenance level) – baseline position, plus a low level of COVID-19 issues, similar to levels experienced at the time of the meeting (August/early September 2020)

c)    COVID-19 (second or subsequent peak) - baseline position, plus high levels of COVID-19

d)    COVID-19 (subsequent peak plus other diseases – e.g. Flu/Norovirus) - baseline position, plus high levels of COVID-19, plus potential outbreaks of flu or other communicable diseases

 

The plan would be subject to further guidance and key lines of enquiry from NHS England.

 

5.4 The key aims of the Gloucestershire Winter Plan 2020/21, (aligned to Phase 3 of the NHS response to COVID-19), would be to: -

 

a)    Accelerate the return of non COVID-19 health services, making full use of the capacity available between now and the winter;

b)    Recover the maximum elective activity possible between now and the winter;

c)    Restore service delivery in Primary and Community Care;

d)    Expand and improve mental health services and services for people with Learning Disabilities/Autism;

e)    Prepare for the winter, alongside a possible COVID-19 resurgence by:-

 

i)     Sustaining current staffing, beds and capacity;

ii)    Expanding the seasonal flu vaccination programme;

iii)   Delivering on the Think 111 First programme;

iv)   Maximising Hear and Treat and See and Treat within the ambulance trust;

v)    Continued use of NHS Volunteer responder schemes;

vi)   Continue working with Gloucestershire County Council to ensure that those who are medically fit for discharge are not delayed in hospital;

 

f)     The above to take into account any lessons learnt from responding to the pandemic thus far. The plan to concentrate on protecting the most vulnerable in the community; preparing for a potential second resurgence in the virus and making contingency plans for possible increased staffing sickness levels  ...  view the full minutes text for item 5.

6.

Covid-19 Temporary Service Changes pdf icon PDF 1 MB

Minutes:

Ellen Rule, Director of Transformation and Service Redesign for the NHS Gloucestershire Clinical Commissioning Group (CCG), (on behalf of the One Gloucestershire Integrated Care System (ICS), gave a detailed update on the temporary service changes introduced to support the Gloucestershire response to COVID-19 and to assist with the Winter Planning process for 2020/21.

 

6.1 Outlining the changes in a condensed summary of the information included in the detailed body of the report, it was explained that the purpose of the document was to update the committee on the COVID-19 incident response and proposals for the extension of the temporary variations, (discussed with HOSC members at HOSC meetings earlier in the year), required to meet ongoing operational requirements.

 

6.2 In presenting the report, the Gloucestershire Integrated Health and Care System (ICS) aimed to seek the support of the committee to extend the operational changes in place to March 2021 to enable the ongoing delivery of health services in an environment where COVID-19 continues to represent a considerable risk to the health of the population and compromises the safe and productive delivery of health and care services in Gloucestershire.

 

6.3 The report is to be considered in the context of the work being undertaken to develop a ‘Winter Plan’ for Gloucestershire, referred to as the ‘Winter Sustainability and Surge Management Plan’. It was reported that the temporary service change proposals had been considered in light of the usual challenges presented to Gloucestershire Health Services during the winter and the additional challenge of needing to undertake winter planning in the context of the ongoing pandemic and the potential for a second wave of viral infections across the county.

 

6.4 It was anticipated that the majority of changes would be reversed at the end of the winter period.

 

6.5 In line with the locally agreed Memorandum of Understanding (MOU), a series of proforma documents had been completed, identifying the need for temporary service changes. Appended to the report, the proforma documents set out the detail for the proposed changes to allow the committee to consider the substantial nature of the proposed service variations and the proposed renewal of a number of emergency (temporary) service changes presented to the committee during the incident response. These included: -

 

6.6 The temporary reconfiguration of Emergency General Surgery from Cheltenham General Hospital to Gloucestershire Royal Hospital (GRH) in April 2020; renewed in July 2020. The Memorandum of Understanding (MOU), proposed a further extension of 6 months to enable the current service configuration to remain in place through the winter of 2020/21, ending in March 2021).

 

6.7 A series of other temporary service changes at both GRH and CGH, (considered by the committee before enacted in June 2020). These included:-

 

a)    The change from an Emergency Department to Minor Injury and Illness Unit at CHG 7-days a week from 8am to 8pm;

b)    All 999 and undifferentiated GP referrals to be centralised at GRH, including centralisation of the Acute Medical Service, (a consequence of  ...  view the full minutes text for item 6.

7.

Gloucestershire Clinical Commissioning Group Performance Report pdf icon PDF 2 MB

Minutes:

Mary Hutton, Accountable Officer for the NHS Gloucestershire Clinical Commissioning Group (CCG), presented an overview of GCCG performance against NHS national and local standards, as reported to the GCCG Governing Body. The performance report included a summary of key and mitigating actions to i) support continued performance and ii) provide assurances where performance might be below target or where there might be outlying variations across the county.

 

7.1 The committee reflected on the impact of COVID-19 on activity and performance targets. Members were advised that patient behaviours had changed significantly during the lockdown period, resulting in new demand patterns and a wide range of ongoing challenges. In response, the CCG was constantly reviewing performance. Every effort was being made to return services to pre-pandemic levels and develop confidence in the delivery of services in a safe environment.

 

7.2 Although performance had dropped significantly against the majority of NHS targets, it was confirmed that GCCG was performing similar to, or exceeding, the national performance average for most areas. One exception was the 4 hour target, which was slightly below the national average.

 

7.3 Another area highlighted by the report was the significant drop in dementia diagnoses, both locally and nationally. It was suggested this may have been due to a combination of data quality issues and a reduction in patient activity in both primary and secondary care services during the COVID-19 response. A further analysis was underway, to consider the impact on dementia patients locally.

 

7.4 Cancer referrals was another area that was being closely monitored. Cancer performance for the 2 week standard, (time to first outpatient appointment), in June 2020 remained excellent, achieving a target of 93%. It was noted that, in April, at the beginning of the lockdown period, a backlog of patients had chosen to avoid hospital settings and actively delay their first appointment, making achieving the target difficult. While this was no longer a common issue, the availability of diagnostics and patients shielding for clinical reasons continued to impact on the performance of this target.

 

7.5 Other good news was the improvement in the performance against target for 62 day cancer treatment waits, reported at 74.6% in May, 79.3% in June, 85.7% in July and currently, at 87.7%. The committee welcomed this improvement.

 

7.6 Mental Health recovery performance dropped significantly in April, with only 37.5% patients finishing treatment and entering recovery. This improved in May and June 2020, achieving 44.3% and 54.5% performance against recovery targets and meeting the national 50% standard in June.

 

7.7 A welcome note of achievement was reported in the urology performance target, which, until recently, had reflected weak performance for the GCCG. The improved performance was seen as a great achievement for the Trust, reflecting strong leadership and hard work from the teams involved. It was anticipated that the performance of this area would continue to reflect further improvements going forward.

 

7.8 Areas showing poorer performance, including A and E performance, continued to be monitored.

 

The performance report was noted.

8.

Work Plan

Members to identify if there is any items they wish to add to the work plan.

 

Next meeting:

 

October 2020 - TBC

 

17 November 2020

Minutes:

Responding to the request to suggest items for consideration at future meetings, it was suggested that the following items be added to the committee work plan for the October and November meetings: -

 

22 Oct – Fit for the Future Consultation

22 Oct – Forest of Dean Community Hospital Consultation

17 Nov – Phlebotomy Services Update, (in particular, at Cirencester Hospital)

17 Nov  – Public Heath Update 

 

Issues to incorporate as possible items for discussion at future meetings included: -

 

1. Health Inequalities arising from COVID-19

2. Vaccination Programme Update

3. Mental Health Issues/Impact of COVID-19 in schools (National Project)

 

9.

One Gloucestershire ICS Lead Report pdf icon PDF 558 KB

Minutes:

The committee noted an update report detailing the work involved in the management of programmes and projects across Gloucestershire’s Integrated Care System (ICS), including the impact of COVID-19 on the system.

10.

GCCG Clinical Chair/ Accountable Officer Report pdf icon PDF 202 KB

Minutes:

The Committee noted the contents of the NHS Gloucestershire Clinical Commissioning Group (GCCG) Clinical Chair’s and Accountable Officer’s Report.

 

Dr Andrew Seymour                                                Mary Hutton

Clinical Chair                                                           Accountable Officer

NHS Gloucestershire CCG                                    NHS Gloucestershire CCG