Venue: Council Chamber - Shire Hall, Gloucester. View directions
To note any apologies for absence
Apologies were received from Cllr Helen Molyneux (Forest of Dean District Council) and Cllr Robert Vines (Gloucestershire County Council).
No substitutions were made.
Declarations of Interest
To advise of any pecuniary or personal declarations of interest on matters relating to the agenda
No declarations of interest were made at the meeting.
To confirm the minutes of the meeting held on 22 October 2020
The minutes of the meeting held on 22 October 2020 were confirmed as a true record of that meeting.
The Gloucestershire Health Overview and Scrutiny Committee is currently 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 the County Council, may make a representation on any matter which relates to any item on the Health Overview and Scrutiny Committee agenda for that meeting.
Notification of your intention to attend the meeting and make a representation should be given by 4.00 pm three clear working days before the date of the meeting, (excluding the day of the meeting).
The notification deadline to make representation at the committee meeting on Tuesday 17 November 2020 is 4.00 pm on Wednesday 11 November 2020.
To confirm your request to make a representation, please email Jo Moore on email@example.com
Please note, this meeting will be held as a remote access meeting, for which it will be necessary to join the meeting by electronic means via the Webex application. An invitation to join the meeting will be provided prior to the meeting. If you have any questions on this process, please include in the email.
Phlebotomy Services in the South Cotswolds
One public representation was made at the meeting.
The following statement (including several questions) was submitted by Marco Taylor in response to concerns relating to Phlebotomy Services in the South Cotswolds.
Statement (taken as read at the meeting)
Further to my earlier representation, (at the Health and Overview Scrutiny Committee meeting on 15 September 2020), regarding the un-consulted degradation in access to phlebotomy services in the South Cotswolds, I note that the Clinical Commissioning Group has provided a report regarding the background.
There are a number of inaccuracies and omissions that I wish to highlight to the committee for further scrutiny. Wait times for blood tests at local GP practices have now typically increased to 3-4 weeks and in addition local evidence of inexperienced staff requiring several attempts to successfully find a vein and take a blood sample are common, creating a distressing experience especially for nervous patients.
I can contrast this to my direct experience of the pre-bookable hospital service in August where I was able to get a next day appointment and have my blood sample taken very easily. The result is many patients requiring primary care blood tests are now having to unnecessarily having to travel to Gloucester as they cannot wait a month for a test and as there is no direct bus service to Gloucester from Cirencester this is having a disproportionate impact on those who are unable to access a car or drive, typically older and more vulnerable people. Furthermore, this is exposing more people unnecessarily to environments with a higher risk of COVID-19 transmission.
In addition to raising the serious concerns, I would like to raise the following key questions for the CCG to respond to and the committee to scrutinise their responses:-
1) At the previous meeting I requested evidence of what consultation had taken place with the local community about the changes to phlebotomy services. No evidence was provided other than reference to engagement with the patient participation group.
I have searched the last two years' agendas of the CCG PPG and have found only one agenda item in February 2020 with the description: "Jo gave a brief update on how Phlebotomy Services are currently provided in Gloucestershire".
There is no indication of a discussion about future changes nor any form of meaningful consultation, let alone how many members of the Cirencester community were involved.
There is also reference to a link to an "Experiences of using Phlebotomy Services in Gloucestershire (blood tests)", which it is noted no reference has been made to as part of any decision making process.
Please can the CCG provide details of the full extent of consultation that took place related to this change in care setting for key community health services be provided including specifically how many members of the Cirencester community were involved?
2) Also at the previous meeting, I requested evidence that the needs and challenges reflecting the Cirencester area were examined separately from the ... view the full minutes text for item 4.
An update on changes to community phlebotomy services, including recent revisions to the arrangements in the Cirencester area.
Mary Hutton, (Accountable Officer for Gloucestershire NHS CCG/Lead Officer for One Gloucestershire Integrated Care System ICS), referred members to the report on Community Phlebotomy Services.
In response to the public representation made by Mr Marco Taylor at the September committee meeting, (and to the public representation made by Mr Taylor at this meeting), the committee received an update on community phlebotomy (blood testing) services. The purpose of the update was to brief members on the rationale for making changes to community phlebotomy services in Gloucestershire, including recent revisions to the service arrangements in the Cirencester area.
Referencing a review of service provision in 2019, (involving consultation with GP’s across the county), followed by updates to the committee in March, July and September 2020, members were advised that, prior to the recent changes, community phlebotomy services had been provided in a range of settings/locations across the county, including ‘drop in’ hospital clinics and at GP practices. Blood tests can be requested by a range of clinicians, including GPs and by hospitals based clinical teams.
Before the changes, some patients had been able to access local phlebotomy services at local GP practices, whilst other patients had to travel to a hospital setting to receive a blood test. High levels of demand within hospital settings had resulted in long waiting times for many patients. On occasions, services had to close earlier than scheduled in order to manage the high volume of patients requiring tests, with some patients having to revisit the hospital at a later date.
To address the situation, the CCG had endeavoured to make improvements to the provision of phlebotomy services with the aim of ensuring all patients had timely access to a safe and high quality community service at a location as near to their home as possible and, in doing so, providing a consistent service across the county.
Following changes introduced over the summer, blood tests generated by a GP or Practice Nurse continued to be provided by primary care services, whilst blood tests generated as part of a hospital outpatient appointment was now the responsibility of the hospital managing the patients care.
The CCG had funded all 73 Gloucestershire GP Practices to start the provision of phlebotomy services for patients requiring ‘primary care requested’ blood tests from 1 July 2020 (1 August 2020 in Cirencester). Acknowledging specific issues affecting the Cirencester area, additional temporary arrangements had been put in place, (to be supplemented by additional permanent arrangements from 2 December 2020).
A consequence of the changes had been a notable increase in CCG spending on community phlebotomy services. Furthermore, in response to the Covid-19 emergency and the need for social distancing requirements, some appointments were taking longer than anticipated.
Members were advised that, prior to the changes, the total demand for providing phlebotomy services at the Gloucestershire Royal, Cheltenham General and Cirencester Hospitals, had often been so great, the resources available for providing the services had been significantly overstretched.
GP practices now had their own in-house phlebotomy capacity ... view the full minutes text for item 5.
To consider an overview of performance by the Gloucestershire Clinical Commissioning Group against NHS constitutional and other agreed standards.
To include an update on ambulance response times during the COVID-19 Pandemic.
Mary Hutton, (Lead Officer from the NHS CCG/One Gloucestershire Integrated Care Service), and Dr Andy Seymour (Clinical Chair), gave an update on the performance of the Gloucestershire CCG against NHS constitutional and other agreed standards. A summary of performance against national and local standards, as reported to the GCCG Governing Body, formed part of the update.
At the time of the meeting, it was confirmed that the number of Covid-19 cases across the county was increasing, with a significant increase in the number of hospital admissions. The number of cases was higher than anticipated, with increased pressures placed on urgent care services. It was important to note, however, that both Covid-19 and Non-Covid-19 patients were still able to access beds and services across the county.
Overall, Gloucestershire was performing well in comparison to the national position, with the exception of the A & E 4 hour performance standard. It was confirmed that there had been a significant decline in overall A & E performance locally, largely attributed to the Covid-19 measures in place in relation to infection, prevention and control and social distancing. Such measures had impacted significantly on the performance of the emergency department at the Gloucestershire Royal Hospital site.
Cancer performance targets had improved over the summer months, particularly in meeting the 62 day standard. Gloucestershire compared well to the national position in relation to all cancer targets.
Work on improving diagnostic performance standards was continuing but still significantly impacted by the COVID-19 emergency. Performance had, however, stabilised, with some signs of recovery.
Responding to specific questions on the pressures placed on Gloucestershire Royal Hospital from having to respond to the Covid-19 emergency, members were assured that every effort was being made to prepare for a second wave of the virus and the impact of such on the county’s hospitals during the winter.
Particular concern was expressed about the need to cancel planned surgery, as had been reported on the radio the previous day. Mary Hutton acknowledged the concerns and informed the committee that a considerable amount of work was being taken to address the issue, including a revision and enhancement of the winter plan. It was noted that Gloucestershire was one of the few hospital trusts in the region continuing to prioritise cancer patients. A huge effort was being undertaken as part of a joined up team effort and working programme.
Acknowledging concerns about ambulance waiting times at Gloucestershire Royal, and conscious that, whilst the system was currently not performing as well as it should be, it was also pointed out that emergency departments in Gloucestershire were coping better and less crowded than in other parts of the country.
The committee noted the significant amount of work being invested in responding to the challenges of the pandemic and commended the efforts of all those involved. Several members expressed strong support for the work being undertaken and a concerned understanding of the demands being placed on NHS staff.
One member enquired whether a dashboard of performance data from other local ... view the full minutes text for item 6.
An update from the Director of Public Health on recent developments in response to the COVID-19 pandemic in Gloucestershire.
Sarah Scott, Director of Public Health, gave an update on Covid-19 related data for Gloucestershire. The update referenced information included in the Gloucestershire Covid-19 Weekly Summary (Week 45) document, based on data for the period 2 to 8 November 2020. It was noted that the data was updated daily and that the information presented at this meeting was now retrospective. The summary sheet is attached to the minutes of the meeting and available on the GCC website.
Concerns were noted about the rapid increase in the number of Covid-19 cases across many parts of the county during recent weeks. The increase was notably larger in specific age groups, primarily the 19-35 age group and in elderly people. Data continued to be analysed daily and was under constant review.
Clarifying that the number of Covid-19 related cases in Gloucestershire continued to be lower than in other areas of the South West, the Director of Public Health hoped transmission rates would start to decline following the introduction of new lockdown measures. Concerns remained about the impact of the virus on the county on entering the winter period.
Robust track and trace testing was being carried across the county, with a Gloucestershire Contact Tracing Pilot being introduced from 19 November 2920.
Noting concerns about a recent experience at a mobile testing unit, a member was informed that the county was following strict government testing guidelines.
Questioning the arrangements for conducting tests in respect of care home staff, the Director of Public Health confirmed staff were tested weekly and care home residents every 28 days. It was noted that recent data indicated an increase in the number of staff contracting the virus but a slight decrease in the number of residents who tested positive. At the request of the committee, it was agreed to provide data on this issue after the meeting. Action by – Director of Public Health
Personal Protective Equipment (PPE) supplies plus training on how to conduct testing in care homes was being rolled out, in addition to revised guidance on the arrangements for care home visiting. The decision on whether to allow visiting in care homes was the responsibility for care home managers. The NHS CCG confirmed that there were fewer Covid-19 patients admitted to hospital from care homes during the second wave of the pandemic.
When asked what support members might provide to their local communities, the Director of Public Health reaffirmed the need to remain vigilant about adhering to basic government guidelines. This would be particularly important during the anticipated roll out of a possible vaccine prior to Christmas.
The Director of Public Health also reinforced, (on entering the second wave of the pandemic), the importance of raising awareness about the mental health support available across the county and, wherever possible, for members to encourage people to seek help, if needed. Referring to the significant number of factors that can influence a person’s mental health, Sarah advised the committee that promoting mental wellbeing was everyone’s business. It was ... view the full minutes text for item 7.
To receive an update from the One Gloucestershire Integrated Care System (ICS) Partnership.
The NHS Partners of One Gloucestershire include: -
NHS Gloucestershire Clinical Commissioning Group
Primary Care (GP) Providers
Gloucestershire Health and Care NHS Foundation Trust
Gloucestershire Hospitals NHS Foundation Trust
South West Ambulance Service NHS Foundation Trust
Mary Hutton, (representing One Gloucestershire Integrated Care System), introduced the report by emphasising the need to consider the needs of the population in response to the Covid-19 pandemic and planning for the anticipated pressures on the NHS during the winter months.
It was explained that work on the future needs of the Gloucestershire population was a major focus of work, relying on feedback from the public, patients, carers and staff to help plan how the system needed to change and adapt going forward.
Recognising the extreme pressures placed on carers nationally, a key focus of work was to understand the activities required to support the carers in the county. The results of an online survey completed over the summer, (inviting Gloucestershire Carers to share their experiences and asking how ICS could support them), was completed by 273 carers. The results of the survey had been presented at various meetings, including the CCG Executive Group.
In addition, Gloucestershire Carers Hub was organising a Gloucestershire Carers Rights Week event to be held later in the month to showcase various aspects of wellbeing support available to carers from a variety of means.
Dr Andy Seymour, (Clinical Chair), referred to the collaborative work that had been undertaken in many parts of the country to recognise/early diagnose a repercussion of Covid-19, referred to as silent hypoxia, (where a patient is not getting enough oxygen to the body). In response to the idea of introducing home oximetry (measuring the level of oxygen in a person’s blood in their own home), a Covid-19 Virtual Ward had been developed and implemented in several regions around the UK.
The aim of developing a Covid-19 Virtual Ward was to identify patients showing signs of early deterioration in the community and where clinically appropriate, increase their care to provide better results for the person. The Gloucestershire Covid-19 Virtual Ward model to support clinicians to follow up and monitor patients, (confirmed with or suspected to have Covid-19 and at a higher risk of deterioration), within their own homes. Dr Seymour informed members that use of the virtual ward would be rolled out across the county during the next few weeks and would be a great help to the system.
Noting the emphasis on mental health referred to in the Director of Public Health’s update to the committee, Mary Hutton reiterated the need to adapt mental health services to deal with the impact of Covid-19 on the mental health of the county, including children and young people.
During the first phase of the pandemic, a children and young people wellbeing chat-line had been made available during weekdays from 9 to 5pm, providing guidance and support to the young people of the county and a parent support line. Both functions had been provided throughout the summer holidays and extended from September onwards. The service had been recently adapted to include a wellbeing lunch time ‘drop in’ service for Secondary Schools, to be rolled out to all Trailblazer Secondary Schools.
Responding to questions, members were ... view the full minutes text for item 8.
To note the NHS Gloucestershire Clinical Commissioning Group (GCCG) Clinical Chair and Accountable Officers’ Report.
Introducing the report, Mary Hutton, (representing GCCG and One Gloucestershire Integrated Care System), asked whether the content of the report was too broad and if the information needed to be adapted?
In response, members commended the report and welcomed the depth of information it provided. It was suggested, however, that, in order to maintain the level of information provided to members in between meetings, the report needed to be supplemented with regular updates and briefings, to be circulated via email.
Responding to questions on the Covid-19 Emergency, Mary stated that the response to the pandemic continued to be managed month by month. At this stage in the response, there could be no guarantees of when the emergency might end.
Regular updates on the NHS response would continue, including progress reports on the impending roll out of the vaccine. Whilst there was a degree of optimism that, by the summer of 2021, there could be a change in the severity of the pandemic, there remained a significant concern that the impact of the virus during the winter months presented a very serious challenge.
The report was noted.
To note the committee work plan and suggest items for consideration at future meetings.
12 January 2021
2 March 2021
15 June 2021
13 July 2021
14 September 2021
16 November 2021
The dates of the following meetings/events were noted by the committee:
20 Nov 2020 – Children and Young People Mental Health Briefing (All)
12 Jan 2021 – HOSC meeting
26 Jan 2021 – Joint meeting of ASCCSC and HOSC
02 Mar 2021 – HOSC meeting (final meeting of the current committee)
15 Jun 2021 – HOSC meeting (induction meeting of the incoming committee)
13 Jul 2021 – HOSC meeting
14 Sep 2021 – HOSC meeting
16 Nov 2021 – HOSC meeting
The following requests/actions were made in relation to the committee work plan:-
a) SWAST performance indicator/update report (including consideration of the challenges presented to SWAST during the Pandemic) – item to be considered (pending work pressures) at the 12 Jan 2021 meeting;
b) Fit for the Future Consultation (Outputs Report) – 12 Jan 2021;
c) Forest of Dean Community Hospital Consultation (Outputs Report) – 12 Jan 2021;
d) Update on the review of the GCC decision to spilt the remit of the Health Overview and Scrutiny Committee from the Adult Social Care and Communities Committee – 2021
e) Review of public representation pilot at HOSC meetings – via email
f) Briefing Note: Vaccine Roll Out Update (circulated by email to all members) – 2021
g) Briefing Note: Support to Schools Programme Update (including roll out of the Children and Young People Wellbeing Chat-Line Service during the Pandemic) – 2021
h) Eating Disorder Update – 2021
i) Community Phlebotomy Services Update – 2 March 2021