Agenda and minutes

To note any apologies for absence

No apologies

To confirm the minutes of the meeting held on 8 September 2020 (minutes attached)

In noting the minutes of 8 September 2020, members attention was drawn to point 4.22 of the minutes and a statement from the Director of Public Health, which advised: -

Guidance on care home visiting will be sent to care home providers for comment. Guidance will also be provided for day care centres.

Seeking clarification on the statement, particularly in light of recent events in terms of the advice given to care homes in Gloucestershire and details of updated arrangements for visiting relatives in care homes, the Chairman of the Committee asked for an update from the Director of Public Health.

Referring to the need to balance the safety of staff and residents at care homes with concerns about the mental health of residents and their families, the Director of Public Health confirmed that, since the last meeting, the Public Health Team had now reviewed its local guidance against new DHSC guidance and confirmed that the following message had been sent to care home staff colleagues: 

Dear Colleagues,

As you are aware, we have been urgently looking at ways in which we can safely increase visiting in care homes through increased infection prevention and control measures and a risk assessment process that can be tailored to an individual resident, visitor and setting.

Work to agree and implement these plans continues, but in light of the change to the national situation and associated new guidance around care home visiting expected this week, we want to ensure anything we issue reflects the national position.

With that in mind, we are aiming to have documentation out to care home managers early next week, which will be supported by a workshop to go through the guidance and answer any questions you may have.

In the meantime, if you need any further support or advice, please contact the Integrated Brokerage Team.

The Director of Public Health explained that there were no easy choices to make when considering the arrangements for care home visits during a pandemic, particularly in view of the increasing number of Covid-19 cases in Gloucestershire care homes in recent weeks, (at the time of the meeting, 13 care homes were reported as experiencing outbreaks of the virus, affecting 90 staff and 64 residents).

Webinar training would be provided on the new guidance but ultimately, it would be the decision for the individual care home to implement.

Members welcomed the decision to enable care homes to allow visits and the potential, (where the correct safety measures were in place), for residents to maintain contact with their families.

Responding to questions, the Director of Public Health confirmed that, currently, there was no provision to introduce track and trace testing for family member/visitors to care homes. It was noted that some care homes had adopted their own models of testing and that safety measures based on national guidance had been put in place.

It was confirmed that track and trace testing for visitors to care homes, (based on evidence sourced from a couple of national  ...  view the full minutes text for item 2.

To receive any declarations of interest at the meeting.

No declarations of interest were made at the meeting.

The Public Health Annual Report is a professional statement from the Director of Public Health on the health and wellbeing of Gloucestershire. The report includes independent recommendations on the council’s actions to promote and improve mental health and wellbeing across the county.

The focus of the Director of Public Health’s Annual Report 2020/21 is the impact of COVID-19 on Black, Asian and minority ethnic communities in Gloucestershire and includes recommendations for the local system to address the inequalities highlighted in the report.

Sarah Scott, Director of Public Health, presented the Public Health Annual Report 2020, (including slideshow presentation). Reporting from a Covid-19 related perspective, the theme of the report focussed on the impact of the pandemic on the Black, Asian, and Minority Ethnic (BAME) communities of Gloucestershire.

The Director of Public Health reinforced the value in focussing the report on race, health and inequality issues on the local population during a pandemic and taking this opportunity to make recommendations for improvement.

Welcoming Althia Lyn, (Co-Chair of the Black Workers Network and Co-Author of the report), to the meeting, the Director of Public Health informed the committee that the Black Workers Network had taken a lead in the development of the recommendations presented by the report and instrumental in coordinating many of the case studies.

The Director of Public Health also referred to the tremendous team effort that had gone into producing the report, including the inequalities work and contributions from the Prevention, Wellbeing and Communities Team based at Gloucestershire County Council.

It was noted that the report had drawn heavily on research undertaken by Public Health England in their work to consider the impact of COVID-19 on BAME communities.

The report and powerpoint presentation can be viewed on the council website here.

Acknowledging that people from BAME communities were 2.5 to 3 times more likely to develop Covid-19 symptoms due to the huge inequalities impacting on these groups, the committee noted the stark statistics presented by the report. Stressing the need for reliable and comprehensive data and noting the high levels of resilience and community support evident within some of the case studies, the report also identified serious inequalities and significant challenges emerging from the pandemic.

Highlighting one example of the impact of the virus on the BAME community and the significant number of people diagnosed with diabetes and subsequently affected by the disease, the report reinforced the need for organisations to develop a cultural shift in the services and opportunities they provided to people from Black, Asian and Ethnic Minority groups.

Evidence and a better understanding of the need for change by organisations who support BAME communities was noted as essential. Whilst there was some evidence of a move towards a cultural shift, improved training, increased awareness and better outcomes would be critical in ensuring meaningful changes and in supporting the health and welfare of people from BAME communities.

The development of culturally competent occupational risk assessment tools for use in a variety of occupational  settings had been accelerated in recent months. The aim of carrying out occupational risk assessments was to reduce the risk of exposure to COVID-19, especially for key workers working with a large cross section of the general public or in contact with those infected with COVID-19.

Members were informed that the County Council had introduced a two-stage process to carrying out risk assessments, involving an initial check list to determine vulnerability, followed by a full COVID-19 risk assessment undertaken by the Occupational Health Team.  ...  view the full minutes text for item 4.

To note the Gloucestershire Safeguarding Adults Board Annual Report 2019/20.

Margaret Willcox, Executive Director of Adult Social Care, presented Gloucestershire’s Safeguarding Adults Board (GSAB) Annual Report 2019/20. The report included information on the response to Covid-19 and was taken as read at the meeting.

It was noted that, in response to the unprecedented demands that had been placed on adult care services during the pandemic, a number of agencies had chosen to restructure, refocussing their resources where they were most needed. The role of the GSAB was to provide assurances during such changes and to fulfil its statutory responsibility of monitoring and evaluating the work by partner agencies to safeguard and promote the health and well-being of adults with care and support needs.

Referring to the priorities included in the 3-year strategic plan 2018/21, (Making Safeguarding Personal, Prevention and Improving Safeguarding Practice and Board Effectiveness), it was proposed that, (as a consequence of the pandemic), a recommendation be made to the board to extend the duration of the strategy for a further year from March 2021. A new strategy would commence in March 2022.

Responding to concerns about gaps in service provision, including a gap in service provision to patients with complex and multiple conditions during transition from Paediatrics to Adult Services, (considered a root cause of many poor patient experiences and expressions of safeguarding concerns), the Executive Director assured members that this was an area of concern under review by the Board.

Noting concerns about the relationship between the GSAB and the Children’s Safeguarding Board, the Executive Director stated that, whilst it was agreed the work of the two boards had drifted apart during the past 12 months, the Director of Children’s Services, (at the Children and Families Scrutiny Committee meeting held on 9 November 2020), had been tasked with aligning the work of the Children’s Board with the GSAB.

Responding to another area of concern, the committee noted that a significant increase in the number of allegations that had been made against staff during the early months of 2020 had prompted a review and revision of the processes managers were required to follow when investigating the allegations. This area of work was being led by the Operational Director of People and Organisational Development at GCC. Members were advised that, going forward, it would be necessary to strike a balance in responding to the allegations in a professional manner, whilst at the same time, taking a compassionate and caring approach. 

The report was noted.

A report from the Executive Director of Adult Social Care on the long term viability of care homes and domiciliary care providers in Gloucestershire.

Margaret Willcox, Executive Director of Adult Social Care, updated members on issues relating to the long term viability of care homes and domiciliary care providers in Gloucestershire.

Referencing some of the issues affecting the county prior to and as a consequence of the impact of the Covid-19 pandemic, the committee noted the significant impact of the virus on care homes, both locally and nationally.

The decision by many families with relatives suffering from dementia to not place family members in care homes but preferring to care for them in their own homes, often with the support of domiciliary care workers had made a huge impact on the care industry. The most notable outcomes have been the huge capacity/bed spaces in care homes and the huge demand for domiciliary care workers. The committee noted that there were no certainties on how this imbalance might impact on the long term viability of care homes in the future.

Another issue considered at the meeting related to government guidance on the discharge of patients from hospital into care homes during the pandemic and how this had impacted on care homes in Gloucestershire. This issue was coupled with concerns about the impact of placing patients discharged from hospital into community hospitals in order to avoid the risk of the Covid-19 virus entering care homes.

Responding to concerns about the demands on domiciliary care, it was agreed there would be a need going forward to address the gap between the demand and supply of domiciliary care workers.

The issue of discharging patients from hospital into care homes and community hospitals was an issue under constant review. The criteria for meeting the requirements of placing discharged patients in care homes remained very strict with many homes failing to meet the criteria nor willing to accept the risk of spreading the Covid-19 virus. Whilst having to adhere to national policy, Gloucestershire had taken the professional view of safeguarding care homes and ensuring patients with medical needs received the care they needed. The measures put in place included the discharging of patients into local community hospitals, and if required, looking to set up dedicated Covid-19 beds in care homes.

In terms of the national directive, the Executive Director stated that the county would resist the directive to place people discharged from hospital in care homes for as long as possible. The committee welcomed this reassurance and requested that it be kept updated on any future developments. Action by Executive Director for Adult Social Care.

Responding to questions about the potential for people being admitted from out of county to receive specialist care in Gloucestershire hospitals/care facilities, it was agreed this was not something that was welcomed by the county. As a national policy, it was felt this had not been well thought out, especially in terms of mental health care. Members were assured the concern was being managed carefully, and to date, hospitals had coped admirably with admissions from out of county.

In the meantime, the Council would  ...  view the full minutes text for item 6.

An update from the Executive Director of Adult Social Care.

Margaret Willcox, Executive Director of Adult Social Care, presented the Director of Adult Social Care Report.

The report was taken as read with references to the following updates: -

1)    Development of an Adult Social Care Technology Strategy, setting out the council’s technological and digital ambitions for adult social care for the next three years.

2)    An update on the recommissioning of the Mental Health Social Work Service and changes to the service proposed in 2019. These included:  

a)    Revised vision and priorities for social care within integrated mental health services

b)    Efficiencies and performance improvements in the delivery of core social care responsibilities

c)    Improved managerial control of social care budgets and expenditure

At the outset, the Mental Health Commissioning Team was working with senior colleagues within the Gloucestershire Health & Care NHS Foundation Trust to develop plans from which to implement the changes.

Progress was delayed, however, in the first instance by the merger of the 2gether NHS Foundation Trust and Gloucestershire Care Services NHS Trust on 1 October 2019, and secondly, due to the Covid-19 pandemic and subsequent lockdown.

It was noted that, work on the project had now formally restarted, with the first meeting of the Project Board post-Covid-19 held on the 29 June 2020, followed by monthly steering group meetings.

The key structural changes to be delivered through this piece of work included:

a)    Current countywide teams to be split into three services;

b)    Social workers to work in integrated Community Teams;

c)    Hospital social workers based at in-patient sites;

d)    A new Social Care Hub formed to manage all social care service elements not involved in the provision of direct treatment.

The refocusing of mental health social work resources will enable the service to:

a)    Make improvements to the council’s personalisation approach

b)    Develop a cultural change programme

c)    Undertake placement reviews and review panel processes/approach

d)    Create stronger pathways with Individual Placement and Support (IPS)  

e)    Strengthen partnership relationships with key stakeholders

f)     Deliver a savings target

The Mental Health Commissioning Team continue to engage positively with GHC to ensure the successful delivery of the change programme through existing Project Board meetings and usual contract monitoring processes.

The report was noted.

An update from the Director of Public Health, including the impact of recent developments in response to the COVID-19 emergency.

Sarah Scott, Director of Public Health, presented the Director of Public Health Report, including an update on Covid-19 related data for Gloucestershire. It was noted that data was updated daily and that the information presented at the meeting was already retrospective.

Concerns were relayed 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 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 begin to decline following the introduction of new lockdown measures.

Welcoming the update, one member requested that future updates included i) comparative data on the number of admissions to hospital from care homes, (in comparison to the numbers recorded during the first wave of the virus), and ii) the number of people from care homes requiring a ventilator, (in comparison with the number recorded during the early stages of the pandemic).

Another member enquired about the number of delayed cases in the treatment and recovery from non-covid medical conditions. Members were reassured that the treatment of other medical conditions was being maintained, with no significant impact in having to respond to the coronavirus.

Both the Director of Public Health and the Executive Director of Adult Social Care reinforced that, pending the roll out of a possible vaccine prior to Christmas, it was still vital for everyone to remain vigilant and abide by government guidelines. The roll out of the vaccine was likely to take time.

In response to a request for an update on the impact of the virus on the county’s suicide rates, members attention was drawn to the section of the Director’s report detailing the work currently underway in Gloucestershire to understand and respond to the impact of Covid-19 on mental health.

The committee noted the section of the report relating to suicide rates. During the discussion, it was noted that, at this stage in the pandemic, no firm conclusions could be drawn from the data relating to suicide rates, both locally and nationally.

In the interim, Gloucestershire’s Suicide Prevention Steering Group, Chaired by Public Health, had carried out surveillance exercises of suspected suicides occurring during the pandemic. Data from the surveillance would be used to identify emerging issues or potential suicide clusters. Members noted that the data only considered suspected, not confirmed, cases of suicide.

The Steering Group included representation from the Coroners Office, Specialist Mental Health Service, Police, Mental Health Liaison (Education), and Clinical Commissioning Group.

Members were informed how the Samaritans were advising local areas to take care when making references to suicide, specifically when making links between Covid-19 and suicide rates. This was due to the sensitivity surrounding the issue of suicide and the potential to add to people’s distress;  ...  view the full minutes text for item 8.

An update on matters relating to the delivery of services within the Chief Fire Officer’s portfolio of services comprising Gloucestershire Fire and Rescue Service, Trading Standards, Civil Protection and Coroners Services.

Wayne Bowcock, Chief Fire Officer for Gloucestershire Fire and Rescue, summarised the key points referred to in the Chief Fire Officer update report.

HMICFRS Inspection Review

Updating members on the HMICFRS Inspection Review, the Chief Fire Officer confirmed that the Fire and Rescue Service continued to work on the outcomes of the GFRS HMICFRS Inspection Report published in December 2019 and to progress the areas identified for improvement in the Improvement Plan.

An inspection review was currently underway to i) review progress against the recommendations in the inspection report and ii) analyse how GFRS was responding to the Covid-19 pandemic.

The inspectorate had been specifically asked to consider: -

(a) What was working well, including any lessons learnt;

(b) How the fire sector of GFRS was responding to the Covid-19 crisis;

(c) How the fire service was dealing with the problems it faced; and

(d) What changes were likely as a result of the Covid-19 pandemic.

Data collection, document reviews, self-assessment survey and staff survey had been submitted for review in September 2020. Virtual inspection interviews with strategic leads had commenced on the day prior to the meeting, (9 November 2020), of which the findings would be published by HMICFRS towards the end of the year. The inspection review had been delayed due to the Covid-19 pandemic.

The Chief Fire Officer reported good progress of the actions relating to the 118 recommendations included in the inspection report. Only 11 recommendations remained outstanding, for which the council’s audit and governance evaluation process played an important role.

An effective and more collaborative working relationship had established between the GFRS and the Audit Risk Assurance (ARA) Team. Regular meetings were held, with further ones scheduled. The audit risk team had been invited to attend all Improvement Board meetings and encouraged to ask questions/challenge area leads. This was to ensure greater transparency; add another level of quality assurance; and provide collaborative support to the efficiency of the improvement journey.

Business Planning

The Community Safety Annual Plan 2020 – 2021 was about to be posted on the GFRS StaffHub, including an overview of the projects and activities proposed for the next 12 months. The work was aligned with the activities on the Corporate Management Plan and would be consulted on from April 2021.

The Draft Statement of Assurance  2019 – 2020, (review of performance from the previous year), had been submitted for approval to the Strategic Leadership Team on 28 September 2020. Work on all Improvement Board activities was anticipated by the end of 2020/early 2021 and was currently on target.

Public Safety

GFRS support provided to SWAST, (from the crewing of ambulances by fire-fighters), through the initial onset of the COVID-19 period had ended on 31 August 2020. The initiative had seen 5,698 mobilisations across the south-west region, with Gloucestershire contributing to 748 of these mobilisations. GFRS had recently agreed to support the SWAST FT for a further 4 months, commencing on 1 November 2020, as part of their plans to  ...  view the full minutes text for item 9.

To consider performance data for Quarter 2 of 2020/21 in relation to the delivery of services in Adult Social Care, Public Health and Fire and Rescue Services for Gloucestershire.

Margaret Willcox, (Executive Director for Adult Social Care), Sarah Scott, Director for Public Health) and Wayne Bowcock, Chief Fire Officer), updated the committee on the performance data for Quarter 2 2020/21 for each of their respective service areas.

Acknowledging that this particular performance report represented data reflecting the first significant impact of the Covid-19 pandemic, the committee noted the increased demand for services and the subsequent pressures placed on officers to respond to such demands.

Members were advised that the simplistic reporting of information did not reflect the full extent of the pressures being placed on officers or the work required to address the issues arising from the pandemic. It was agreed there had been a huge cultural shift in the delivery in services since the beginning of the year and that this was likely to have a long standing impact on how services would need to be delivered in the future.

Cllr Tim Harman, Cabinet Member for Public Health and Communities, stressed the need to engage at all levels in the fight against the virus and requested county councillors to urge district councillor colleagues to link their district council websites to the county council website in order to receive the latest information. He added that this would ensure local councils were kept regularly informed and updated on the services available to them.

Margaret Willcox, Executive Director for Adult Social Care, reported three additional pieces of information that had become evident since publication of the report. The first piece of information related to the notable increase in demand placed on care services during the past 28 days; the second related to the increasing demand in the number of patient Covid-19 beds during the past week and the third related to the recent announcement from the Department for Health and Social Care to confirm a letter would be sent to all local authorities, advising them of the request to use care home bed space for Covid-19 patients being discharged from hospital. It was noted that the criteria for this use was very strict and would exempt a large number of care homes.

Margaret Willcox advised the committee that this would be her last meeting as Executive Director for Adult Social Care prior to her retirement from the County Council in January 2021. Sarah Scott, Director of Public Health, would be taking up her new role as Executive Director for Public Health and Adult Social Care in the New Year.

The committee noted the report and requested regular updates on the impact of the pandemic on all three service areas.

To note the committee work plan and review the items suggested for consideration at future meetings.

26 January 2021

9 March 2021

22 June 2021

6 July 2021

7 September 2021

9 November 2021

The committee noted that the next meeting of the Adult Social Care and Communities Scrutiny Committee would be a joint committee meeting with the members of the Health Overview and Scrutiny Committee. The focus of the meeting will be to consider the county’s response to the Covid-19 emergency, with updates from the Executive Director of Adult Social Care and Public Health, Chief Fire Officer and NHS professionals.