Agenda item

Review of Temporary Service Changes

To consider an update of temporary service changes proposed for Gloucestershire Hospitals


Simon Lanceley, representing Gloucestershire Hospitals NHS Foundation Trust, (GHT), and Paul Roberts, representing Gloucestershire Health and Care NHS Foundation Trust  (GHC), gave a detailed update on the status of the COVID-19 Temporary Service Changes introduced during 2020/21, including a brief summary of the proposals presented to the former committee and an outline of service restoration plans. 


It was explained that, as part of the Gloucestershire Integrated Care System’s (ICS) response to the COVID-19 Pandemic, several service changes had been implemented by GHT and by GHC. The changes were implemented as Temporary, (Emergency), Service Changes, as defined in a Memorandum of Understanding agreed between the ICS and the Health Overview and Scrutiny Committee (HOSC). The changes were implemented in 3 phases between April 2020 and January 2021.


The report to the committee, (plus the associated report considered at item 7 of the agenda, Fit for the Future Programme), set out the ICS plans for the continued development of Gloucestershire’s Health Services. The plans aimed to make improvements and sustain the quality of health services in Gloucestershire, in addition to proposing further temporary measures intended to ensure the ICS was able to maintain a state of preparedness for future COVID-19 waves that might impact on health services during the remainder of the year.


In accordance with the commitment to limit the use of temporary service changes, members were informed that proposals to restore the majority of services, including those with the largest impact on patients, had now been completed.


Taking into account ongoing learning from COVID-19 and the current status of the pandemic, including current national COVID-19 regulations, it was proposed that the following Temporary Service Changes be retained: -


1)    Retention of high care respiratory at Gloucestershire Royal Hospital (GRH) (forming part of the acute medical take change).


It was proposed that High Care Respiratory remain at GRH as a Temporary Service Change for the remainder of the fiscal year, (to March 2022), to enable GHT and GHC maintain their ability to be responsive to further ‘waves’ of COVID-19 that might impact during the rest of the year. It was proposed that work continue on the evidence to develop a longer-term proposal for Respiratory Care in Gloucestershire, for which an update would be provided at the next meeting of HOSC.


2)    Retention of Acute Stroke and Rehabilitation at Cheltenham General Hospital (CGH).


It was proposed Acute Stroke & Rehabilitation Services be retained at Cheltenham General Hospital and for the additional Stroke Rehabilitation beds located at the Vale Community Hospital be retained as a Temporary Service Change until March 2022. It was agreed work should continue on developing a longer-term proposal for Stroke Care in Gloucestershire, for which an update would be provided at the next meeting of HOSC.


3)    Retention of Medical Day Unit at Cheltenham General Hospital CGH


Given the positive benefits already identified from locating the Medical Day Unit at CGH, (both for patients accessing services at the unit and also for patients accessing Emergency Department services at GRH), it was proposed that the Medical Day Unit at CGH be retained as a Temporary Service Change to March 2022, (minimising any disruption to patients and staff), whilst, concurrently, undertaking a targeted engagement and consultation with affected patient groups regarding the proposal that the unit be moved to CGH as a permanent service change.


Summarising the ending of the service changes introduced by the ICS in early 2020, (in response to the developing COVID-19 pandemic), the ICS expressed its gratitude to the committee for its continued support and scrutiny challenge during the past 15 months. It was reported that the significant majority of COVID-19 Temporary Service Changes would end in August 2021, with the exception of the services referred to above and listed below, for which it was proposed: -


Gloucestershire Hospitals NHS Foundation Trust


1)    High Care Respiratory – remain at GRH.

2)    Acute Stroke and Rehabilitation - remain at CGH.

3)    Medical Day Unit – remain at CGH.


Gloucestershire Health Care NHS Foundation Trust


4)    Dilke Minor Injury and Incidents Unit (MIIU) – remain closed until all social distancing measures are removed (this change to be kept under review).

5)    Stroud Minor Injury and Incidents Unit (MIIU) – to reopen in pre-pandemic state in December 2021, following refurbishment programme.


Members attention was drawn to the three pro-formas at Annexes 1, 2 and 3 of the report and consideration of whether the proposed changes constituted a ‘substantial service variation’ in the services provided.


Annex 1: Pro-forma - Consideration of ‘substantial’ nature of a proposed service variation - Stroke Services


Annex 2: Pro-forma - Consideration of ‘substantial’ nature of a proposed service variation: Respiratory Services


Annex 3: Pro-forma - Consideration of ‘substantial’ nature of a proposed service variation: Medical Day Unit


It was explained that the purpose of the pro-forma documents, (referred to as Memorandum of Understandings), was to assist the committee consider whether the proposed changes constituted a substantial variation, (or development), of that particular health service.


Footnote: Memorandum of Understanding (MOU)


HOSC performs a key role in holding NHS Commissioners and NHS Trusts to account, in scrutinising local NHS services and in ensuring NHS Commissioners and Trusts involve, engage and consult lawfully and appropriately with local people. This includes determining whether a service change constitutes a ‘substantial variation’ and, if this is the case, outlining the necessary requirements to be placed upon the NHS body if an issue is considered a ‘substantial variation’.


A ‘memorandum of understanding’ (MOU) proforma is prepared by the local NHS to assist the Health Scrutiny Committee in its understanding of what constitutes a substantial variation or development in a health service.


In order to consider whether a proposal constitutes a ‘substantial’ variation, local NHS Commissioner/s and NHS Trust/s meet with the Lead Members of the Health Overview and Scrutiny Committee to consider the proposal. The purpose of this arrangement is to avoid any potential differences of understanding at a later stage which might compromise or delay progress.


NHS Commissioner/s and NHS Trust/s complete a MOU pro-forma to discuss with the Chair of the Committee and Democratic Services at the County Council and present to the Health Overview and Scrutiny Committee. The Health Overview and Scrutiny Committee will ultimately determine whether a proposed change is a substantial variation (N.B. there is no nationally agreed definition of what constitutes ‘substantial variation’.


The Memorandum of Understanding (MOU) was agreed by local NHS Commissioners, (NHS Gloucestershire Clinical Commissioning Group/NHS England and NHS Improvement), NHS Partners, (Gloucestershire Health and Care NHS Foundation Trust, Gloucestershire Hospitals NHS Foundation Trust, South West Ambulance Service NHS Foundation Trust) and the Gloucestershire Health Overview and Scrutiny Committee. The MOU will be reviewed in 2021/22 to take into account new ICS statutory changes to be set out in the new Health Act. 


Responding to the update, the following comments were made by the committee:-


a)    In anticipation of the impact of closures of the Minor Illness and Injury Units (MIIU) at Dilke and Stroud Hospitals, members highlighted the need to monitor the impact of such changes on patients and neighbouring hospitals, (namely Lydney and Cirencester Community Hospitals).


b)    Responding to concerns about the backlog of Primary Care appointments arising from the Pandemic, members were informed that GP’s were treating a significant number of patients and that Primary Care appointments were being made, both face-to-face and online or by telephone. 


c)    Staffing levels at the emergency department at Cheltenham General Hospital had restored to pre-pandemic levels. Staff allocations are not based on historic staffing levels but assessed according to demand and capacity. Staff rotas are matched to demand/capacity analysis, with additional staff drawn upon to balance any possible variations.


d)    One member enquired about the average wait times at both Gloucester and Cheltenham Accident and Emergency Departments, (walk-in patients and those waiting in ambulances). She enquired if the position had improved following the reopening of Cheltenham A&E and requested details on the night time position at Gloucester A&E. Action by GCCG (to be included in the standard Performance Report).


e)    It was confirmed Acute Care Unit patients were bypassing Accident and Emergency Units and proceeding direct to the medical teams at both sites. (This was in addition to patients being offered new home-based service arrangements). Similar arrangements were also in place for trauma and orthopaedic patients; 


f)     Noting concerns about increased pressures on the South West Ambulance Service Foundation Trust, (SWAST), it was agreed to include regular updates on SWAST performance/response times to the committee at future meetings. Transport arrangements for the transfer of patients between the two sites, (GRH/CGH), was not impacting on the ambulance service. An internal local hospital transport service was available for the transfer of patients.


The report was noted.

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