Venue: Council Chamber - Shire Hall, Gloucester. View directions
Declarations of Interest
Please see note (a) at the end of the agenda.
No additional declarations made.
Draft minutes of the meeting on 5 March 2019 (To follow).
Draft minutes of the meeting on 21 May 2019.
3.1 The minutes of the Health and Care Scrutiny Committee meeting on 5 March 2019 were agreed as a correct record.
3.2 The minutes of the Health Overview and Scrutiny Committee meeting on 21 May 2019 were agreed as a correct record.
3.3 Democratic Services apologised for the lateness of the 5 March 2019 minutes. Members were keen to highlight that late reports to Committee (post the clear 5 working day statutory deadline for publishing Committee papers) is not acceptable. This was reiterated by the Chair.
3.4 There was also a request for a glossary of terms from the NHS partners to aid the Committee in their preparation for meetings.
ACTION: MARY HUTTON/DEBORAH LEE/PAUL ROBERTS
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 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 4pm three clear working days before the date of the meeting.
The closing date for
notification is 4pm on 10 July
If any individual has any particular requirements please include in the email.
No public representations were received.
Indicative Timings – 10:20 to :11:05
Update on the Gloucestershire Health and Care NHS Foundation Trust
5.1 The Chair opened the item by explaining to members that the presentation slides in the published pack has been reduced, at the Chair’s request, and this reduced version had been published as a supplementary item.
5.2 Colin Merker gave a brief overview of the presentation for members, highlighting the following points:
· This merger has not resulted from one Trust struggling to perform, both Trusts have been rated GOOD by CQC.
· These Trusts do not overlap but offer complimentary services and a number of patients have support from both.
· The merger will create a new offer for Gloucestershire, improving quality, experience and efficiencies for all involved.
· There is a significant and compelling case for change which will allow both services to address the inequities of long-term physical and mental health problems.
· This merger is about enhancing services, not losing them, improving pathways and will simplify the number of providers within the system.
5.3 On questioning, members were keen to understand how involved the patients and staff had been in this movement. In response, members were reassured that these proposals are good for patients and carers and have been widely supported by staff that have seen the move as exciting and holding new opportunities. The Trusts continue to hold interactive workshops to talk about aspirations and concerns as well as a Pulse Survey every month which centres on being involved and feeling informed.
5.4 The Committee noted that there will be no formal redundancies resulting from the merger, although some staff may seek voluntary redundancy. The care services staff will transfer to 2gether and both Trusts are currently producing joint policies to ease this transfer.
5.5 A member questioned whether the Trusts had identified any disadvantages of the merger. In response, members heard the main concern was making sure all areas had equal support due to the amount of changes at one time.
5.6 There was reassurance that there is a formal process in place to measure achievement of objectives for the merger. For each individual change, there would be a number of direct assessments to measure progress and outcomes. As well as the GCCG being under a fair level of scrutiny locally and externally.
5.7 Responding to comments in the presentation around improved quality of care, a member asked what improvements patient would notice on the ground. It was explained at the moment, there is an overlap of the two Trusts involved for around 60% in older people, 55% in children’s and 40% in adults. These organisations currently lack the combined working to reduce complication for patients.
5.8 The Committee were reassured that this wasn’t a move to reduce patients under both services to one point of contact, its about improving the co-ordination.
5.9 The Chair questioned the impact on out of hour’s availability. The Committee heard that both services currently provide 24/7 availability but one of the main hopes from merger is that there will be a reduction in emergency incidents and therefore the need for our of hour ... view the full minutes text for item 5.
Indicative Timings – 11:05 to :11:50
Members to be briefing on:
· Urgent care and centres of excellence
· Current arrangements and proposals
6.1 Becky Parish opened the item by first, giving an update on the NHS Long Term Plan Engagement from Spring 2019.
6.2 The Committee heard that members of the public were asked ‘what matters to you’ in relation to:
· ‘The Place’: how you and your family get health advice, support and services when you need them, in your home, neighbourhood, community and county.
· ‘The Life Course’ – your health priorities at every stage in life.
· Supporting better care – supporting staff, making best use of technology, reducing waste and making best use of resources.
6.3 In response, the local NHS received 3000 individual comments and this will be formed into a full report analysing the qualitative data.
6.4 Members were informed the main feedback in reference to each area was:
· The Place: access to GP appointments, access to good quality advice available and accessible in a timely way, getting urgent advice and treatment, 24 hours a day, 7 days a week
· The Life Course: having choice and control over their own lives, with a very strong focus on adult and young peoples mental health
· Supporting better care: best use of resources i.e. reducing waste and using technology efficiently. It was agreed for members to receive a briefing note on the new ‘Joining Up Your Information’ database that is now live.
ACTION: BECKY PARISH
6.5 There was then a brief overview of the next stage of engagement across the county.
6.6 Members heard for summer/autumn 2019, there would be a number of workshops, surveys and drop ins, as well as a Citizens’ Jury and Engagement Hearing. The Committee were keen to have dates and details of all the engagement activities as soon as they were available.
6.7 The Chair reinforced this action so that Committee members are able to attend as many engagement sessions as possible over the autumn, as well as spreading the word within their communities.
ACTION: BECKY PARISH
6.8 Several members asked details on the Citizens Jury. They were informed that the jury will be made up of diverse representatives from across the county, it will be a week long, likely to be held mid-October and a location is still being finalised. It will be open to the public to watch and a report following the event will also be in the public domain. A briefing paper on the Jury and breakdown of membership will be shared with the Committee in due course.
ACTION: BECKY PARISH
6.9 Cheltenham members raised concerns that the discussion topic for the jury effects Cheltenham and Gloucester significantly. It would therefore be seen as appropriate for the venue to be in one or both of these districts so as many local constituents are able to attend as possible.
6.10 The Committee were aware of the last Citizens Jury being on the topic of Forest of Dean hospitals, and noted that a decision regarding the exact location for the new hospital for the Forest of Dean had still not been made 12 months on. ... view the full minutes text for item 6.
Memorandum of understanding
Indicative Timings – 11:50 to :12:00
Update from the Chair regarding progress.
7.1 The Chair reminded the Committee that they are going to adopt a Memorandum of Understanding with the Trusts on key definitions used in the Committee’s work. There have been ongoing issues with the definitions of phrases such as a ‘significant service change’ or ‘pilot scheme’ which have been unclear.
7.2 Moving forward, the Memorandum will include clear definitions of phrases used by the NHS locally and help the Committee understand what they are being asked to comment on.
7.3 Research has been undertaken looking at government guidance, other HOSC’s around the country and a draft document has been produced between the Chair and the local NHS.
7.4 The Chair would now like members’ assistance in reviewing the document and having a critical spotlight focus session to develop it.
ACTION: CHAIR/DEMOCRATIC SERVICES
7.5 The Committee and local NHS representatives welcomed the Memorandum.
7.6 It was agreed members would work on the draft with a view of bringing a final version to the September Committee meeting.
Indicative Timings – 12:00 to :12:15
8.1 Mary Hutton gave a brief over view of the report, highlighting the following points:
• Improved response for contacting the 111 service
• Good joint working on the continued focus of getting people back home from hospital. There is a good performance on the national target of people remaining in hospital for more than 21 days.
• Following the slight performance drop on the 2 week wait cancer pathway due to a high volume of dermatology referrals and limited specialist capacity – performance is expected to improve again for May.
• Work is still being done on the 62 day treatment target; hopefully these improvements will be seen in the coming months.
8.2 A member requested a short paper on the Mental Health IAPT chart to explain the graph figures, to also include an access to treatment graph which was not included in the report.
ACTION: COLIN MERKER
8.3 A member noted the consistently missed target response time for ambulances through the past year. It was requested that a visit from SWAST be added to the work plan to look at this in more detail.
ACTION: DEMOCRATIC SERVICES
8.4 The Committee were informed that a new full-time practitioner in the urology department is now fully trained and will return to the department next month.
9.1 Candace Plouffe advised members that the June Radiology update focused on recruitment within the service, particularly highlighting the recruitment of a new community Radiographer due to start in August. There will be a focus on providing additional provision in Tewkesbury and North Cotswolds.
9.2 Deborah Lee highlighted that there is a longstanding problem with graduates coming into the service for Gloucestershire. The Trust is currently in conversation with the University of Gloucestershire about providing degree/apprenticeship training from 2020. This was described as a positive conversation and if it comes to fruition, a really positive step for county, albeit one which woud take three to four years to provide a recruitment pipeline.
9.3 A member highlighted the increase in waiting times across the county. The Trust recognised this and is actively addressing the issue. The Committee were informed that some patients are choosing to use Gloucester/Cheltenham services rather than their local service. This means that staff are concentrated where the demand is and there are no more staff to distribute to other areas. It was stressed that even though wait times are not on target, it is still an overall improving picture and urgent patients are always seen promptly.
9.4 The Committee were advised that the temporary service change has allowed for strategic improvements to be made, before the service is at risk of emergency measures having to be put in place.
10.1 The Chair advised members that this item’s report documents the journey of the General Surgery Task Group up until the judicial review challenge.
10.2 Deborah Lee informed the Committee that the drive for change hasn’t diminished, there continues to be concerns and the Trust is currently looking at trying to mitigate the risks identified initially, as well as having long-term solution discussions.
10.3 The Committee noted the report and requested continuing updates from the Trust on said plans, as well as a formal update with clinical colleagues on the winter plan preparations for the September Committee.
ACTION: DEBORAH LEE
The Committee noted the report. There were no questions from members.
12.1 Mary Hutton took the report as read and opened up to the Committee for questions.
12.2 A member welcomed the news of the successful Rough Sleepers Initiative bid and that Gloucestershire is among the highest nationally for accessing accommodation. It was noted that this initiative is going from strength to strength in the county.
12.3 Members also welcomed the news of GP practices working together to offer over 100,000 additional GP surgery appointments available this year. There was a request for a breakdown on what percentage of the appointments would be with GPs/nurses etc.
ACTION: MARY HUTTON
12.4 A member also highlighted that the issue of patients missing GP appointments is still something that needs addressing.