Public Document Pack

Scrutiny

Meeting papers

Health, Community and Care Overview and Scrutiny Committee

Monday 18th January, 2010 at 1.30 pm

Cabinet Suite - Shire Hall, Gloucester

Health, Community and Care Overview and Scrutiny Committee

Monday 18th January, 2010 at 1.30 pm

Cabinet Suite - Shire Hall, Gloucester

AGENDA

FORMAL BUSINESS

1 APOLOGIES Elizabeth Power

2 APPROVAL OF THE MINU TES OF THE MEETING H ELD ON 2 Elizabeth Power NOVEMBER 2009 (Pages 1 - 10) 3 DECLARATIONS OF INTE REST Elizabeth Power

STANDING ITEMS

4 CHAIRMAN'S REPORT (Pages 11 - 12) Cllr Andrew Gravells Committee to receive a report from the Chairman on issues that have arisen since the last meeting.

Indicative timing – 1.40pm-1.45pm 5 LOCAL INVOLVEMENT NE TWORK (LINK) REPORT (Pages 13 - 14) Barbara Marshall Committee to receive a report from the Chair of the LINk Stewardship Tel: 01452 Board, updating the committee on activity since the last meeting. 528491

Indicative timing – 1.45pm-1.50pm 6 NHS GLOUCESTERSHIRE CHIEF EXECUTIVE'S RE PORT (Pages 15 - Jan Stubbings 30) Tel: 08454 221686 Committee to be updated on any important issues arising since the last committee meeting.

Indicative timing – 1.50pm-2.10pm

OVERVIEW AND SCRUTIN Y ITEMS

7 WINGMOOR FARM WASTE DISPOSAL SITES (Pages 31 - 38) Caryn Hall

1. Committee to receive an update from Caryn Hall about recent Community Views events. 2. Committee to receive a verbal update from the Environment Agency about the progress of the dust analysis.

Indicative timing – 2.10pm-2.40pm

8 SERVICE IMPROVEMENT PROPOSAL FOR BURN CA RE SERVICES Cllr Andrew FOR ADULTS AND CHILDREN (Pages 39 - 46) Gravells

The committee is asked to

• Note the proposed approach to improving burn care services. • Note the improved quality and safety of service that the model will deliver over time. • Note the involvement of patients, carers, clinicians and the public in the process of developing the recommended way forward. • Approve the proposed approach, including the intention to designate four providers of burn care services.

Indicative timing – 2.40pm-2.45pm

9 CAPITAL PROJECTS UPD ATE (Pages 47 - 64) Becky Parish Tel: 08454 Outcome – The committee is asked to note the report from NHS 221515 Gloucestershire.

Indicative timing – 2.45pm-2.55pm 10 NHS GLOUCESTERSHIRE PERFORMANCE REPORT (Pages 65 - 86) Becky Parish Tel: 08454 Committee to receive the latest update on key NHS performance targets. 221515

Outcome 1 – Committee to consider whether performance is on track and if plans are in place to tackle any areas of concern

Outcome 2 – Where there are concerns the committee should consider whether it wishes to request that a more detailed exceptions report be provided at the next available meeting, or whether it is an area for a more in depth scrutiny investigation, perhaps through a task group.

Indicative timing – 2.55pm-3.10pm 11 C&AC DIRECTORATE QUA RTER 2 2009/10 PERF ORMANCE REPORT Mark Branton

Committee to receive a quarterly update on service-related performance data.

Outcome 1 – Committee to consider whether performance is on track and if plans are in place to tackle any areas of concern

Outcome 2 – Where there are concerns the committee should consider whether it wishes to request that a more detailed exceptions report be provided at the next available meeting, or whether it is an area for a more in depth scrutiny investigation, perhaps through a task group.

Indicative timing – 3.10pm-3.40pm 12 C&AC DIRECTORATE ANN UAL PERFORMANCE ASSE SSMENT (Pages Mark Branton 87 - 98)

Committee to note the CQC 2009 Annual Performance Assessment of the C&AC Directorate

Indicative timing – 3.40pm-4.00pm 13 THE BIG PLAN (LEARNI NG DISABILITIES) Chris Haynes

Committee to hear about The Big Plan for Learning Disabilities

Indicative timing – 4.00pm-4.15pm 14 AGE EQUALITY IN HEAL TH AND SOCIAL CARE Cllr Andrew Gravells To discuss a joint response to the Department of Health Consultation which closes on 15 th February 2010.

Indicative timing – 4.15pm-4.20pm

TASK GROUP ITEMS

15 HEALTHY YOUNG MINDS MATTER (CAMHS) (Pages 99 - 106) Elizabeth Power

The committee is asked to note the report of the Healthy Young Minds Matter Task Group and its recommendations.

Indicative timing – 4.20pm-4.30pm

ORGANISATIONAL ITEMS

16 COMMITTEE REPORT Cllr Andrew Gravells To agree any issues to include in a report to the Scrutiny Management Committee and/or Full Council.

Indicative timing – 4.30pm-4.35pm 17 DATES AND VENUES OF FUTURE MEETINGS Elizabeth Power

The committee is asked to note the dates of meetings in 2010 and the start time of 1.30pm.

• 15 March 2010 – 1.30pm. – Tewkesbury Borough Council • 10 May 2010 – 1.30pm. – Forest of Dean District Council, Coleford • 12 July 2010 – 1.30pm. – Cheltenham Borough Council • 13 September 2010 – 1.30pm. – Cotswold District Council, Cirencester

• 8 November 2010 – 1.30pm.Stroud District Council

Me mbership – Cllr Ron Allen, Cllr Peter Braidwood, Cllr Andrew Gravells (Chair), Cllr Christopher Pallet, Cllr Mike Skinner, Cllr Duncan Smith, Cllr Brian Thornton and Cllr Lesley Williams

Added Members - Cllr Raymond Apperley, Cllr Penny Hall, Cllr Sheila Jeffery, Cllr Jan Lugg, Cllr Margaret Ogden and Cllr Marrilyn Smart

(a) DECLARATIONS OF INTEREST – Members requiring advice or clarification about whether to make a declaration of interest are invited to contact the Monitoring Officer (Nigel Roberts
01452 425201/fax: 426790/e-mail: [email protected]) prior to the start of the meeting.

(b) INSPECTION OF PAPERS AND GENERAL QUERIES - If you wish to inspect Minutes or Reports relating to any item on this agenda or have any other general queries about the meeting, please contact: Elizabeth Power, Senior Scrutiny Adviser (Scrutiny Team)
:01452 425204/fax: 425850/e-mail: [email protected] (c) GENERAL ARRANGEMENTS 1 Will Members please sign the attendance list. 2 Please note that substitution arrangements are in place for Scrutiny (see p64 of the Constitution).

EVACUATION PROCEDURE - in the event of the fire alarms sounding during the meeting please leave as directed in a calm and orderly manner and go to the assembly point. Please remain there and await further instructions.

Agenda Item 2 Subject to approval at the next meeting of the committee (18th January 2010)

HEALTH, COMMUNITY & CARE OVERVIEW AND SCRUTINY COMMITTEE MINUTES of a meeting held on 2nd November 2009 at 10am in the Council Chamber, Forest of Dean District Council, Coleford PRESENT:

Ron Allen P Lesley Williams A

Peter Braidwood P Ray Apperley P Stroud District Council Andrew Gravells* P Penny Hall Cheltenham Borough Council Christopher Pallet P Sheila Jeffery P Cotswold District Council Mike Skinner A Jan Lugg P Gloucester City Council Duncan Smith P Margaret Ogden P Tewkesbury Borough Council Klara Sudbury P Marrilyn Smart OBE P Forest of Dean District Council Brian Thornton P Ceri Jones S

P = present A = apologies Ab = absent S = substitute * = Chairman

The following were also present: Becky Parish, NHS Gloucestershire Caroline Smith, NHS Gloucestershire Laura Nicholas, NHS Gloucestershire Debra Elliott, NHS Gloucestershire Sally Pearson, Gloucester Hospitals NHS Foundation Trust Barbara Marshall, Gloucestershire Local Involvement Network (LINk) Christine Welsh, Gloucestershire Rural Community Council Councillor David Thompson, Ruardean and Lydbrook Councillor Terry Hale, Newland and St Briavels, County Councillor for Coleford Matthew Bing, Lay Worker, NHS Gloucestershire County council officers: Elizabeth Power, Senior Scrutiny Adviser (Health) Sam Mongon, Scrutiny Team

59. Apologies Councillor Mike Skinner (substituted by Councillor Ceri Jones) Councillor Lesley Williams Chris Griffin, Gloucestershire County Council

Page 1 Subject to approval at the next meeting of the committee (18th January 2010)

Jan Stubbings, Chief Executive, NHS Gloucestershire Jill Crook, Director of Clinical Development, NHS Gloucestershire 60. Minutes of the meeting held on 7th September 2009 These were approved as a correct record and signed by the Chairman. 60.1 The following matters arising were discussed: Minute 46.6 – a member pointed out that this information had not yet been supplied. Becky Parish said that she will follow this up.

Minute 50.9 – the PEAT report will come to the committee in January 2010.

Minute 51.3 – A member asked about the current patient handover situation at Weston Hospital. Becky Parish said that she will follow this up before the next meeting.

Minute 52 – A member asked about progress of arranging a visit to Wingmoor Farm. Elizabeth Power said that she will make enquiries as to whether this is possible.

61. Declarations of interest Councillor P Hall member of the Royal College of Nursing member of the Gloucestershire LINk

Councillor J Lugg member of the Royal College of Psychiatrists

Councillor M Ogden retired member of the Royal College of Nursing

Councillor K Sudbury governor of Gloucestershire Hospitals NHS Foundation Trust

Councillor D Smith governor of 2gether NHS Foundation Trust

62. Chairman’s Report The committee noted the report. 62.1 The Chairman began by asking Becky Parish to pass on his thanks to everyone involved in the NHS Gloucestershire Information Event for Councillors in September. He said that he had found it very informative and asked whether it could become an annual event. Becky Parish agreed to take the comment back, as it would certainly be a good idea when council membership changes in the future.

62. 2 There followed some discussion of the proposals to change the date and/or time of committee meetings in the future. The Chairman explained the reasons behind them, including the fact that leaving them on Monday mornings will create clashes with meetings at Shire Hall involving directors from the Community & Adult Care

Page 2 Subject to approval at the next meeting of the committee (18th January 2010)

Directorate, meaning that senior officers would not be able to attend committee meetings. It was noted that since the Chairman wrote his report, a suggestion had been made to move meetings to the afternoon to avoid this, and he proposed that this be tried from January 2010. It was agreed that the committee should take advantage of management and officer availability.

62.4 Another member pointed out that the Group Director also meets every Monday at 12.30pm with the Lead Cabinet Member. It was agreed to return to this subject later in the agenda.

62.5 The Chairman informed the committee that the increased workload would need careful monitoring and that the committee should take care not to neglect any Directorate service areas. Cllr Jones thanked the Chairman for bringing these reservations to the attention of the committee.

62.6 Cllr Jones then congratulated the Chairman on his recent appointments as Chair of the new South West Scrutiny Member Network and Vice-Chair of the South West Health Scrutiny Network Programme Board.

63. Local Involvement Network (LINk) update The committee noted the report. 63.1 A member asked a question about Enter and View. Barbara Marshall replied that the Enter and View powers will only be used when absolutely necessary and when information cannot be found any other way. 63.2 In response to a question about the influence that the LINk has regarding visiting establishments and providers, Barbara Marshall said that the group who visit make a report to the provider, who is then required to report to the LINk within 20 days. If the response is not satisfactory, the LINk can refer the issue to this committee. 63.3 The LINk is looking forward to developing a close working relationship with the Care Quality Commission (CQC). The transfer of information ‘in real time’ will be of great benefit. 63.4 Barbara Marshall reiterated the invitation to all committee members to attend any of the forthcoming Community Engagement Events. A member commented that it is encouraging to see some evening events to allow a wider range of people to attend.

64. NHS Gloucestershire Chief Executive’s Report The committee noted the report which was presented by Becky Parish. 64.1 Dementia Strategy Local Action Plan (DSLAP) - In response to a question, Becky Parish said that the process to identify patients with dementia is a challenge for the Dementia Strategy. The strategy will be brought to the committee when it is complete, along with an update of how the key themes will be approached.

Page 3 Subject to approval at the next meeting of the committee (18th January 2010)

64.2 Neurological Services Review – a member asked whether the committee could see the key themes of the report mentioned in item 4.6. Becky Parish said she will ask the project manager whether it can be circulated. ACTION Becky Parish 64.3 In response to a question about 4.10, Becky Parish said that all users of Ermin House had been written to and been offered the opportunity to give their views. Their responses will be collated by the end of November. There is an additional cost element, in that all service users are being reviewed as to which services they are eligible for. It is hoped that there will be more choice for service users after the review. 64.4 The 4 Cs – in response to a question, Becky Parish informed the committee that the new single complaints system is supported by staff training, which was well attended by community staff. The new system is run by GUiDE & PALS, who already have experience of co-ordinating the previous compliments and complaints system. There will probably be a need to increase capacity in the future, which would mean more funding would also be needed. 64.5 Welsh Border Survey – Brian Thornton expressed his thanks to Becky Parish and Debra Elliott for commissioning the survey, and for meeting with him and Marrilyn Smart in October to discuss the results. The meeting had set their minds at rest that the problems which they had identified were not widespread. He added that Mark Harper MP is still concerned about Sedbury and Tutshill, but he will keep the committee informed of any developments. 64.6 Marrilyn Smart added her thanks to Becky and Debra and said that it had been useful to speak with NSH Gloucestershire directly to resolve issues. The ideal situation would be to have local services wherever possible. She commented that the proposed change of hospital opening hours was disappointing but she accepted the reasons for it. She also thanked Jill Crook for informing herself and Brian about the change before it was publicly announced. 64.7 Chlamydia screening – A member praised the Chlamydia testing scheme as a good thing, and asked whether there was any data coming back. However, she also expressed concerns about future campaigns, asking whether 16-24 year olds are being educated to test again in the future. Another member commented that 14-16 year olds should be tested too, as a way of scaring them into behaving responsibly. Becky Parish offered to take these comments back to the relevant teams at the PCT. 64.8 Swine flu assurance – Sally Pearson explained to the committee that hospital arrangements for a surge in cases are ready, as part of the contingency plans for the county. Regarding the specialised needs of children, GHNHSFT will be able to expand the Intensive Care capacity for children if Bristol Children’s Hospital were to become full. There are state-of-the-art Intensive Care Units with additional capacity, including ventilation equipment suitable for children. Level 6 of the Tower Block also has space which could be used to treat children if necessary. 64.9 Becky Parish outlined the latest news on swine flu in Gloucestershire, and said that she would circulate a copy of a written briefing by email after the meeting. ACTION Becky Parish

Page 4 Subject to approval at the next meeting of the committee (18th January 2010)

64.10 There were no definite dates for the availability of the swine flu vaccine, but the vaccination of front-line staff had started. 64.11 In response to a question about swine flu vaccines for the under-18 age group, Becky Parish replied that this was being considered. The Chief Medical Officer has worked with the World Health Organisation to identify the at-risk groups. The USA is already offering them to anyone aged 6 months to 24 years old, but they might not be using the same illnesses as the UK in deciding the risk factors. She offered to ask Dr Arora about the differences in guidance between the two countries. ACTION Becky Parish 64.12 In response to a question, Becky Parish said that there is no way of diagnosing swine flu for certain without testing or swabbing. 64.13 Sally Pearson commented that national figures suggest that the mortality rate is increasing with this particular virus. Australia has seen the biggest increase in cases amongst 1-15 year olds. 64.14 A member commented that as a retired nurse she was concerned to receive an invitation to re-register if eligible, to be on standby to return to nursing if the virus were to cause staff shortages. She said that there are approximately 90,000 retired nurses in the UK, and asked whether they would all be needed during a pandemic, and how would they be reintegrated into the work place. Sally Pearson replied that there will be induction programmes for those who needed them (if they have been out of the nursing environment for many years). The swine flu virus will present a challenge to maintain the workforce, so recently retired nurses would be preferred over those who retired some time ago. 64.15 New hospital in Moreton in Marsh – A member commented that things had gone quiet about the plans for the hospital in Moreton, and asked what the current situation was. Becky Parish said that there will be a stakeholder meeting in November, for which invitations will be issued to those involved. 64.16 Centralisation of breast cancer services – A member asked whether there were any plans to centralise breast cancer services in the county. Sally Pearson replied that there were no changes proposed to the mobile breast screening service, but there were discussions ongoing about the treatment of women presenting with suspected symptoms. There were no decisions being taken at the time, and any future proposals will be brought to the committee. 64.17 Gloucestershire Carers Strategy Update – A member asked how children will be protected from inappropriate caring, and how improved support for carers will be funded. Becky Parish replied that over the ten year strategy, allocations have been made to Gloucestershire for support. Young Carer support was increased over the last 12 months. The response to the new strategy will be ready in 2010. 64.18 A member commented the figures mentioned in item 13.5 allocated to breaks for carers. He stressed that the message must be conveyed to Government that although these amounts of money seem a lot globally, the local allocation per carer is very small (approx £10-£13 per carer). Becky Parish responded by saying that the Young Carer’s Group for example operates on economies of scale by providing activities for children and young people to have a regular break from their caring role.

Page 5 Subject to approval at the next meeting of the committee (18th January 2010)

64.19 A member commented that the committee had not been involved in the local joint commissioning plan yet, and asked whether it was too late to get involved. He also asked whether the committee could see the Special Leave Policy. ACTION Becky Parish 64.20 A member said that she had recently received a Guide to Healthcare in the Community in the post. She was concerned that community beds are scattered across the community. Becky Parish responded by saying that there will be an update on community hospitals at the committee meeting in January, and to reassure members’ concerns she added that the number of beds in the Cheltenham area will be increased. 64.21 A member mentioned a recent Nursing Standard article about the Government target that by the end of 2010 every secondary school should have a school nurse, and that every group of primary schools should also have access to one. 64.22 Get the right treatment – Becky Parish informed the committee that the Gloucester Health Access Centre will be re-advertised during November, as part of the promotional campaign to encourage people to use the appropriate care pathway for their needs

65. Independence Trust presentation 65.1 Peter Steel, Chief Executive of the Independence Trust, gave an informative and thought-provoking presentation about the work of the Trust. It is a well established Gloucestershire charity providing alcohol, drug, mental health and wellbeing services aiming to work with the whole community.

65.2 A discussion followed about demand for counselling and resources for it, the difficulties involved in working with statutory partners within a statutory framework, alcohol consumption and effects, social opportunities, the cost of alcohol related re- offending, alcohol legislation and cultural change.

65.3 The Chairman spoke about the attempts made jointly by the city and county councils over recent years, to improve the situation of a gentleman who lives on the streets of Gloucester, but their help is always refused. Another member expressed concern about the use of the term “lifestyle choice” in reference to those with mental health issues who develop alcohol dependency. She pointed out that it in many of these cases, this is not a choice. Another member agreed, and said that dual diagnosis is a good example of where joined-up working and service provision could really make a difference.

66. Dental Commissioning Strategy 66.1 Debra Elliott, Programme Director, Primary & Community Care outlined the Oral Health Strategy and Dental Commissioning Plan. She highlighted the current

Page 6 Subject to approval at the next meeting of the committee (18th January 2010)

commissioning of dental services in the county, and then explained the future changes and the implications for existing providers. 66.2 A member asked why the proposals for dental services in the Forest of Dean were loose. Debra Elliott replied that they wanted the market to respond about what it needs. The new contract is for up to four dental chairs per practice. NHS Gloucestershire will be encouraging providers to get familiar with the local area. The committee will be informed of who has been awarded the contracts in late November/early December. ACTION Debra Elliott 66.3 In response to a question, Debra Elliott said that it was a national dictate to carry out dental screening only in special schools, so if it appeared to be a false economy there is little that can be changed. Shona Arora was interested in targeting services more appropriately, and there may be a possibility to screen locally again in the future. 66.4 In response to a question, Debra Elliott said that there is a national procurement route for tendering, which was followed in this case. 66.5 In response to a question about access, Debra Elliott said that not all dental practices had disabled access. There is audit work going on at the moment to check standards of access. 66.6 A member suggested that certificates of dental attendance should be reinstated, to allow statistics of dental attendance to be collected. Debra Elliott was not sure whether this would be practical. 66.7 The chairman said that NHS Gloucestershire has the lowest NHS dental patient numbers in the South West Strategic Health Authority (SHA) area. Debra replied that historically the county had high numbers of private patients. The chairman thanked Debra Elliott for her presentation and for the help she had given earlier in the year to the group of councillors who met with her to increase their understanding of NHS dental access better.

67. Performance Report September 2009 The committee noted the report. The discussion which followed included these issues: 67.1 In response to a question about the Delancey Hospital site, Becky Parish said that an update could be included in the Community Hospital report in January, and recommended that the member concerned talked to Sally Pearson. 67.2 A member commented that the RAG chart (Red, Amber, Green) is a useful way of tracking the key targets month by month, but the year to date (YTD) does not give an anticipated outcome, or whether the targets will be met. Becky Parish said that these reports are brought to reassure the committee that NHS Gloucestershire is doing all it can, but will pass the comment on.

68. World Class Commissioning and the Strategic Framework

Page 7 Subject to approval at the next meeting of the committee (18th January 2010)

68.1 Laura Nicholas, Programme Director for Strategy Development at NHS Gloucestershire gave a presentation about the World Class Commissioning initiative and how NHS Gloucestershire plan to use this in their strategy to improve the health and wellbeing of the local population. World Class Commissioning is a key Government strategy, which will require PCTs to change, encouraging improvement over time by assessing governance and performance against competencies. The draft of the NHS Gloucestershire strategy was due to be presented to the NHS Gloucestershire Board on 26 November.

68.2 The committee had the opportunity to look at a copy of the draft statement during the meeting. A member pointed out that he had not found a reference to the Health, Community and Care Scrutiny Committee in the draft, and asked where it would be referenced and what kind of relationship would be expected in the context of this strategy. Laura Nicholas replied that the involvement of the committee would be based on partnership working, and that she would be happy to reference the committee in the document. Barbara Marshall also pointed out that the LINk was not similarly referenced in the VCS section, and Laura Nicholas replied that she would be happy to ensure that the LINk appears in the final draft. ACTION Laura Nicholas

68.3 In response to a comment, Laura Nicholas said that she accepted the comment that the document appeared to be bureaucratic. A good strategic plan should report top- down and bottom-up communication, and pull many different work strands together into one place. The intention is to produce a simplified version for wider circulation.

68.4 In response to a question about independent sector providers, Laura Nicholas said that independent sector providers have to meet the same, if not higher, standards as NHS providers. The committee will learn more about the UK Specialist Hospital (UKSH) at Shepton Mallett during 2010 as it becomes established.

68.5 Another member asked that NHS Gloucestershire take care to ensure that training, support and sickness cover support the PCT’s vision for a high quality workforce. This request was noted.

69. Introduction to the work of the Community & Adult Care Directorate 69.1 The committee noted the initial briefing paper from Margaret Sheather, Group Director, Community & Adult Care. The purpose of the paper was to give an introduction to the work of the Directorate and to suggest some issues for the committee to add to the work plan for the coming year. There was a brief discussion about the work plan, during which the chairman asked the committee to let him know of any issues that they would wish to look at. 69.2 The work plan will be drafted in the next few weeks and circulated when senior health and Community & Adult Care Directorate officers have had an input. ACTION All

Page 8 Subject to approval at the next meeting of the committee (18th January 2010)

70. Committee report The committee agreed that the chairman would be responsible for determining what to include in any report to council or to the Overview and Scrutiny Management Committee. ACTION: Cllr Gravells

71. Dates and venues of future meetings The committee discussed the proposals to change the time of the meeting to allow senior officers from the Community & Adult Care Directorate to attend. It was agreed to trial meeting on Monday afternoons, starting at 1.30pm, with a pre-meeting at 12.30pm. Catering arrangements will be worked out over the next few weeks.

72. Any other business Jan Stubbings’ apologies for January 18 th were noted.

Meeting ends 1.25pm Chairman - Cllr Andrew Gravells

Page 9 This page is intentionally left blank

Page 10 Agenda Item 4

Chairman’s Report to the Health, Community & Care Overview and Scrutiny Committee Councillor Andrew Gravells 18 th January 2010

This report provides an update on the issues that have arisen since the last meeting of the Health, Community & Care Overview and Scrutiny Committee, including an update on the work of the Great Western Ambulance Service Joint Health Scrutiny Committee.

1. South West Health Scrutiny Network Programme Board This group met on 1st December in Taunton. I was unable to attend, but Liz and Simon went along. Simon presented a paper suggesting that the many scrutiny networks across the South West should be more joined up to offer a more coordinated approach. A small group of Project Board members are scoping the ways this could be taken forward. The Joint Committee Protocol for Specialised Commissioning was also on the agenda. Gloucestershire was one of the last local authorities in the region to approve the protocol at full council, but it has now been approved with a caveat that the membership (ie the political proportionality) is reported back to them when we participate in a joint committee. We are researching how other regions of the country are approaching this issue.

2. Dual diagnosis and housing issues I met with Peter Steel after our last committee meeting to explore some of the issues he raised in his informative and thought-provoking presentation. I would like to suggest that we consider looking at dual diagnosis and housing issues, as there is clearly a gap at county level where housing is concerned. There are also links to the thematic plan of the Gloucestershire Health and Community Wellbeing Partnership (of which GCC is a member, and part of the Gloucestershire Conference) – one of their priority outcomes is to look at ways of having an impact on health inequalities by reducing alcohol related harm. This is an area of work which we could form a task group for.

3. Work programme 2010 From comments and suggestions received from members, I suggest we look at Utopia, to look in more depth at issues around emergency care, how the Hospitals Trust and PCT are dealing with reaching targets for A&E waiting times (with interest in how they work in partnership with GCC on discharges from hospital); Dual Diagnosis, to look at partnership working; and Independent Sector Treatment Centres, regarding their operating procedures especially regarding unexpected emergency care.

Page 11 4. Gloucestershire Hospitals NHS Foundation Trust I met with Dr Frank Harsent and Sally Pearson on 16 th December. We discussed a range of issues, including the role of Monitor and the CQC in inspections, the performance data which we get from NHS Gloucestershire, UTOPIA and discharge pathways. Dr Harsent will attend our meetings every six months from March 2010 to give a brief update and look forward, as will Shaun Clee, Chief Executive of 2gether.

5. Care Quality Commission Andy Brand and Sheila Reynolds, our regional managers at the CQC, came to meet me on 18 th December. This was a really useful meeting to help us to understand how they want us to communicate with them, and what information they would like us to send them. The CQC has recently published the new Essential Standards of Quality and Safety, which replace the previous Core Standards and can be viewed on their website www.cqc.org.uk .

6. Great Western Ambulance Service Joint Health Scrutiny Committee The committee met on October 30 th . It was agreed to establish a time-limited task group to look at rural ambulance performance in the three lowest- performing areas of the GWAS region (Cotswolds, Forest of Dean and Kennet in Wiltshire), and whether the Community First Responder (CFR) scheme can have an impact in those areas. Sheila Jeffery and Terry Hale are members of this group, and the first meeting is scheduled for January 13 th . The next meeting of the Joint Health Scrutiny Committee is on January 29 th , hosted in Bath by Bath and North East Somerset Council (BANES).

7. Future events The following events are coming up.

NHS South West Health Scrutiny Chairs Network – 22 nd January, Taunton.

Introductory meeting with David Martin – I will be meeting David, the Interim Group Director, Community & Adult Care Directorate on 1st February.

South West Scrutiny Network – 5th February, venue to be arranged. More information is available from Simon Harper in the Scrutiny Team.

Member seminar on the National Dementia Strategy – 17 th February, Council Chamber, Shire Hall. This is being organised by the Community & Adult Care Directorate and is open to all County Councillors. Invitations will be sent to District Councillors in the next couple of weeks – please let Elizabeth know if you haven’t received one.

Page 12 Agenda Item 5

GLOUCESTERSHIRE LOCAL INVOLVEMENT NETWORK UPDATE FOR THE HEALTH, COMMUNITY AND CARE OVERVIEW AND SCRUTINY COMMITTEE

January 2010

Care Quality Commission (CQC) A number of LINk members met with Sheila Reynolds, Local Area Manager and Andy Brand, Health Assessor on the 18 th December. From April 2010 all health and adult service care providers will have to meet essential standards of safety and quality in order to obtain their registration. LINk is one of the groups expected to give their views on how well the providers meet these standards. Information about NHS providers is needed by the end of January 2010. The information that we send to the CQC will be shared with the health care providers, commissioners and HCCOSC.

LINk workplan Task groups on Discharge and Podiatry have had their first meetings. Focus groups on the ambulance/out-of-hours services and mental health services are being held in the next few weeks.

Administration of Medicines During the last year Gloucestershire LINk has signposted a number of concerns/complaints to PALS at Gloucestershire Hospitals NHF Foundation Trust (GHNHSFT) about the administration of medicines to inpatients. These concerns were from patients themselves and their carers. They had occurred at both hospital sites and on different types of wards. Some of the concerns came to the LINk from members of the public. Others were from the personal experiences of LINk members. The LINk Stewardship Board, at their November meeting, agreed to that our concerns should be formally reported to the Trust, NHS Gloucestershire and the CQC.

The Trust has immediately responded to our concerns and taken them seriously. LINk members have been offered a presentation on the initiatives that have been put in place to improve the situation. A date in January has been agreed.

Community Engagement Events Since the last HCCOSC meeting the Gloucestershire LINk has held two events, one in Berkeley and one in Northleach. The following are a selection of the views expressed • Transport – a particular issue in Berkeley when the new hospital is built in Dursley • Access from the more remote areas of the Severnside parishes to the GP surgery is not very good for people without access to transport • Volunteer drivers have problems parking at Gloucester and Cheltenham hospitals • People with Learning Disabilities have greater difficulty accessing services than the general public • Excellent response from ambulance services to 999 calls

The Final Three Events: • Cheltenham : Tuesday 12 th January 2010 from 6pm to 8pm at Hesters Way Neighbourhood Project, Community Resource Centre, Cassin Drive, Cheltenham GL51 7SU • Gloucester : Wednesday 17 th February 2010 from, 6pm to 8pm at The Baptist Church Centre, Matson Avenue, Matson Gloucester GL4 1LA • Brockworth : Tuesday 2 nd March 2010 from 12noon to 2pm at Brockworth Community Centre, Court Road, Brockworth GL3 4ET We have appreciated the attendance of HCCOSC members at our previous events and hope that members may be able to attend some of these remaining events.

Barbara Marshall Chair, LINk Stewardship Board, Gloucestershire LINk 7th January 2010

Page 13 This page is intentionally left blank

Page 14 Agenda Item 6

Gloucestershire Health, Community and Care Overview and Scrutiny Committee

18 January 2010

NHS Gloucestershire 1 - Chief Executive’s Report

1. Update on Mental Health Commissioning

1.1 Plans are in place for the full implementation of all targets and objectives associated with the implementation of the NHS South West Strategic Framework and the National Service Framework for Mental Health. The implementation of the National Service Framework objectives will be achieved by December 2009, ahead of the national timescale of March 2010, with the required progress being made against all the NHS South West mental health ambitions for 2009-2011.

1.2 The SHA have recently confirmed the expected increase in central funding of £1m for Improving Access to Psychological Therapies (IAPT) from April 2010. The new service in Gloucestershire was launched on the 28 September 2009, and 792 referrals were made for treatment within the first six weeks. The additional funding will enable the planned increase in Psychological Therapists across all GP practices within the county and to achieve the access and activity targets.

1.3 A new health based Section 136 (Mental Health Act 1983) Place of Safety unit, known as the Maxwell Centre, was opened in January 2009 within the Wotton Lawn Hospital site in Gloucester. The unit is managed by 2Gether NHS Trust staff, working in partnership with the Gloucestershire Constabulary. This new health based service provides an alternative to police cells for people detained under the mental health act who require assessment of their mental health needs. The

1 NHS Gloucestershire Vision and Values

Our Vision : Achieving excellence in health for the people of Gloucestershire Our Values : We should: • Work with our patients to promote and support healthy living and self care • Promote innovation in patient care and celebrate success • Provide sustainable services as close to the patient’s home as possible where this is consistent with safe, quality and cost effective care • Pay proper attention to partnerships and involve service users, carers, staff, contractors, partners, and the public in developing services • Listen to our local communities and learn from feedback • Communicate clearly and be honest about what can be achieved and the challenges ahead • Treat our service users, carers and staff fairly with respect and politeness • Trust and support our staff • Value the diversity of our staff and our population.

Page 15 contract performance and activity reporting indicates the unit to be operating effectively, responding to over 200 referrals since becoming operational. The new service has recently been reported in the National Journal of Psychiatric Intensive Care (2009, 1- 6.) as a model of good practice in this service area.

1.4 The engagement of effective service user involvement within the planning and monitoring of mental health services is being developed through service user networks across the county. The County Council and NHS Gloucestershire have jointly commissioned Rethink (Voluntary sector organisation) to develop and provide ongoing support for three locality network groups to work closely with the Local Implementation Team. The new initiative is progressing as planned with a successful appointment recently made to the Service User Network Coordinator post within Rethink in Gloucestershire.

2. Pooled Budgets in Gloucestershire

2.1 The national policy direction is for greater integration between health and social care for both commissioning and service provision so as to support users of services by various government funded organisations to provide and plan for services in a joined up and co-ordinated way. Recent policy developments such as “Putting People First” and Lord Darzi’s “Next Stage Review” have strongly favoured such an approach.

2.2 Section 31 of the 1999 Health Act introduced “flexibilities” to allow effective partnership working between the NHS and local authorities – this has now been replaced by Section 75 of the NHS Act 2006. This legislation allows budget pooling to create a relationship of equals whereby partners contribute to the shared budget but retain statutory responsibility for their services.

2.3 A pooled budget is a mechanism, in which partners consolidate resources to form a discrete common fund. This pool is then used to deliver delegated functions or agreed projects or delivery of specific services for a defined client group.

2.4 The purpose and scope of the fund are agreed at the outset with the aims and outcomes for the partnership set out in a formal written agreement and the level of contribution made by each partner is agreed before the pooled budget is approved.

2.5 The pooled budget will then be used on the services identified in the partnership agreement without reference to the contribution of individual partners, therefore focusing on the needs of the client group rather than organisational boundaries. Approaches to risk management and governance are agreed between the partners. The establishment of a pooled budget under Section 75 needs to be notified to the Department of Health.

2.6 Current situation within Gloucestershire A number of pooled budget arrangements already exist in Gloucestershire between NHS Gloucestershire (NHSG) and

Page 16 Gloucestershire County Council (GCC). These were primarily put in place by the predecessor Primary Care Trusts. The formal transfer of funding that is currently in place for commissioning services are:

• Section 256 agreements (which under the NHS Act 2006 allow grant payments – either capital or revenue – to local authorities) totalling £10m with GCC covering a range of Learning Disability, Mental Health, Children & Young People and Intermediate Care joint commissioning arrangements. • Funding transfers (£10.1m) to GCC in respect of Valuing People Now which is a transfer of Learning Disability Social Care resources and responsibilities. This transfer includes £7.2m funds for Brandon Trust which was a Section 75. • Pooled Budget arrangement, £1.7m for Multi Agency Re-Provision with the balance relating to Learning Disability Section 256 agreements. • Further transfers in respect of Valuing People Now are being finalised in year and these relate to St Mary’s Campus reprovision, Learning Disability Social Care elements within NHS funded placements and Capital Assets associated with the Brandon Trust contract. • NHSG has a Section 75 agreement that delegates functions rather than resources in relation to the administration and payment of Care Homes for Continuing Healthcare. • In addition to these there are Section 75 agreements in place between GCC and Gloucestershire Care Services covering Occupational Therapy services and Community Equipment arrangements.

2.7 NHSG and GCC have recognised the importance of integration as a way of improving services for the people of Gloucestershire. To date the two organisations have supported the creation of joint commissioning posts for mental health, learning disability and older people. These postholders have responsibility for commissioning both health and social care services but they do this currently almost as two separate roles.

2.8 Agreement has been reached in principle to move towards pooled budgets for areas where we already have joint commissioning managers in place. The first area where this will be developed is in relation to the commissioning of care of adults with a mental health need or learning disability.

2.9 Next Steps NHSG and GCC are working to explore the governance, financial implications and risk share arrangements that are needed to support the move towards further pooled budget arrangements.

3. Children and Young People

3.1 NHSG has an agreed list of strategic priorities for children and young people that are aligned with those of GCC and the Gloucestershire Children and Young People’s Plan.

Page 17 In addition to universal services these include: • community paediatricians, • paediatric curative and palliative care at the acute trust, • a community paediatric nursing service with on call out of hours support for end of life care. • and a local voluntary provider who provide nursing support for children with life limiting conditions.

3.2 In addition, care packages for individual children are often jointly funded with GCC through a combination of provision from the community nursing team, voluntary and private providers.

3.3 We are currently developing a children’s palliative care strategy which will identify needs and gaps of service provision in Gloucestershire.

4. Autumn Statement For Services For Disabled Children

4.1 PCTs across England have been asked by Department for Children, Schools and Families (DCSF) and the Department of Health (DH) to produce a statement on services for disabled children.

4.2 These statements are expected to set out the actions that the PCT is taking, either alone or in partnership, particularly in the four areas of short breaks, community equipment, wheelchairs, and palliative care in response to specific questions posed by DH/NHS South West.

4.3 This Statement was developed and submitted to NHS South West on 29th October 2009. This return was submitted in the following broader context.

4.4 NHSG is an active partner within the Gloucestershire Children & Young People's Strategic Partnership (CYPSP) which is the Gloucestershire Children's Trust arrangement.

4.5 A Commissioning Strategy for Children with Disabilities was developed on behalf of the CYPSP during 2007/08 and children with disabilities have appeared in the two Gloucestershire Children & Young People's Plans 2006-2009 and 2009 – 2012, both of which have been adopted by NHSG along with the other partners of the CYPSP.

4.6 Gloucestershire is a pathfinder area for Aiming High for Disabled Children Short Breaks, and also a pilot area for individualised budgets for disabled children, both of which represent partnership working between NHSG and GCC. The County Council and NHSG are also co-signatories to the Every Disabled Child Matters Charter.

4.7 The NHSG principles for commissioning and service improvement for children and young people include a range of commitments to deliver local services which are: • joined up across agencies; • allow for early assessment and intervention to help prevent these needs becoming more serious;

Page 18 • meet children and young people's needs in universal settings wherever possible; • support access to specialist support as necessary on a step-up, step-down approach; and • provide very specialist help as close to home as possible.

4.8 These principles apply to disabled children and young people as well as to children and young people generally.

5. Annual Report of the Director of Infection Prevention and Control 2008-09

5.1 The Annual Report of the Director of Infection Prevention and Control 2008-09 details the arrangements for infection prevention and control within the county.

5.2 The work in infection prevention and control is comprehensive and ongoing and allowed NHSG to declare full compliance with the Health and Social Care Act 2008 in April 2009. MRSA bacteraemias and C. Difficile infections have been reduced during 2008/9. Audit and cleanliness scores show improvement plans are in place to build on this work during 2009/10

6. Promoting physical activity through design

6.1 The role of environmental design and planning in encouraging physical activity was explored at a seminar on 30 November 2009, hosted by NHSG.

6.2 Public health guidance published by the National Institute for Health and Clinical Excellence (NICE) has highlighted how the design of the built and natural environment can support people to be more active, with proven benefits for health and wellbeing.

6.3 The seminar included presentations from leading experts in the fields of urban design, town planning and the natural environment, and feature representatives from the World Health Organisations’ Healthy Cities project, and Natural England – pioneers of the Green Gym initiative.

6.4 Good design and planning can make a real difference to how we use our buildings, open spaces and communities, and provide solutions to making physical activity part of our daily lives. Simple things like making stairs easy to find and attractive to use, linking shops and workplaces to walking and cycling networks and designing playgrounds to encourage active play can support people to get more active.

Page 19 Working with our patients to promote and support healthy living and self care

7. Get the Right Treatment – Choose Well http://www.choosewellglos.nhs.uk/

7.1 As reported to the Scrutiny Committee in November 2009, NHSG was planning an information campaign to encourage people to access the most appropriate services to meet their needs. ‘Get the Right Treatment’ – Choose Well was launched in December 2009 to help people to make the right choices and to remind them to only visit Hospital A&E in an emergency.

7.2 The Hospital Emergency Department has a key role to play in treating people who need emergency treatment, but it is vital that hospital staff are able to focus on treating patients in most need of this specialist care.

7.3 The campaign has encouraged people to think about the full range of healthcare options which for non emergency care can be more convenient and appropriate to meet their needs.

7.4 NHSG is asking people to think ‘pharmacist’ for a number of ailments. Pharmacists are experts on medicines and how they work. They are qualified to give advice on coughs, colds, sore throats, aches and pains, sprains and stomach upsets. People don’t need to make an appointment and the pharmacist can advice them on whether they need to visit or call other NHS services.

7.5 NHSG is also asking people to think ‘Gloucester Health Access Centre’ - Open 8am to 8pm - 7 days a week. Run by local GPs and nurses, the centre offers a walk-in service for minor ailments and injuries such as minor cuts, bites and stings and allergies. They can also provide Sexual Health Services, for example contraception advice and Chlamydia screening. The Gloucester Health Access Centre is based at St Michael’s Branch Surgery, St Michael’s Square, off Brunswick Road, Gloucester.

7.6 If individuals have a flare up of a long standing illness such as kidney or lung disease, bronchitis, asthma or diabetes that is not responding to self care or advice from a pharmacist, the campaign encourages them to think about making an appointment with their GP Surgery.

7.7 GPs are experts in family medicine. If anyone is worried about the health of their child they are encouraged to call their GP.

8. Smokefree Gloucestershire Alliance

8.1 The Smokefree Gloucestershire Alliance was successfully re-launched on the 1st June 2009 to revive the partnership between organisations including Environmental Health, Trading Standards and the NHS in reducing the death and disability caused by smoking in Gloucestershire.

Page 20 8.2 Since then, the Alliance has met to identify key priorities for the County. These are: • protecting children in the home and car from second-hand smoke; • stopping the inflow of young people recruited as smokers; and • reducing smoking prevalence in routine and manual groups.

8.3 In 2010, these priorities will be embedded in a new localised tobacco control strategy for Gloucestershire. This document/action plan will also be informed by the new national tobacco control strategy due to be launched in December 2009.

9. Students in Gloucestershire learn the ‘toxic truths’ about tobacco

9.1 Students in schools across Gloucestershire can now get an insight into the real cost of a cigarette, thanks to an innovative new teaching resource launching in December 2009.

9.2 ‘Toxic tobacco truths’ goes beyond the usual focus on health issues to highlight the hard facts behind the tobacco industry. The toolkit for teachers and youth workers developed by NHSG and GCC, explores the wider issues surrounding tobacco, including the role of advertising, the manufacturing process, and its human and environmental cost.

9.3 The project, the first of its kind in the South West, was developed in response to requests from schools and youth clubs for help in reducing smoking uptake. Nearly 40% of pupils in Gloucestershire schools have tried smoking by Year 10. Of these, around 16% smoke 20 or more cigarettes a week.

9.4 Local students were involved in developing material to ensure that the content appealed to them and their peers. In one of the lessons, students calculate how much money they would save over a lifetime of not smoking, and in another, students explore guerrilla marketing campaigns to discourage smoking amongst their peers.

9.5 To support the resource pack, NHS Gloucestershire has also commissioned ‘Fags and Me - From First Drag to Final Fag’ - a touring theatre production following the journey of twenty-a-day Sarah as she makes the decision to quit. The play, produced by Fairgame theatre group will tour schools and youth clubs across the county from January through to April next year.

10. ‘Best to Test’ – Chlamydia screening hits the high street

10.1 Young people in Gloucestershire were reminded to look after their sexual health, as part of a Christmas and New Year outreach campaign in December 2009.

10.2 A team of outreach workers hit the streets to talk to young people aged 16-24 while they are out and about with friends at the evenings and weekends. The teams provided information on local sexual health services, and free Chlamydia screening kits.

Page 21

10.3 A mobile Chlamydia screening van was also be located in the centre of Gloucester and Cheltenham for two weekends in December and January. The van featured computer games and a photo booth to encourage young people to stop for a chat.

10.4 The initiative is the latest in NHSG’s ‘Best to Test’ campaign. The campaign aims to raise awareness of the dangers of Chlamydia and make testing as simple as possible.

10.5 The Chlamydia Screening Team already offers free testing to 16-24 year olds in a number of locations, including GP surgeries, pharmacies, youth services, schools & colleges, and military bases.

10.6 Chlamydia is the most common sexually transmitted infection (STI) amongst young people, and can be easily tested and treated. However, 80% of women and 50% of men do not experience any symptoms. If left untreated, the infection can go undiagnosed leading to serious complications, including infertility. The test is simple and painless, a urine test for men and a self administered swab test for women. The Chlamydia Screening Office will give results within two weeks, and discuss convenient locations for treatment.

10.7 The outreach activity coincided with the launch of a new national sexual health campaign by the Department of Health, ‘Worth Talking About’, which aims to help young people make informed choices about contraception and look after their sexual health.

Promoting innovation in patient care and celebrating success Innovate

11. Innovate 09 Conference

11.1 “High Quality Healthcare for all’ sets out the Government’s vision for the NHS and makes significant reference to the need to unlock local innovation to drive forward improvements in quality and value for money.

11.2 NHSG hosted the Innovate 09 Conference at Cheltenham Racecourse on 4th and 5th November 2009 with the aim of bringing together NHS staff and partners from across Gloucestershire, the South West and other neighbouring counties to celebrate innovation, learn about the application of best practice (both from inside and outside the NHS) and to take ideas and tools back into their workplace.

11.3 The conference featured a range of high profile speakers including: • Camilla Batmanghelidjh (Psychotherapist and founder of Kids Company); • Professor Chris Ham (Governor of the Health Foundation); • Chris McCarthy (Director of the Innovation Learning Network at Kaiser Permanente); and • Emmanuel Gobillot (International Speaker on Innovation and Leadership).

Page 22 There were also opportunities for delegates to attend master classes delivered by leading innovators, offering inspirational ideas to take back to the workplace.

Feedback from internal and external attendees has been extremely positive.

Providing sustainable services as close to the patient’s home as possible where this is consistent with safe, quality and cost effective care

12. 3 Counties Cancer Network (3CCN) Complex Head and Neck Surgery

12.1 The National Institute for Health and Clinical Excellence (NICE) published ‘Improving Outcomes Guidance (IOG) in Head and Neck Cancers’ in 2004. The Guidance was based on the best available evidence including outcomes from different health care models and expert clinical advice.

12.2 The key aims were to ensure: • Highest quality care; • Patient safety; and • Best possible outcomes.

12.3 The IOG made it clear that the best available evidence supports centralisation of complex surgical services into specialist centres. The reasons for this are:

• Experience of surgical teams and staff; • Maintaining standards and quality of surgery; • Patient safety; and • Striving to improve outcomes and survival.

12.4 Complex surgery is only a small element of the total pathway of care that the patient and carer experience and the majority of care such as assessment and aftercare would continue to be provided locally and as close to home as possible.

12.5 An independent expert review was established by the 3 Counties Cancer Network (3CCN) Team on behalf of the network commissioning group in September 2008. The review was undertaken by a specialist team including patients and carers, Ear, Nose and Throat and Maxillofacial Consultants and the Director of the National Cancer Action Team. The External Review made a clear recommendation to move to a single complex surgical site for the 3 Counties Cancer Network. This recommendation was based on the expected caseload, with insufficient cases anticipated to allow benefits from the NICE guidance to be achieved within the current arrangement.

12.6 The 3CCN Board accepted the recommendation that there should be one centre for complex surgery for patients with head and neck cancers for the population of the three counties supported by excellent local services, in line with national guidance.

Page 23

12.7 In February 2009, the 3CCN issued an informal invitation for the procurement of the specialist multidisciplinary head and neck cancer team and surgical centre. Both Worcestershire Acute Hospitals NHS Trust (WAHNHST) and Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) submitted their proposals. GHNHSFT submitted their proposal 7 days late.

12.8 In May 2009, the 3CCN Board established a review panel, including representatives from the commissioners (Primary Care Trusts), patient representatives and supported by national experts in head and neck cancer. This panel looked at the preferred location for the specialist surgical centre. The panel used a set of agreed criteria, which had been set out in a service specification for head and neck cancers and followed national peer review measures. Both WAHNHST and GHNHSFT presented their bids.

12.9 Following a lengthy discussion, the recommendation of the Panel was that, both proposals satisfied the criteria but taking various factors into consideration, such as the tour of facilities, the presentations and the supporting evidence, the majority of the panel favoured Gloucestershire Royal Hospital by a narrow margin.

12.10 The Chief Executives of the Primary Care Trusts in Herefordshire, Gloucestershire and Worcestershire considered the May 2009 exercise as part of the wider review process.

12.11 In July 2009, as part of an objective and transparent approach, the advice of Professor Sir Mike Richards CBE, National Cancer Director was sought and he was asked to comment on whether surgical services for head and neck cancer should be provided on a single site and whether there is evidence that there would be a detrimental impact on care given at the site that is not selected.

12.12 Professor Sir Mike Richards considered: • The report of the Independent Expert Panel held on 5 September 2008 • The submission from WAHNHST (April 2009) • The submission from GHNHSFT (May 2009) • The report of the review held on 18 May 2009 • A letter from Mr Graham Jones and Mr Chris Ayshford from WAHNHST, setting out a case for surgery to be undertaken on two sites within a single multi- disciplinary team.

12.13 In October 2009, the 3CCN Chair received Professor Sir Mike Richards’ advice. This advice has been shared with the Chief Executives of the Primary Care Trusts in Herefordshire, Gloucestershire and Worcestershire. Professor Sir Mike Richards’ stated that:

• There is increasing evidence across a range of cancer sites concerning the benefits in terms of clinical outcomes of centralising complex surgery.

Page 24 • Two reviews have been conducted, both of which involved eminent experts in the field. The first review concluded strongly that surgery should be delivered from a single site. The second, which was tasked with identifying the optimal site, did not in any way suggest that surgery should be undertaken on both sites. • He therefore strongly recommended that a single surgical centre should be established in the 3 Counties Cancer Network. • This should be done in such a way as to minimise inconvenience for patients by providing assessment, minor surgery and aftercare as close to home as possible. • It is clear from the report of the 18th May 2009 that a fair and comprehensive process was undertaken. • The volume of head and neck cancer surgery is small in comparison with overall workload in Ear, Nose and Throat departments. • He does not believe that centralisation of head and neck cancer surgery should destabilise the service for patients with other head and neck conditions on the site which is not selected. • He has not heard of any concerns from other parts of the country where centralisation has now been fully implemented. • He would strongly urge the centralisation of surgery on a single site in the network area and to do this as soon as reasonably possible.

12.14 Next Steps The process of validating the data received from the provider trusts in Gloucestershire and Worcestershire as part of their bids is currently underway. Validation is being carried out by members of the 3CCN, lead head and neck clinicians from both Worcestershire Acute Hospitals Trust and Gloucestershire Hospitals NHS Foundation Trust and managers from both Trusts. If validation is confirmed, the 3 Counties Cancer Network Board will be asked to consider the outcome of Professor Richards’ work, the outcome of the expert reviews, any proposals arising from a dialogue between clinicians and the Trusts and patient feedback.

12.15 A final decision on the future commissioning of this service will then be taken by the three Primary Care Trust Boards. In reaching their decisions the Primary Care Trusts will be considering this issue within the context of their overall strategies for improving cancer services.

12.16 We want to keep uncertainty to a minimum, but at the same time need to ensure that every aspect of care is considered and that we fully understand the impact that a decision like this would have on existing facilities. The focus should be on achieving the best possible care for all patients across the three counties and this will continue to be our guiding principle.

Page 25 Paying proper attention to partnerships and involving service users, carers, staff, contractors, partners, and the public in developing services

13. The Ermin Neurological Centre (ENC)

13.1 In November 2009, Scrutiny Members were informed that NHSG and GHNHSFT were discussing with current service users and staff at ENC proposed changes to respite services for people with long-term neurological conditions in Gloucestershire.

13.2 The principles upon which our proposals are being developed are:

• Providing high quality and responsive services to people with a long term neurological condition • Providing greater choice with an extended range of providers • Providing care closer to home • Improving patient pathways • Ensuring every eligible patient receives the offer of appropriate care and services provided by the NHS and social services • Making best use of skills, resources and funding

13.3 Current provision Respite services for people with a long term neurological condition in Gloucestershire are currently provided at Ermin Neurological Centre, a facility and service operated by Gloucestershire Hospitals NHS Foundation Trust on the Gloucestershire Royal Hospital site.

13.4 This existing arrangement of respite provision in Gloucestershire does not offer choice for Gloucestershire residents as it does not provide access to services closer to home for the majority of the county’s residents, situated as it is, at a single location in Gloucester City. This view has been expressed to us by patients and their carers, with an increasing number of requests from them and their carers for respite to be offered in alternative settings.

13.5 As a result of feedback from patients, their carers and voluntary sector organisations, we are keen to consider the options for delivering more innovative and personalised respite services in Gloucestershire. We know that the ENC has been a much valued service for many years, but we need to consider the future vision for the delivery of respite services in Gloucestershire, which ensures a range of appropriate choices for local residents.

13.6 There are four main services currently being provided by the ENC:

1. Motor Neurone Disease Palliative care 2. Planned respite for Multiple Sclerosis (MS) and Acquired Brain Injury (ABI) patients 3. Rehabilitation for ABI and some MS patients 4. Intravenous therapy for MS patients

Page 26

13.7 Involvement Activity to support the ENC Project A detailed ‘Ermin Neurological Centre Project’ Involvement/ Engagement Plan was produced at the beginning of the Project. Local ‘Levels’ of Engagement Guidance for GPCT Involvement Activity approved in 2007 and endorsed through the NHS Gloucestershire Involvement and Engagement Strategy approved 2008 requires that: “The PCT will ensure that effective and relevant PPI activity is undertaken using the framework of the three levels of involvement”

13.8 The Ermin Neurological Centre Project Group (ENCPG) identified that the proposed changes to services currently provided at ENC most closely fitted within Levels 1 and 2 of Engagement as described below:

• Level 1 – reflects the changes or improvement made in relation to individual patients. This relates to the person to person activity including relationship building and the quality of involvement and communication that is established between service users/patients, carers and relatives and the clinicians/staff. This level of involvement and communication does not require wider patient and community involvement/communication nor formal public consultation.

• Level 2 – focuses on specific service developments or policy changes that do not require formal public consultation. For example opportunities for groups of patients and staff to concentrate on a particular service, for example stroke services. If any changes proposed are considered to have a significant impact (Health Overview and Scrutiny Impact Assessment) Level 3 public consultation would apply.

• Level 3 addresses how the PCT engages and communicates with both patients and the wider community in relation to major strategic service change.

13.9 Activity to date has included:

• Completion by the Project Manager of a Service Change Checklist – used as an internal check to test the rationale for service change. • Information shared with Overview and Scrutiny Committee through updates at formal meetings and via communications with the Committee Chair. • Visits to Ermin House for key opinion formers: - Non-Executive Director - Local Involvement Network (LINk) representative (also involved in wider Neurological Services Review) - Scrutiny Committee Chair (date for visit to be confirmed at time of writing this report) • Visits to alternative new provider in Gloucester (as above) • Letters to all current service users, describing project and asking for comments. • Staff briefing sessions

Page 27 • Discussion at 21 October 2009 Neurological Services Review Event regarding respite services led by Project Manager • Individual assessments of all current service users. NHSG’s Project Manager noted excellent partnership working with Gloucestershire County Council Adult Social Care staff. • All carers offered Carers Assessments

Listening to our local communities and learn from feedback

14. Consultation on New Patient Rights

14.1 The NHS Constitution is intended to be both a living and an enduring document. It needs to reflect developments in services but any changes to it must be considered carefully. A consultation on a small number of proposed additions to the NHS Constitution that reflect recent developments took place nationally and locally at the end of last year.

14.2 Staff, patients, carers and the public were asked what they thought about the inclusion of two new rights in the NHS Constitution, what they thought about other potential future changes to the NHS Constitution and what they thought about the introduction of the new role of Constitution Champion.

14.3 In addition to the existing 25 rights and 14 pledges for patients and the public, the consultation asked what people thought about government proposals to:

• introduce a new right to access services within maximum waiting times or for the NHS to take all reasonable steps to offer a range of alternative providers if this is not possible;

• introduce a new right to a NHS Health Check every five years for those aged 40–74, to come into effect in 2012, and the right to see an alternative provider if you are not offered one by the provider you approach;

• explore the introduction of a number of potential future rights; and

• introduce the role of ‘Constitution Champion’.

14.4 This consultation focussed on the above areas and was not a consultation on the NHS Constitution as a whole. The NHS Constitution was itself the result of extensive consultation and has already received widespread support.

14.5 Collated responses from the local consultation will be sent to NHS South West for submission to the Department of Health in January 2010.

Page 28 Valuing the diversity of our staff and our population.

15. Social Inclusion Conference for Gloucestershire

15.1 The conference was held on Friday 16th October 2009 at Gloucester Rugby Business Centre and included a visit from HRH The Princess Royal. It aimed to foster a culture of social inclusion particularly in relation to mental health in Gloucestershire, through the launch of the Social Inclusion Strategy.

15.2 The event was planned by Gloucestershire’s Social Inclusion Executive Group and was sponsored by NHSG, GCC and 2gether NHS Foundation Trust. The programme was designed by service users in partnership with 2gether NHS Foundation Trust and partner organisations including NHSG. Participants from across stakeholder groups were invited and the event was a compelling driver for positive change in Gloucestershire.

15.3 On behalf of the Social Inclusion Executive Group, Jan Stubbings, Chief Executive, NHSG introduced the Social Inclusion Strategy for Gloucestershire, which was then signed by:

• 2gether NHS FT, • Gloucestershire County Council, • Carers Gloucestershire • Gloucestershire LINk • Gloucestershire Association for Voluntary & Community Action • Gloucestershire Safer and Stronger Partnership • Gloucestershire Media • NHS Gloucestershire • Job Centre Plus

Jan Stubbings Chief Executive, NHS Gloucestershire January 2010

Page 29 This page is intentionally left blank

Page 30 Agenda Item 7

Gloucestershire Health, Community and Care Overview and Scrutiny Committee

18th January 2010

Update on Community Health Impact Assessment Wingmoor Sites, Bishop’s Cleeve, Gloucestershire

1 Introduction 1.1 NHS Gloucestershire facilitated a community Steering Group to undertake a community health impact assessment (HIA). The completed community HIA report was presented to the then HOSC in March 2009. An update was presented in September 2009 with a request for a further update to be made in January 2010.

2 Update 2.1 Since the production of the community HIA the community Steering Group have met on a number of occasions to follow up the recommendations made at the end of the community HIA report (referred to as key areas for action in the report).

2.2 During these meetings the community Steering Group identified a number of new additional issues which have also been followed up in order to establish where responsibilities lie for certain regulatory functions due to the complexity of the sites, processes and operations.

2.3 On the 8 th and 9 th December 2009 the Steering Group held a “community views” event at Bishop’s Cleeve Parish Council offices to ask the local community for their views regarding the key areas of action that the report had identified. To enable the responses of the community to be analysed, a semi-structured questionnaire was used (see Appendix A). Approximately 250 people attended over the two days and over 300 questionnaires were given out. Over 50 questionnaires were also sent out via post and e-mail following requests from those who were unable to attend the two day event.

2.4 The closing date for receipt of completed questionnaires was the 31 st December 2009 and at the time of writing this report 119 questionnaires had been returned for analysis.

2.5 Analysis of the questionnaires is taking place in the first 2 weeks of January, therefore a brief update on the results of the analysis will only be able to be verbally presented to HCCOSC at its January meeting. The full results will be presented to the Wingmoor Liaison Forum at its meeting in late January 2010. 1

Page 31 3 Future Action 3.1 The final written analysis of the results of the community views questionnaire will be added to the community HIA report as an additional appendix.

3.2 The community Steering Group has agreed that the outstanding work of the Group should now now fall under the remit of the Wingmoor Liaison Forum and actions can be followed up within this setting.

4 Conclusion 4.1 The Steering Group believe that obtaining a wider community perspective relating to the community HIA report will add weight to understanding the health issues that the community believe are important relating to the Wingmoor sites.

4.2 The community HIA report continues to be a useful piece of community evidence and intelligence that can be used to inform work around local planning and policy formulation which might not otherwise have been collated except through the auspices of a community HIA. The report is therefore able to be used by all those with an interest or other stakehold in the Wingmoor sites.

5 Recommendations HCCOSC is requested to;

• Note the report. • Recommend that the outstanding actions from the community HIA report are followed up through the auspices of the Wingmoor Liaison Forum.

6 Appendices § Appendix A Blank community views questionnaire

Caryn L Hall Consultant in Public Health NHS Gloucestershire

January 2010

2

Page 32 Appendix 1

Seeking Your Views Wingmoor Waste Treatment Plant and Landfill Sites Community Health Impact Assessment Report

Introduction Earlier this year, a group of people (called the Community Health Impact Assessment Steering Group) from Bishop’s Cleeve and the surrounding areas completed a community health impact assessment (sometimes called an HIA) of the Wingmoor waste treatment plant and landfill sites with assistance from NHS Gloucestershire.

The report that was produced by the group identified some key areas of action that the group felt should be addressed by a number of different organisations. All these organisations have since received a copy of this report, but it is important to note that they are only obliged to consider these areas for action within the context of their statutory responsibilities.

The full HIA report was presented to the Gloucestershire Health Overview and Scrutiny Committee (HOSC) at a meeting on the 13 th March 2009 – the full report can be accessed through the County Council website.

Next Steps The report identified a number of key areas for action for a number of different agencies and the Community HIA Steering Group are now looking for your views on these. Please complete the attached questionnaire and give your views on the HIA report. The questionnaire must be returned to the FREEPOST address listed on the back page no later than 31 December 2009. In order to assist you in completing the questionnaire, all 23 of the key areas for action are listed so that you can read these in full. You may also find it helpful to read the full report.

All responses to the questionnaire will be collated, analysed and a report produced. It is proposed that this report will be added as an appendix to the HIA report and made publicly available.

Your responses will be treated in the strictest confidence and you will not be able to be identified in responding to the questionnaire. It is however useful for us to understand where you live and how long you have lived there. We would therefore request that you complete the beginning part of your postcode on the questionnaire to help with the analysis and answer the question on length of time at that postcode.

Page 33 Listed below are the key areas for action as listed in the community HIA report

NHS Gloucestershire (Gloucestershire Primary Care Trust) A NHS Gloucestershire must undertake a study to determine the potential effects of the Wingmoor sites on the physical and mental health and wellbeing / stress of local residents (to include asthma) who live in proximity to the Wingmoor sites to be completed in 2009.

B NHS Gloucestershire must undertake a comparative update of the Bishop’s Cleeve Neighbourhood Health Profile every 3 years commencing in 2009.

C NHS Gloucestershire must undertake a long term prospective cohort study of new born babies in the area surrounding the Wingmoor sites in order to identify any specific health issues to commence in 2009.

Health Protection Agency D The Health Protection Agency must lead, in collaboration with key stakeholders, a community consultation event that will ensure the views of the local community are captured with respect to the issues raised in this report.

E The Health Protection Agency must resource and implement the proposal to introduce an Environmental Public Health Tracking Programme to commence in 2009 or at the earliest opportunity. The Environmental Public Health Tracking Programme must report their findings at regular intervals to the appropriate fora so that residents are made aware of any findings.

Wingmoor Site Operators F Operators of the Wingmoor sites must take a joined up approach with clear lines of responsibility to ensure that the community is provided with timely, clear, readily accessible information about their site including the exact nature of wastes accepted, presented in an easy to read and understand format to commence April 2009.

G Operators must identify and share with the community how their site operations as a whole impact on the local community and how they are minimising those impacts to commence April 2009.

Gloucestershire County Council H Gloucestershire County Council must ensure that planning applications are accompanied by a formal health impact assessment and human health risk assessment as part of a wider ranging environmental impact assessment, when future applications for planning consent are submitted. The community must be directly involved in these processes. Regular ongoing reviews of the health impact assessment and human health risk assessment must take place.

2

Page 34 I Gloucestershire County Council must actively undertake to take into account the cumulative effects of the combined Wingmoor site operations including traffic management when considering any future planning application.

J Gloucestershire County Council must undertake to use ‘quiet surfaces’ on the key roads that surround the Wingmoor sites.

Gloucestershire Local Resilience Forum K Gloucestershire Local Resilience Forum must undertake in autumn 2009 an exercise around the subject of a road traffic collision in Bishop’s Cleeve involving a vehicle carrying hazardous waste to ensure that an appropriate response is in place.

L Gloucestershire Local Resilience Forum Risk Assessment sub-group must undertake to give due consideration that the Wingmoor sites and associated activities are placed on the community risk register.

Tewkesbury Borough Council M Tewkesbury Borough Council must recommence passive tube monitoring for nitrogen dioxide on Stoke Orchard Road and also introduce monitoring on the A435 Bishop’s Cleeve By-Pass in May 2009 or as soon as is reasonably practicable. The results must be made available in a timely manner to the Wingmoor Liaison Forum so that they are publicly accessible.

N Tewkesbury Borough Council must undertake real time air quality monitoring and analysis at Stoke Orchard Road, Bishop’s Cleeve and the A435 Bishop’s Cleeve By-Pass to establish an accurate baseline of the impact of traffic on air quality in the area to commence in 2009. Comparative annual air quality monitoring and analysis thereafter must be undertaken to identify trends.

O Tewkesbury Borough Council must undertake to give specific consideration to the Bishop’s Cleeve area and the locality surrounding the Wingmoor sites when undertaking its Updating and Screening Assessment on air quality for 2009.

Environment Agency P The Environment Agency must actively take into account the cumulative effects of the combined landfill site operations at Wingmoor when considering any future permit applications.

Q The Environment Agency must undertake to complete the analyses of the dust monitoring carried out by DustScan Ltd to commence in 2009 or as soon as is practicable. The results of the analyses must be made publically available and sent to the Wingmoor Liaison Forum. These analyses must be undertaken annually thereafter following monitoring.

3

Page 35 R The Environment Agency must commit to carrying out the recommendations of the findings of the Macleod study relating to air pollution control residues.

S The Environment Agency must undertake research with regard to the effects to health of the “cocktail effect” of wastes that enter landfill sites.

T The Environment Agency must undertake noise monitoring of the Wingmoor sites and associated traffic to establish a baseline to be completed in 2009.

Government Office of the South West U Government Office of the South West must undertake to review the planning position in the South West region with regard to waste treatment and landfill sites and in particular sites that handle hazardous waste.

Gloucestershire Health Overview and Scrutiny Committee V The Health Overview and Scrutiny Committee must undertake to ensure that the key areas of action identified in this report are monitored regularly to ensure that the actions are being undertaken by the identified agencies.

Wingmoor Liaison Forum W The Wingmoor Liaison Forum must undertake to ensure that the key areas of action identified in this report are monitored regularly to ensure that the actions are being undertaken by the identified agencies.

4

Page 36 Questionnaire - Community Health Impact Assessment

Do the key areas for action from the report reflect the issues that are important to you? (Please circle yes or no)

YES NO

If you replied NO …….

What would you wish to see added?

What would you wish to see removed?

Does the report as a whole, adequately and accurately reflect the issues that are important to you? (Please circle yes or no)

YES NO

If not, why not?

Of the key areas of actions listed, which is the most important issue / key action to you (Please write the letter of the key area of action in the box)

5

Page 37

Please return the questionnaire to the address below Caryn L Hall (HIA) FREEPOST NO: RRZE-ZASK-RRXC NHS Gloucestershire, Sanger House, 5220 Valiant Court, Gloucester Business Park, Brockworth, Gloucester, GL3 4FE

Please write in the boxes below the start of the postcode where you live eg GL52 7

Please write in the box how many years you have lived at this postcode

The questionnaire must be with us no later than the 31 st December 2009.

6

Page 38 Agenda Item 8

Document 2 Executive Summary of Service Improvement Proposal South West Specialised Commissioning Group Specialised Burn Care Services For Adults and Children Gloucestershire PCT South Central Specialised Commissioning Group

Gloucestershire

Health Overview and Scrutiny Committee

Executive Summary of the Service Improvement Proposal for Burn Care Services for Adults and Children

December 2009

Prepared by:

The South West Specialised Commissioning Group on behalf of the South Central Specialised Commissioning Group and Health Commission Wales (to be succeeded by Welsh Health Specialised Services Committee)

S:\Services\0.9 Burn Care Services (all ages)\Designation Documents Nov 2009\HOSC Documents\PCT individual HOSC docs\Glos\Doc 2 Burns Exec Summary General final 08Dec09.doc Page 1 of 7

Page 39 HOSC Briefing – Gloucestershire Document 2 - Executive Summary South West Specialised Commissioning Group South Central Specialised Commissioning Group

1 Executive Summary 1.1 The purpose of the report is to provide information to Health Overview and Scrutiny Committees on the designation of burn care services within the South West UK Burn Care Network. Specifically this summary report sets out how burn care will be improved through the designation of specialised burn care providers, working to offer a full range of specialised burn care services to the population of the Network. 1.2 Our proposals do not involve major change for existing services and will: x Ensure that specialised burn care services comply with National Burn Care Standards; x Ensure patients are treated by the service best able to meet their needs; x Ensure that patients receive the highest quality burn care treatment; x Improve clinical outcomes and survival rates over time; x Establish a new specialised burns service for people in Devon and Cornwall in the South West of England; x Over time, develop models for rehabilitation, outreach and long term follow up that will enable more care to be delivered and accessed nearer to where people live. Table 1 – Summary of designation proposals Provider Adult Child

Morriston Hospital, Swansea Centre; Unit Facility and and Facility Unit Frenchay Hospital, Bristol working jointly with Facility and Centre; Unit Bristol Children’s Hospital until planned transfer of Unit and Facility all specialised children’s services to the Bristol Children’s Hospital is completed

Salisbury District General Hospital, Salisbury Facility and Facility and Unit Unit Derriford Hospital, Plymouth Facility Facility

1.3 A number of factors are taken into consideration in assessing burn injuries including the size or total burn surface area and site of the burn, the depth of skin injury, the age of the patient, the presence of co-existing conditions and other associated injuries e.g. fractures, crush and or penetration injuries.

S:\Services\0.9 Burn Care Services (all ages)\Designation Documents Nov 2009\HOSC Documents\PCT individual HOSC docs\Glos\Doc 2 Burns Exec Summary General final 08Dec09.doc Page 2 of 7

Page 40 HOSC Briefing – Gloucestershire Document 2 - Executive Summary South West Specialised Commissioning Group South Central Specialised Commissioning Group

1.4 Treatment and care involves all members of a multi disciplinary team and can include periods within intensive care, repeated operations, long rehabilitation periods requiring input from nursing, therapists and other specialists such as psychologists and social work. Follow up is often long term involving reconstructive surgery, dressing management, psychological and social support. 1.5 To date, specialised burn care has been provided by three hospitals: x Frenchay Hospital, North Bristol NHS Trust, provides all levels of care for both children and adults, with very complex care for children provided jointly with the Paediatric Intensive Care Service at Bristol Children’s Hospital, University Hospitals Bristol NHS Foundation Trust. x Salisbury District Hospital, Salisbury NHS Foundation Trust provides all levels of care for adults and moderate to severe care for children. However, children with very severe burns and complex care needs have been transferred to Bristol under a local agreement between the two providers within the last 12 months. x Morriston Hospital, Swansea, Abertawe Bro Morgannwg University NHS Trust provides all levels of care for adults and children. 1.6 Thankfully, the numbers of severe and very severe burn injuries is small with evidence to suggest that these numbers are decreasing over time. Between January 2006 and December 2008, just 28 adults and 9 children sustained a burn injury identified as complex, across the whole Network which serves 10 million people. 1.7 The model of service set out in the National Burn Care Review (2001) identified three levels of care:

Centre

Units

Facilities

GP, A&E Minor Injuries

x Facility – caring for minor to moderate burn injuries x Unit – caring for moderate to severe burn injuries x Centre – caring for the most severe and complex injuries

S:\Services\0.9 Burn Care Services (all ages)\Designation Documents Nov 2009\HOSC Documents\PCT individual HOSC docs\Glos\Doc 2 Burns Exec Summary General final 08Dec09.doc Page 3 of 7

Page 41 HOSC Briefing – Gloucestershire Document 2 - Executive Summary South West Specialised Commissioning Group South Central Specialised Commissioning Group

1.8 Our proposals involve the formal designation of four specialised burn care providers, including the designation of a new provider, to deliver the three levels of care identified above, for the South West UK Burn Care Network. The service providers will work together as a network of services using agreed patient transfer thresholds to assess patients and identify those with complex injuries, ensuring that they are treated and cared for by the service that can best meet their needs. 1.9 Our proposals do not involve major change for existing services and will establish a new specialised burn care service at Derriford Hospital in Plymouth to serve Devon and Cornwall in the South West of England. A very small number of adult patients (between 10 and 20 per year) will transfer to Swansea in Wales for their care from the South West and South Central areas of the Network and an even smaller number of children (less than 5 per year) will transfer from Wales to Bristol for their specialist care. The rationale underpinning our designation proposals is as follows: Adults 1.10 All three providers Swansea, Bristol and Salisbury have highly dedicated and well developed multi-disciplinary teams providing specialised burn care. Each of the providers met the standards to varying levels with no provider meeting them all. 1.11 Swansea has the best quality physical infrastructure and resources, since all elements of care are located within a dedicated unit, including wards, theatres, intensive care and rehabilitation. 1.12 The infrastructure and physical lay out of services at Frenchay Hospital, in Bristol, is such that wards, theatres and intensive care are not located near to each other. In particular, there is a long distance between wards/theatres and intensive care through corridors which are unheated due to the number of access points along their length. Not all of the theatres are dedicated or located together which requires the team to manage logistical issues not present in Swansea and Salisbury. Generally the estate is older. While it is noted that this does not necessarily impact adversely on patient care, more modern and better designed infrastructure helps clinical teams control and reduce infection rates and work efficiently. 1.13 Salisbury has good quality physical resources, with thermally regulated ward beds, but limited intensive care capacity, with only one cubicle available, not ring fenced to burns. They do not have the same logistical challenges as Bristol. 1.14 All of the teams demonstrated good team working but Swansea was able to demonstrate the strongest care pathway management and team coordination. Swansea also had the strongest governance arrangements, including audit and research of the three adult services.

S:\Services\0.9 Burn Care Services (all ages)\Designation Documents Nov 2009\HOSC Documents\PCT individual HOSC docs\Glos\Doc 2 Burns Exec Summary General final 08Dec09.doc Page 4 of 7

Page 42 HOSC Briefing – Gloucestershire Document 2 - Executive Summary South West Specialised Commissioning Group South Central Specialised Commissioning Group

1.15 Overall, the provider that achieves the closest compliance with standards for providing burns centre level care is the Morriston Hospital at Swansea, Abertawe Bro Morgannwg University NHS Trust. Children 1.16 All three current providers, Swansea, Bristol and Salisbury have highly dedicated and well developed multi-disciplinary teams providing specialised burn care for children. Each of the teams has made progress since the last assessment on staff training but further work is required in all of the services to be designated in order to ensure all staff are fully trained in burn care as well as looking after children, including safeguarding. This is very important within burn care as sadly some injuries to children are not accidental. 1.17 One of the key burn care standards relating to the treatment of severe and complex burn injuries in children is that the burn service is co-located with Paediatric Intensive Care (PICU). This standard is further supported by more recent guidance set out under the Commissioning Safe and Sustainable Specialised Paediatric Services. 1.18 Over time there has been debate about how many Centre level services should be designated within England and Wales. The Commissioning Bodies for the South West, South Central and South Wales supported the South West UK Burn Care Network to argue strongly with the National Burn Care Group that there should be one paediatric burn care centre in each Network and this has been supported. 1.19 Within the South West UK Burn Care Network only Bristol has the capability to achieve compliance with the standards. Although not yet co-located with PICU which is located at the Children’s Hospital in Bristol, the burn service at Frenchay does have a high specification High Dependency Unit and joint working arrangements with PICU with specialist burn staff available on the ward while the child requires support from PICU. 1.20 Bristol has a well established PICU retrieval team and formal agreements have now been reached between Bristol and Wales to enable Bristol to be formally designated to lead retrieval of patients from Wales. 1.21 In the Bristol Health Services Plan all specialist children’s services will be transferred to the Bristol Children’s Hospital and detailed planning is now underway with a view to this work being completed in 2014. At this point the paediatric burn care service will be fully compliant with burn care standards for children. In the interim period commissioners and the Network will continue to review the joint working arrangements and clinical outcomes to ensure the highest quality services for children. 1.22 All services require further work in terms of ensuring all staff looking after children are trained in recognising their needs and deliver care in a way that is appropriate for children as well as ensuring their safety.

S:\Services\0.9 Burn Care Services (all ages)\Designation Documents Nov 2009\HOSC Documents\PCT individual HOSC docs\Glos\Doc 2 Burns Exec Summary General final 08Dec09.doc Page 5 of 7

Page 43 HOSC Briefing – Gloucestershire Document 2 - Executive Summary South West Specialised Commissioning Group South Central Specialised Commissioning Group

1.23 Further work is required to develop comprehensive and fully coordinated outreach and follow up services for children. Plymouth - Children and adults 1.24 The Plymouth plastic surgery service has conducted a self assessment against the burns standards, which demonstrated that most of the components required to comply with Facility level standards are in place but that work within the service is needed to meet the standards in full. The Network views the establishment of a burns Facility in the Peninsula as a positive development as it will reduce the number of journeys to burns units for injuries that could be treated at Facility level. Key issues relating to patient and public views 1.25 The key messages from the patient and public engagement process are that patients and their families think that expertise and good outcomes are the most important aspects of care and have stated that they are willing to travel longer distances for very specialised care, if necessary. However, if they do have to be treated a long way from their home, they want it to be easy for their friends and family to visit. 1.26 The work undertaken shows that travel times for patient transport, via ambulance, in the acute phase of treatment is acceptable at any of the sites. Bristol is the most central location. However, travel times and the logistics of journeys for patients and their families that do not live near to services, will be significant for any of the service providers, especially for people using public transport. However, as stated above patients have indicated that they are prepared to travel longer distances for very specialised care and the number of patients involved is small. 1.27 There are already good support services and resources in place for families and other visitors and commissioners will use the information provided by patients and the public through this process to further improve them. In addition, the Network will develop more locally based and coordinated outreach and follow up services to further streamline services. In Summary The expected benefits from the proposed service improvements are: 1.28 Assurance that specialised burn care services comply with National Burn Care Standards, and where they do not identification of action plans to address them; 1.29 Implementation of patient transfer and referral thresholds that will ensure that patients are treated by the service best able to meet their needs; treatment by specialist teams that are experienced in the most complex care management; 1.30 Fewer patients having to travel out of Devon and Cornwall for specialised burn care treatment;

S:\Services\0.9 Burn Care Services (all ages)\Designation Documents Nov 2009\HOSC Documents\PCT individual HOSC docs\Glos\Doc 2 Burns Exec Summary General final 08Dec09.doc Page 6 of 7

Page 44 HOSC Briefing – Gloucestershire Document 2 - Executive Summary South West Specialised Commissioning Group South Central Specialised Commissioning Group

1.31 Excellent patient care and support to families and other carers through identification of a key worker for each patient, support to families where patients are being cared for a significant distance from their home and long term commitment to maintaining links with patients groups; continued involvement from patients and families in improving services; 1.32 Maintenance and further development of skills and expertise within all services through clinical teams working flexibly and supporting each other; 1.33 Improved clinical outcomes and survival rates over time, through continued audit of clinical outcomes, other forms of reflection on best practice as well as training and education of specialist teams and referring services such as Accident and Emergency Departments; 1.34 Development over the next two years of models for rehabilitation, outreach and long term follow up that will enable more care to be delivered/accessed nearer to where people live; 1.35 A more systematic approach to contributing to strategies to prevent burns within local communities; 1.36 Assurance that designated services are sustainable over time; 1.37 Management and coordination of burns services and work across teams to strengthen services and patient care through the South West Burn Care Network. Concluding statement 1.38 The designation proposals for burns services will help to achieve improved services for patients with burn injuries and their families for around 10 million people ensuring that people with burns that need specialised treatment will be able to access the expert care they need whilst ensuring as much care as possible is delivered as close to where people live. We hope that our partners across the Network will support these proposals, enabling us to implement the new arrangements formally by April 2010.

S:\Services\0.9 Burn Care Services (all ages)\Designation Documents Nov 2009\HOSC Documents\PCT individual HOSC docs\Glos\Doc 2 Burns Exec Summary General final 08Dec09.doc Page 7 of 7

Page 45 This page is intentionally left blank

Page 46 Agenda Item 9

Gloucestershire Health, Community and Care Overview and Scrutiny Committee

18 January 2010

Health and Social Care Projects Update January 2010

NHS Gloucestershire is undertaking a number of capital projects across the County. An update on each project is given below. Each of the projects is at a different stage of development and the current stage is described below. For information, the planning processes used by the NHS move through the following stages to ensure that cases are robust. This framework is flexible and there is often overlap between the different stages to secure more rapid delivery:

• Strategic Outline Case (SOC) – a broad outline of the strategic case for change is described and a basic feasibility study (clinical and economic) is carried out. • Outline Business Case (OBC) – the case is developed further with detailed analysis of the needs of the local population; a clear description of the service model and a strong case demonstrating financial (capital and revenue) implications and affordability • Full Business Case (FBC) – the final stage of planning (often rapidly after the OBC) where outstanding issues are firmed up and the implementation plan is confirmed.

1

Page 47 Berkeley Vale In September 2006 a Strategic Outline Case (SOC) was approved by NHS Gloucestershire’s predecessor organisation, Cotswold and Vale PC, following public consultation and support from the Health Overview and Scrutiny Committee (HOSC) as part of the Future of Healthcare in Gloucestershire consultation, which took place from 12 June 2006 to 4 September 2006. The capital funding for the development was awarded from the national Community Hospital Fund in December 2007.

An Outline Business Case (OBC) was prepared, which identified the preferred option to be the development of all proposed services on one site in Dursley. The OBC was approved on 24th September 2009. The site selected via the Options Appraisal Process with key stakeholders was on the Littlecombe development.

The Berkeley Vale locality is a distinct geographical area within the Stroud and Berkeley Vale Practice Based Commissioning cluster (PbC). It encompasses the populations of the towns of Berkeley, Cam, Dursley, Wotton-under-Edge and surrounding villages. The population served is estimated to be 37,570 (January 2009) and is approximately 32% of the total population served by the PbC cluster.

The proposed development scheme comprises a new community health and care resource facility with car parking, in a new, fully landscaped setting. The services that will be provided within the proposals include:

• 20 inpatient sub-acute beds, providing local people with support through direct admission from the local community in Berkeley Vale, as well as transfers for active rehabilitation following an acute episode of care in another hospital; • an extended range of community therapy services; • an extended range of outpatient services; • re-provision of MIU facilities currently provided from Berkeley Hospital to include extended range of treatment and assessment services; • a range of fixed diagnostic services including X-ray in addition to facilities for mobile diagnostic services, such as an MRI scanner; • single point of access for integrated health and social care teams, which will work across the hospital and community based facilities and services; and • provision of facilities for suitable voluntary care services.

Both the Strategic Outline Case and Outline Business Case demonstrated that the condition and suitability of the Berkeley Hospital building is considered to compromise the standard of care and the delivery of NHS targets. There are particular concerns in relation to:

• privacy and dignity for patients, • full compliance with the Disability Discrimination Act in all areas; • reducing infection rates; • ensuring a suitable working environment for staff, • the estimated cost of backlog maintenance is £691,000; and • delivery of environmental and sustainability targets.

2

Page 48

The existing Sandpits Clinic building suffers from issues of poor access and the inability to meet required care standards for the future in old, expensive- to-maintain buildings. It is estimated that the cost of backlog maintenance is £103,000.

Services currently available at Sandpits will be relocated to the new health and care resource facility.

NHSG has established an overarching service model which is interpreted locally to provide Locality Service Models. It will address the service quality and efficiency gains needed to ensure continued improvement in the health of local people whilst living within a much tighter financial position.

Development Milestones

Full Business Case Draft to SHA Capital Group 24/12/09 NHS G Board Approval 28/01/10 SHA Capital group Approval 18/02/10 SHA Board Approval 18/03/10 Planning Permission Submit planning application 28/11/09 Approval 03/03/10 S106 29/03/10 Judicial review 03/06/10 Procurement OJEU advert 28/09/09 Tender period completed 26/02/10 Tender evaluation completed 12/03/09 Contract decision 26/03/10 Award contract 30/03/10 Construction Start on site 10/06/10 Construction completed 02/09/11 Fitting out commences 05/09/11 Completion 30/09/11 Commissioning Operational commissioning completed 21/10/11 Staff training completed 28/10/11 Final move completed 11/11/11 Decommissioning and disposal Site disposal completed 31/03/12 Post project evaluation First stage evaluation 11/11/12 Second stage evaluation 11/11/13

Community and Staff Engagement The locality Project Participation Group (PPG) is at the heart of the communication and engagement process. This group supports the development of the proposals for the locality and provides a useful sounding-

3

Page 49 board for community opinion. The PPG reports to the Project Steering Group. Its membership includes: LINk representatives, local elected representatives, third sector partners, Village Agents, service users and the League of Friends as well as local GPs and health and social care staff representatives. This Group provides a local network for Patient and Public Involvement and Communication and will continue to provide support through the life of the project. It will also form the basis of longer term engagement and participation in this locality to continue the review and development of local services for local people.

On-going communication and engagement with the public and staff in relation to this development have been key to sharing and developing the service model and has been achieved through the Participation Group, newsletters, staff briefings, public participation events and workshops. Information about the proposed development has been set out in the regular community newsletter ‘Community Involvement News’ and through NHS Gloucestershire’s website and intranet.

Next Steps The Full Business Case was submitted to the Strategic Health Authority in December 2009 and will be presented to the NHS Gloucestershire Board at their meeting on 28 January 2010. The planning application has been submitted to the Stroud District Council for consideration.

4

Page 50 Cheltenham NHS Gloucestershire’s Strategic Plan ‘Achieving Excellence’ refers to the ten community hospitals in Gloucestershire and the long-standing history in the communities they serve. They are designed to serve wider rural populations in a large county with poor transport links to the main acute hospitals in Gloucester and Cheltenham. A review of the existing hospitals was conducted to ensure they could meet or be supported to meet a service model, service principles and essential environmental standards. As a result of the review changes are being made, in line with the PCT’s service model.

In line with the Excellence Strategy and the community hospital review, it was decided that work for the residents of Cheltenham would focus on community hospital type facilities and would be undertaken to consider how best people’s needs could be met for patients who are currently accessing community beds in Tewkesbury and other Community Hospitals. A consideration is also to reduce the level and length of stay of inpatient episodes in Cheltenham General Hospital.

A team, including representatives from the Cheltenham Practice Based Commissioning (PbC) Clusters has been established to work through a number of options and care pathways with a view to producing service model solutions for further (cost) evaluation. This will be presented in due course to the NHSG Board for further deliberation.

5

Page 51 Gloucester Community Hospital

Background A Strategic Outline Case to develop a community hospital for Gloucester was presented to and received support from the NHS Gloucestershire Board in November 2007. The opportunity arose to purchase the building known as Holly House from 2gether Foundation Trust. A detailed Full Business Case was submitted to, and approved by, the Board in November 2008 for NHS Gloucestershire to acquire ownership of Holly House and following some remodelling and refurbishment, convert this into a Community Hospital for Gloucester. The property ownership transferred at the end of March 2009 and continues to be used by the 2gether Foundation Trust utilising a lease agreement until they move their service for older people to the new Charlton Lane development in Cheltenham in May/June 2010.

NHS Gloucestershire is to establish a 28 - 30 bedded (number of beds to be confirmed at final design stage) community hospital to meet the needs of Gloucester residents. The new community hospital in Gloucester will provide a locally accessible community based health service for local residents not requiring an acute setting and needing clinical care for pathways such as rehabilitation, sub-acute care or palliative care as well as for medical day treatments.

Service Outline The inpatient facility will provide a high quality, personalised, responsive, efficient and effective service for patients. A Clinical Service Provider will be appointed using a full Official Journal of the European Union (OJEU) procurement process and will be responsible for all aspects of the clinical care and support services within the community hospital. A Medical Provider will be appointed under a separate contract and this procurement process has already commenced. The Clinical Service and Medical Service providers will be jointly responsible for delivery of the principles outlined in the business case, as follows:

• Provide a service which enhances the patient experience, improves choice and provides positive outcomes • Provide a fully integrated service that links with community and primary care based teams across health and social care • Provide an increased focus on proactive management, particularly of long-term conditions.

The aims of the service are to:

• Provide a locally accessible community service to adults who require an inpatient stay, but do not require the specialist facilities of a District General Hospital • Provide care closer to home for patients who require rehabilitation, medical acute care or palliative care • Provide individual patients with a high quality, efficient, effective and safe service that meets their needs • Provide an integrated service, where practitioners and organisations work together for the benefit of the patient and their family

6

Page 52 • Promote independence and wellbeing • Provide an alternative to and minimise admissions to an acute hospital, either by direct admission, or by enabling people to “step down” from acute hospitals in an appropriate and timely manner.

Procurement The procurement for the medical service contract commenced in December 2009 and has been advertised to GP practices and NHS organisations within the whole of Gloucestershire. The procurement for the Clinical Service Provider will start in January 2010 utilising a full OJEU process. The Design Team has been appointed and will work up a building specification in readiness for appointment of a contractor to commence June or July 2010.

• Medical Service Contract: - Memorandum of Information e-mailed to all GP practices plus the three NHS Providers in the County on 4 December 2009 - Tender presentations/interviews will take place week commencing 15 March 2010 - Doctor(s) will be appointed with 6-month implementation time to enable involvement in developing patient pathways, expanding expertise in community hospital working, liaising with acute sector and social care services, etc. prior to taking up full post when facility open

• Clinical Service Contract: - Official Journal of the European Union (OJEU), Supply2Health and Health Service Journal advert to go out beginning of January 2010. Award of tender will be at June 2010 Board - Provider will have 6-7 months implementation time whilst building work progresses

• Design Team Appointments: - Design Team appointments have been made and initial meeting taken place in December 2009. The Team will develop room layout plans and develop detailed building specification - Building contractor to be appointed and be ready to commence works by beginning of July 2010

Community Engagement An Engagement Strategy has been established that sets out the vision for local engagement. It builds on the principle that we believe staff, patients, the public and partner organisations (stakeholders) should have a voice in how NHS and Social Care services are designed, developed and delivered in Gloucestershire.

There is increasing recognition that a high quality health service is one which is both organised around and responsive to the needs of the people who use it. To this end patients and the public must have genuine opportunities for involvement in decisions about their own care and the way that services are delivered.

7

Page 53 It is important that we work hard with our stakeholders and their representatives to explain and build the case for change based on clinical and patient benefits, and to do so in a language that can be understood by all. A Patient and Public Involvement Group has been established and meets regularly to oversee local engagement with the project. Its membership includes: LINk representatives, local elected representatives, voluntary and community partners, and existing service users. It is intended that the group will assist with roadshows and promotional meetings across Gloucester to raise awareness of and assist with communication about the new community hospital.

Project Specific Key Messages: • Gloucester has never had a community hospital and therefore our initial messaging should help people understand the community hospital concept. • The current facility will be refurbished to offer a vibrant community facility that will care for people in a clean, safe and modern environment. • The proposed community hospital will provide up to 30 beds which could be used to deliver a range of diagnostic and rehabilitation services as suggested in the Business Case (see appendix 1) • The range of services will be restricted by the practicalities of physical space, but given advances in medical technology and practice a greater number of people can be safely looked after in a non acute setting, such as a community hospital. • We will involve local people and staff in shaping the development of the new community hospital and where appropriate the services it provides. • We will work with the local community to develop community pride.

A sub-group of the PPI Group has met to consider evaluation criteria and appropriate questions to be included in the procurement documentation relating to the quality and person-centred aspects of the new community hospital. Bidders for the Clinical Service will present to a Stakeholder Group, including members of the PPI Group, as part of the interview process.

Timescales 2gether Foundation Trust is now indicating there has been some slippage on the Charlton Lane development so vacating of Holly House is estimated as end June 2010. We are currently estimating a 6-month build programme with opening of the new Community Hospital early 2011.

8

Page 54 North Cotswolds The Locality Service Model for North Cotswolds is based on a model of care providing more services closer to home, modern community facilities and extended rehabilitation that is consistent with national and local policies. The Service Model was subject to consultation and presented to HOSC and the predecessor PCT Board in September 2006. Following the award of central funding from the Community Hospitals Capital Fund and approval of the Strategic Outline Case, detailed work was progressed to develop the Outline Business Case and approval was received from the PCT Board in January 2009 and from the SHA Capital Investment Group and Board in September 2009.

The capital development will focus on provision of a new community hospital in Moreton-in-Marsh to provide 22 inpatient semi-acute beds, a minor injuries unit, a range of consultant, specialist nurse and therapy led outpatient services, range of therapy services and a base for health and social care community staff. In addition, the re-provision of premises for two local GP practices will be co-located on the same site. In Bourton-on-the-Water there will be refurbishment and further development of the outpatient and therapy services unit; and intermediate care beds will be commissioned in partnership with Social Services, from a not-for-profit provider.

Following detailed work on the technical appraisals of a number of short-listed sites, an Option Agreement to purchase, subject to planning, has been secured on land to the west of the A429 Fosse Way adjacent to the Fosse Way Garden Centre. Detailed Planning Application was submitted for the development on the Fosse Way site on 2 December 2009.

In order to ensure deliverability of the service model and to see early step changes in ways of working; health and social care staff, the project team (which includes representatives from the local community) and GPs in the Commissioning Cluster have been working in partnership to take forward the new models of care and care pathways. The plan is to develop the service model in staged priorities (immediate, near future and longer term) to enable the new ways of working to be implemented in a managed way.

Full Business Case The Full Business Case (FBC) sets out the final investment proposal for the re-provision of services in the Community Hospital at Moreton-in-Marsh. As described above, the Community Hospital development forms part of a wider programme of service redesign to deliver more local, modernised health and social care services for the population of North Cotswolds, in facilities that are fit for purpose.

The FBC has been prepared to enable the respective boards of NHS Gloucestershire (NHSG) and NHS South West (SHA) to make a final decision on whether to proceed with the proposed investment and associated organisational changes. The FBC therefore provides: • An assessment of any fundamental changes (including the wider policy context) to the proposal since the submission of the approved Outline Business Case (OBC);

9

Page 55 • Refinement of the proposal since the Outline Business Case including final details on the comprehensive redesign of services together with the required range, volume and capacity of services; • Details on the productivity and resilience of the services plan and the revenue implications for commissioners and providers; • Final design and development plans together with the proposed contractual arrangements for building and operating the facilities; • An assessment of the value for money and the capital and revenue affordability of the proposal; • Arrangements put in place to ensure that the project is delivered successfully, including change management, transition and contingency plans and final project management arrangements, risk management plans and a programme for ensuring that all identified benefits of the proposal are secured.

Scope of the development: The service developments specifically addressed in the FBC concern the proposed re-provision of the Community Hospital at Moreton-in-Marsh: • 22 inpatient sub-acute beds, providing local people with support through direct admission from the local community, as well as transfers for active rehabilitation following an acute episode of care in another hospital; • an extended range and volume of community therapy services; • an extended range and volume of outpatient services; • re-provision of MIU facilities currently provided from the existing Moreton Community Hospital; • a range of fixed diagnostic services including x-ray and ultrasound in addition to facilities for future provision of mobile diagnostic services (such as an MRI scanner) and near patient testing; • improved team working across hospital and community based (in- reach) health and social care teams, supported by appropriate facilities and services; • provision of facilities for suitable voluntary care services; • improved working between primary care and hospital and community based services through the co-location of local GP practice facilities on the site of the proposed new Community Hospital (through a separately funded but parallel development).

Development milestones FBC Draft to SHA Capital Group 24/12/09 NHSG Board Approval 28/01/10 SHA Capital group Approval 18/02/10 SHA Board Approval 18/03/10 Planning Permission Submit planning application 02/12/09 Approval 03/03/10 S106 29/03/10 Judicial review 03/06/10

10

Page 56

Development milestones Procurement OJEU advert 28/09/09 Tender period completed 26/02/10 Tender evaluation completed 12/03/09 Contract decision 26/03/10 Award contract 30/03/10 Construction Start on site 10/06/10 Construction completed 02/09/11 Fitting out commences 05/09/11 Completion 30/09/11 Commissioning Operational commissioning completed 21/10/11 Staff training completed 28/10/11 Final move completed 11/11/11 Decommissioning and disposal Site disposal completed 31/03/12 Post project evaluation First stage evaluation 11/11/12 Second stage evaluation 11/11/13

Consultation and public engagement associated with the development of the FBC: There has been continuing engagement with the users and the local public through the well established engagement arrangements described below. Given that the proposals have not fundamentally changed since the OBC, no formal consultation during the preparation of the FBC has been necessary.

A Project Participation Group (PPG) was established early on in the life of the Project. Its membership includes: LINk representatives, local elected representatives, third sector partners, Village Agents, service users and the League of Friends as well as local GPs and health and social care staff representatives. Through the engagement process, the PPG members have contributed to the development of the service model and have been involved in the design of the new hospital. Furthermore the following key issues have been identified and addressed: • The "design principles" in terms of the ethos of a welcoming entrance and clear understandable signposting, • Provision of a "community office" in the central waiting area where patient support or information groups could share use and could include organisations like Mencap or MIND, Parkinsons Society, MS Society, community transport, etc.

Arrangements for ongoing patient/public involvement: On-going communication and engagement with the public and staff in relation to this development have been key to sharing and developing the service model and has been achieved through the PPG. The use of newsletters, staff briefings, public participation events and workshops has been essential and rewarding in terms of engagement. 11

Page 57

Information about the proposed development has been set out in the regular community newsletter ‘Community Involvement News’ and through NHS Gloucestershire’s website and intranet.

We have achieved good engagement and positive and constructive responses to the capital and service developments that are planned. We will continue to actively involve our Participation Group and the wider community as the project moves forward.

12

Page 58 Standish

NHS Gloucestershire is the owner of land at the former Standish Hospital site. The site comprises 12.89 ha (31.87 acres) and is located in the Stroud District area. The Sherbourne family made the site, with house, stables, outbuildings and extensive grounds, available for use as a Red Cross Military Hospital in 1915 and in 1922, as part of a death duties deal, it was given to the County Council. Subsequently, it became part of the portfolio of NHS hospitals when the NHS was created in 1948, and was used primarily as a TB hospital and then an orthopaedic hospital. The hospital was closed in 2004 and services moved to the Gloucestershire Royal Hospital site as part of a major redevelopment.

Before this closure, a community group secured funding from the Department of Health to prepare a business case for a Health Mutual on the site – Standish Mutual Care (SMC), which proposed a range of health and other services for the site including supported living accommodation. However, in 2006 the Department of Health began negotiations with an independent sector organisation with the intention of selling the land for the potential development of secure accommodation.

In October 2007 this sale was suspended temporarily by the Department of Health in order to allow NHS Gloucestershire to consider other options for the site and potential for transfer of the ownership. The PCT was required to submit its plans for the site and the services it intended to commission. The NHS Gloucestershire Board agreed to support an outline business case for the development of a “Continuing Health and Social Care Community Campus” at Standish on 31 July 2008. Support for these plans was required from the Strategic Health Authority, which was subsequently given. The site passed into the ownership of NHS Gloucestershire on 1st April 2009. There is considerable support for the proposed service vision within the local community, which wants the site to be used to benefit the people of Gloucestershire. Proposed facilities would include:

• A care home with its own range of on-site facilities – to include specialist dementia care and short stay places for people with complex physical needs • A resource centre • A range of accessible, barrier free communal facilities in which to meet, undertake activities and pursue interests • Suitable facilities for staff • Provision of facilities such as a shop, laundry, hairdresser and a restaurant, provided that they are commercially viable and ancillary to the primary use of the site • Transportation and road links with the wider community • Development of the grounds to enhance the existing natural environment and provide opportunities for residents to be involved in gardening and growing produce • Sustainable resource infrastructure • Accommodation – Fully self-contained units with kitchen and bathroom facilities that support and empower people with a range of needs and disabilities

13

Page 59

Key milestones Dates Publish OJEU Notice February 2010 Closing date for Expressions of Interest April 2010 Final evaluation and selection of preferred bidder January 2011 Board approval March 2011 Contract award April 2011

Community and staff engagement A New Standish Community Involvement Group (NSCIG) meets regularly and has set up a community Blog page to be populated with information on the development. The Stroud GP Commissioning Cluster has been updated on progress and is keen to be involved to ensure the demand on health services are managed proactively and with sensitivity. Standish will offer diverse opportunities for social interaction, community life, involvement, participation in activities and interests, and will provide individuals with support to take part if they need it.

People from the wider locality will be encouraged to take part in and contribute to community life at Standish. This is particularly important given that Standish is physically separated from the nearest large community of Stonehouse by approximately 1/4mile. In-reach and outreach services and facilities along with good transport links and a sense of local ownership will be important to ensure the development remains a vibrant part of the wider community.

Current position The former Standish Hospital site is located within Stroud District Council. It is outside the settlement boundaries defined on the approved Stroud District Local Plan. A certificate of established (lawful) use was obtained by the Department of Health planning consultants, which confirmed that the primary use of the site had been as a hospital. Discussions have taken place with the Stroud District Council regarding concerns on planning land use issues. There is an understanding that dwellings on site will be for people who have some form of health or social care needs.

It is anticipated that to achieve a successful planning consent for a Continuing Health and Social Care Community on the Standish site, a series of safeguards will need to be put in place. This is to reassure the Planning Authorities at Stroud District Council, the County Council and the regional office of the Department of Environment, that the primary objective of the Community is to deliver ongoing health and social care which is focussed upon meeting the varied needs of people from the local Stroud and Gloucestershire communities. The proposed development should be able to contribute to meeting central government planning guidance in PPS1 Delivering Sustainable Development; PPS3 Housing; PPG15 Planning and the Historic Environment.

Next steps • Agreement from Stroud District Council on the specification for the planned development. • OJEU procurement process begins.

14

Page 60 Tewkesbury

A Strategic Outline Case (SOC) for a replacement community hospital for Tewkesbury, incorporating Primary Care facilities, was previously supported by the NHS Gloucestershire Trust Board in March 2009. The SOC was developed in collaboration with the Tewkesbury Practice Based Commissioning (PbC) Cluster, local staff and the public, and received support from other partners in the Gloucestershire Health economy, including the Gloucestershire Hospitals NHS Foundation Trust and 2gether NHS Foundation Trust.

The SOC included details of a new model of health and social care and proposed that the new services would be provided in a new community hospital, co-located alongside new GP premises, together with enhanced community services using new skills and technologies to support more people to live at home.

The three Tewkesbury GP practices (Church Street Practice, Jesmond House Practice and Watledge Surgery) have prepared a plan for the development of new integrated Tewkesbury GP Premises. This development is in line with the PCT’s Primary Care Development plan and has received approval from the Estates Board. The GPs have a clear vision to develop high quality innovative models of care from the new facilities rather than merely replicating the current service in new facilities. The benefits from the shared site would provide the opportunity for change which is not achievable in the current split location situation. The new service modelling will result in increased productivity, efficiency and improved patient outcomes.

The PCT, working with local stakeholders, particularly Practice Based Commissioners, has reviewed the proposed project set out in the SOC in the context both of national and regional policy guidance and of local strategies and priorities. An in depth review and assessment of the scope of the services and facilities required to serve the people of Tewkesbury and surrounding areas was undertaken for the Outline Business Case (OBC). The OBC acknowledges that:

• The existing GP premises are crowded and not fit for purpose in terms of increasing service provision

• The existing Community Hospital and GP premises lack resilience to flooding

• The current hospital is no longer fit for purpose and cannot deliver the future commissioning intentions of the PCT as efficiently or effectively as is possible. Whilst well supported by the local GPs it is physically disconnected from primary care. The long-term aim is for integrated health and social care community services that can meet the majority of needs for patients and their carers from Tewkesbury and surrounding areas.

15

Page 61 In summary, the new developments will provide accommodation for the following:

In-patient and rehabilitation services • In ‐patient facilities for the prevention of unnecessary admissions to acute hospitals and supporting early discharge • In-patient and day rehabilitation and therapies

Ambulatory care - day treatment, diagnostic, out patients and urgent care • Out ‐patient facilities • Radio ‐diagnostics (including hard ‐standing for mobile CT, MR and Mammography units) • Day treatment such as chemotherapy and blood transfusions • GP Out of Hours • Minor Injuries Unit/urgent care centre

Theatre and endoscopy • Day surgery and day diagnostics such as endoscopy

Community services • Integrated adult health and social care teams • Podiatry

Support facilities • Administration • Training and education • Hotel services • Central staff facilities

The changes to in-patient, out-patient and diagnostic capacity and activity is commensurate with the projected growth and demographic changes in the catchment population for the hospital and the aim of reducing the need for people to travel to more remote acute hospitals for diagnosis and treatment.

The Outline Business Case was supported by the NHS Gloucestershire Board in December 2009. The project team are now developing the Full Business Case

Key milestones Completion OBC Approved by Board November 2009 OBC Approved by NHS South West March 2010 Funding and Procurement rationalisation December 2010 Full Planning Permission December 2010 Design and Planning December 2010 Full Business Case June 2010 Construction December 2012 Commissioning January 2013

16

Page 62 Community and Staff Engagement

A locality Project Participation Group (PPG) has been established to assist with the engagement and communication for the project. Its membership includes: LINk representatives, local elected representatives, community and voluntary sector partners, local business representatives, service users and the League of Friends as well as local GPs and health and social care staff representatives. This Group will continue to provide a local network and support for Patient and Public Involvement and Communication during the development of the FBC and throughout the life of the project.

Information about the proposed development has been set out in the regular community newsletter ‘Community Involvement News’ and through NHS Gloucestershire’s website and intranet.

17

Page 63 This page is intentionally left blank

Page 64 Agenda Item 10

NHS Gloucestershire Health, Community and Care Overview and Scrutiny Committee (HCCOSC)

Performance Report January 2010

1. Introduction

This report will provide the HCCOSC with an overview of NHSG’s performance towards achieving key NHS targets.

2. Performance 2009/10 Operating Framework Key Deliverables

2.1 Cleanliness and Healthcare Associated Infections

2.1.1 MRSA: Monitoring the annual number of MRSA bloodstream infections at less than half the number in 2003/04 – maximum of 18 in Gloucestershire (VSA01).

The MRSA target has been reduced from the target set in 2007/08 to a maximum of 15 identified cases for 2009/10. To date 8 cases of MRSA Bacteraemia have been identified against a maximum target of 9 cases year to date. Two of these positive samples are thought to be blood culture contaminants as a result of poor aseptic technique when taking blood cultures. The policy has been reviewed and re- iterated to all staff within Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT).

2.1.2 Clostridium difficile (C Diff) to deliver a 30% reduction nationally by 2011, compared to the 2007/08 baseline figure (VSA03).

The performance data in Appendix 1 shows that levels of Clostridium Difficile (C Diff) are within expected levels. The graph below shows all C Diff cases attributable to Gloucestershire patients regardless of location or date of test. This demonstrates the progress made in reducing C Diff infections for the residents of Gloucestershire.

Page 65

Total number of C Diff cases attributable to Gloucestershire patients 2007/08; 2008/09 and 2009/10

140

120

100

80 2007/08 2008/09 60 2009/10 40

20

0

y y y ber ber ber April May June Jul gust u em March A October Januar ept Novem Februar S Decem

2.2 Improving Access

2.2.1 Referral to Treatment (RTT). By December 2008, 90% of patients will be seen within 18 weeks for admitted patients and 95% for non-admitted patients (i.e. those patients whose intervention is completed within an out- patient setting). (VSA04)

The 18 week RTT targets have been consistently met at an aggregated level across all specialties throughout this year. The targets were also met at a specialty level with the exception of Orthopaedics admitted patient pathways where 83% of patients were seen within 18 weeks during August, improving to 87.1% in September.

As previously reported, Orthopaedics is recognised as a pressurised speciality and in addressing the orthopaedic waiting times, two main areas are being considered:

• demand management in primary care; and • capacity planning in the acute sector.

Page 66

Capacity Planning in the Acute Sector • The UKSH facility at Emerson’s Green opened on Monday 2 nd November 2009, so is incorporated into the choice of providers offered to patients. • Patients currently on orthopaedic waiting lists with GHNHSFT are being offered the choice of an alternative provider. • A letter has been sent to all GPs advising them of the Patient Choice Initiative. • There will be a focus on newly referred patients and these will be screened with clinical input.

Capacity Planning - Intensive Support Team (IST) • The Department of Health IST is supporting a full work programme with GHNHSFT to address key issues impacting on achieving 18 week Referral to Treatment (RTT).

Demand Management - Musculoskeletal Services (MSK) • An implementation plan has been developed to ensure the MSK service commences in Gloucester and Forest of Dean as of mid January 2010. • Alongside this development, service specifications across the county for MSK services are to be developed within existing contracts to start in April 2010.

2.2.2 Cancer Wait Times

All Cancers: two week wait: a maximum two week wait from an urgent GP referral for suspected cancer to date first seen for suspected cancers

All Cancers: two month urgent referral to treatment: the NHS Plan set the ultimate goal that no patient should wait more than two months (62 days) from a GP urgent referral for suspected cancer to the beginning of treatment, except for good clinical reasons.

The 2 week target performance is below plan, with 89.9% of patients seen within the timescale compared to an expectation of 93%. GHNHSFT are revising recording

Page 67

methodology in line with national guidance, this will ensure an improvement in performance against target.

The 62 day target performance has improved during August and September and is now above plan with 85.2% and 85.4% of patients seen within the expected target of 85% during August and September respectively. This gives a cumulative performance of 82.6% year-to-date (April – September).

Please note the Department of Health has amended the cancer targets; the attached Scorecard (Appendix 1) now incorporates these changes.

• 2 week target from 93.3% to 93% • 31 day target – first treatment from 97.5% to 96% • 62 day target from 84.7% to 85%

3. Delivery of National Targets for the Healthcare Commission Annual Check

The existing national targets remain in place as identified in 2007/08. Progress against these national targets where there is a risk to delivery in 2009/10 is detailed below:

3.1 4 Hour A&E Target

This target requires that at least 98% of patients spend 4 hours or less in any type of A&E from arrival to admission, transfer or discharge from January 2005 onwards.

Across the Health Community, 97.6% of patients were seen within 4 hours in September and 97.8% in October and year- to-date have achieved 97.9%.

The following is an update on actions since the last HCCOSC meeting.

• Weekly Director and Chief Executive meetings continue to take place to review issues impacting on urgent care performance. All healthcare agencies are represented.

Page 68

• A survey was conducted by NHSG to understand the reasons for attendance at GRH. The results indicated that a significant number of people who attend the department live within a seven minute travel time and have had the injury/illness in excess of 24 hours. As a result a targeted communications plan has been developed. Leaflets have been distributed to four GL postcodes within Gloucester City.

• GPs have been recruited to work in A&E at GRH during peak times to manage patients who present with a primary care issue, which will relieve demand on acute physicians.

• Attendance information is being shared with practice based commissioning clusters with the expectation that they will develop plans to provide care closer to home.

3.2 Great Western Ambulance Service (GWAS) Response Times – Cat A 8, Cat A 19 and Cat B response times

Cat A 8 (call connect) – all ambulance trusts to respond to 75% of Category A calls within 8 minutes. This measure became active in April 2008 and replaced the previous Cat A 8 measure.

Cat A 19 – all ambulance trusts to respond to 95% of category A calls within 19 minutes after the request has been made for transport.

Cat B 19 – All ambulance trusts to respond to 95% of category B calls within 19 minutes.

Target performance for the Cat A8 standard is 75%. September has seen sustainment in performance by GWAS of 75.8%, although October saw a drop in performance to 74.7%. This gives a cumulative performance year-to-date (April – October) of 75.4% for GWAS (although the Gloucestershire position individually is 73.7%).

Page 69

Target performance for the Cat A19 standard is 95%. Performance in the months of September and October was 95.7% and 95.2% respectively, with year to date (April - October) performance above target at 95.6%.

Target performance for the Cat B19 standard is 95%. Performance for the month of September for these calls was 92.1%, however, there was a 2.4% drop in performance for October at 89.7% which gives a cumulative year to date performance figure of 91.8% (although the Gloucestershire position individually is 93.6%).

GWAS are implementing the following actions:

• An additional 25 paramedics have been appointed and commenced in service on the 1 November 2009 and plans are in place for a second tranche of recruitment in January 2010.

• A new Urgent Care Clinical desk is in place as of 16 November 2009, supported by five urgent care vehicles that are tasked to manage Category B and GP Urgent Calls.

• Additional co-responder schemes will be coming on line between now and the end of December 2009 in Gloucestershire; the schemes are targeted at the more rural areas within the County.

3.3 Percentage of the population aged 15 - 24 screened or tested for Chlamydia

Based on the local trajectory for the period April to September 8.5% of the target population were screened or tested for Chlamydia, which was below the plan of 11.8%. Care Services are on target to deliver the number of screens projected in 2009/10. The expected screens through the GP and Pharmacy Local Enhanced Service (LES) by year end is 6,075, however, current trajectories indicate we may not be able to achieve this level. The service plans to improve screening through GPs and Pharmacies during the remainder of the financial year. Alongside this a remedial action plan

Page 70

has been agreed in which the service will contract 3,000 screens through an outreach programme in December.

4.0 2009/10 Performance against Operating Framework

As part of the 2009/10 Operating Framework, NHSG committed to publish performance against expectation for those ambitions where there are concerns if the target will under-achieve within the financial year.

4.1 95% of High Risk Blockages of the Carotid Artery will be Operated on within 72 hours of Diagnosis

Currently approximately only 75% of high risk blockages undergo operation within two weeks. Although, additional TIA (Transient ischemic attack) clinic capacity is planned from January 2010, performance against this target is likely to remain red for some time due to having vascular services set-up across both sites. There is a plan to merge all GHNHSFT vascular services onto a single site. This would facilitate the availability of one dedicated vascular surgeon and vascular theatre to provide urgent endarterectomy (remove the lining of an artery restoring normal blood flow) within 48-72 hours for those patients presenting with a TIA.

5.0 Care Quality Commission Assessment (CQC) 2008/09

The overall CQC performance rating for PCTs is made up of two elements:

• Quality of financial management, which looks at how effectively a trust manages its financial resources. • Quality of commissioning, which is an aggregated score of performance against core standards, existing commitments and national priorities.

Both elements are assigned a rating of weak, fair, good or excellent.

Based on the CQC assessment for 2008/09, NHSG received a rating of ‘fair’ for quality of commissioning and ‘good’ for financial management (maintaining financial performance from 2007/08).

Page 71

Due to changes in the mechanisms for assessing the quality of commissioning our score is not directly comparable to previous years.

The data in Appendix 2 shows a breakdown of the quality of commissioning performance indicators, with a comparison to previous years. An in year assessment of 2009/10 as at September 2009 has been included. This shows there has already been an improvement in performance compared to the 2008/09 assessment. Appendix 3 shows the comparison of PCT results across the South West, as well as the scores within the Gloucestershire Health Community.

6.0 Appendices

Appendix 1 – Performance Scorecard – this provides trend data on the key targets, plus all targets where there is a risk to delivery. Appendix 2 – NHS CQC Assessment 2008/09 and in year assessment of 2009/10 Appendix 3 – CQC Assessment 2008/09: Gloucestershire Health Community and SHA

Page 72 Gloucestershire PCT Performance scorecard 2009/10

Principal Delivery Targets Target 2009 April 2009 May June2009 2009 July August2009 September2009 2009 October November2009 December2009 January2010 February2010 2010 March Performance Performance Measured Year to Date to Year EndYear Target ACCESS Referral to Treatment Target 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% CQC Admitted Pathways - Adjusted % in 18 Weeks M 90.0% Actual 90.4% 90.8% 91.3% 91.9% 92.0% 92.2% 91.4% Target 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% CQC Non-Admitted Pathways - Adjusted % in 18 Weeks M 95.0% Actual 96.6% 97.4% 97.3% 97.0% 97.1% 96.8% 97.1% Target 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% CQC Direct access audiology pathways seen within 18 Weeks M 95.0% Actual 99.5% 98.0% 99.4% 99.2% 99.0% 99.0% Cancer Number of Breaches 111 70 126 100 101 93 601 CQC 2 week Target (93% target) C 93.3% % Performance 88.2% 91.4% 86.5% 89.7% 87.5% 89.9% 88.9% Number of Breaches 3 2 2 2 6 2 17 CQC 31 Day Target (96% target) C 97.5% % Performance 97.9% 98.6% 98.6% 98.7% 97.5% 99.0% 98.4% Number of Breaches 24 20 15 22 17 13 111 CQC 62 Day Target (85% target) C 84.7% % Performance 81.3% 78.5% 84.4% 80.7% 85.2% 85.4% 82.6% Accident & Emergency (A&E) Target 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% CQC 4-hour A&E target (Total health community) C 98% Actual % 96.6% 98.7% 97.8% 98.6% 98.0% 97.6% 97.8% 97.9% Great Western Ambulance Service (GWAS) Target 75% 75% 75% 75% 75% 75% 75% 75% 75% 75% 75% 75% 75% CQC Cat A 8 min response C 75% Actual 75.9% 76.9% 75.7% 72.7% 75.9% 75.8% 74.7% 75.4%

Page 73 Target 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% CQC Cat A 19 min response C 95% Actual 95.9% 96.4% 95.7% 95.3% 95.5% 95.7% 95.2% 95.7% Target 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% CQC Cat B 19 min response C 95% Actual 92.3% 92.9% 92.3% 91.0% 91.7% 92.1% 89.7% 91.7% IMPROVING THE HEALTH OF THE POPULATION Smoking Cessation Target 274 548 772 1,044 1,298 1,524 1,830 2,080 2,311 2,680 2,980 3,305 1,298 CQC Number of 4-week smoking quitters C 3,305 Actual 246 484 933 1,060 1,358 1,358 HEALTHCARE INFECTIONS Methicillin Resistant Staphylococcus Aureus (MRSA) Target 2 1 2 1 2 1 1 1 1 1 1 1 9 Vital Sign Number of MRSA infections C 15 Actual 1 0 1 0 3 3 8 Clostridium Difficile (C.Diff) Number of C Diff infections (GHNHSFT) excl. positive samples Target (per month) 22 20 14 14 14 14 14 15 15 16 16 18 98 CQC C 192 within 48 hours of admission : Provider Actual (per month) 14 14 6 14 18 6 72 Number of total C Diff infections (Commissioner activity - includes Target (per month) 50 48 41 41 41 41 41 42 42 45 48 52 262 CQC C 388 GHNHSFT, community hospitals and out of county hospitals) Actual (per month) 35 32 18 37 43 22 187 Genito-Urinary Medicine (GUM) Target 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% CQC % offered service within 48 hours C 100% Actual 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Percentage of the population aged 15 - 24 screened or tested for Target 1.5% 3.5% 5.8% 7.7% 9.7% 11.8% 13.8% 15.9% 18.1% 20.4% 22.7% 25.0% 11.8% CQC C 25% chlamydia Actual 1.3% 2.5% 4.0% 100.0% 6.7% 8.5% 8.5%

The Care Quality Commission (CQC) thresholds have been used to set the Key to 'performance measured' Red, Green and Amber boundaries M = assessed on the latest month position as year end target is a March snap shot C = assessed on cumulative actual performance against the annual plan

C:\moderngov\Data\AgendaItemDocs\5\2\8\AI00000825\AgendaItem10Appendix1PerformanceScorecard1801100.xls This page is intentionally left blank

Page 74 Appendix 2 NHS Gloucestershire Annual Health Check Assessment 2008/09 Including 2009/10 6 Month Self-Assessment

Annual Health Check Assessment Summary

2009/ 10 2008/09 2007/08 2006/07

Quality of Commissioning Fair Previous years’ quality ratings for PCTs are not directly comparable Quality of Financial Good Good Fair Management

Components of Quality of Services Page 75 Core Standards Almost Previous years’ quality Met ratings for PCTs are not directly comparable Existing Commitments Almost Partly Met Almost Partly Met Met/Fully Met Met National Priorities Good/ Good Good Weak Excellent

Core Standards There are two areas of insufficient assurance for core standards in 2008/09 within C04B – Safe Use of Medical Devices and C04d – Medicines Management.

Targ et 2009/10 2008/09 2007/08 2006/07 Comments Expected Appendix 2 Position Safe Use of Medical Compliant Not met Insufficient Compliant Action plan in place within Care Devices Assurance Services to rectify non- compliance incorporating: • Robust medical devices policy and • Robust training regime for medical devices Care Services will have made an interim declaration on the SfBH

For 2009/10 this will be measured through WCC.

Page 76 Medicines Compliant Not met Compliant Compliant The action plan for compliance Management was completed in June 2008. NHS Gloucestershire Care Services will be compliant for 2009/10.

Existing National Targets These are the targets which relate to the 2003 to 2006 planning round and are therefore expected to be maintenance rather than development.

In year assessment for 2009/10 has been based upon performance as at Month 6 (April to September 2009). In order to assess achievement level, the thresholds for 2008/09 have been used, and therefore are subject to change.

Target 2009/10 2008/09 2007/08 2006/07 Comments Apr–Sep Total time in A&E: 4 hours Under Under Achieved Achieved As reported to the Board, Appendix 2 Target 2009/10 2008/09 2007/08 2006/07 Comments Apr–Sep or less Achieved Achieved action plans remain in 97.95% 97.1% place for ensuring a sustainable performance with A&E is achieved.

It is anticipated that performance will continue to improve against this target. All ambulance trusts to Achieved Failed Under Under Based on Apr-Sept 2009 respond to 75% of category 75.4% 71.2% Achieved Achieved performance target would

Page 77 A calls within 8 minutes. be achieved. An action plan to sustain performance is in place and reported to Board. All ambulance trusts to Achieved Under Under Under Based on Apr-Sept 2009 respond to 95% of category 95.6% Achieved Achieved Achieved performance target would A calls within 19 minutes 93.9% be achieved. An action after the request has been plan to sustain made for transport. performance is in place and reported to Board. All ambulance trusts to Under Under Under Under Whilst an improvement respond to 95% of category Achieved Achieved Achieved achieved has been seen from B calls within 19 minutes. 91.8% 87.2% 2008/09, based on the position Apr-Sept 2009, this target would still be under achieved. Action plans to improve Appendix 2 Target 2009/10 2008/09 2007/08 2006/07 Comments Apr–Sep performance are regularly reported to Board. Maintain a three month Achieved Achieved Achieved Achieved No patients waiting in maximum wait for 0% 0% excess of 3 months for revascularisation. revascularisation. Commissioning of Crisis Achieved Achieved Achieved Achieved Resolution/Home Treatment Projected 1206 1214 Deliver a ten percentage Under Failed Under Under Based on the 2008/09 point increase per year in Achieved 44% Achieved Achieved thresholds, we will be the proportion of people 54.5% under-achieved for

Page 78 suffering from a heart attack 2009/10, although who receive thrombolysis performance has within 60 minutes of calling improved. Numbers are for professional help. low for Apr-Sept 2009 (11patients), if numbers remain below 20 patients for the entire year, then this measure will not be counted for 2009/10.

There is an action plan in place which includes increasing the age range for the cohort of patients eligible for thrombolysis. Maintain delayed transfers Achieved Achieved Achieved Achieved of care at a minimal level. 2.6 2.85 Appendix 2 Target 2009/10 2008/09 2007/08 2006/07 Comments Apr–Sep People with diabetes to be Achieved Achieved Achieved Achieved Performance achieved for offered screening for the 103.2% 102.1% Apr-Sept 2009. early detection of diabetic retinopathy. Maintain a maximum wait of Achieved Achieved Achieved Achieved No breaches 26 weeks for inpatients. 0 0 Maintain a maximum wait of Achieved Achieved Achieved Achieved No breaches 13 weeks for an outpatient 0 0 appointment. Access to GUM clinics Achieved Achieved Not Not Performance levels have 100% 100% Applicable Applicable dropped

Page 79 Data quality on ethnic group Under Under Not Not Concerns have been Achieved Achieved Applicable Applicable flagged in the GHNHSFT 76.8% 84.4% Performance Sub Group. Action plan is under development. Commissioning of Early Achieved Achieved Not Not Our target for 2009/10 Intervention of Psychosis Projected 108 Applicable Applicable remains at 70 cases per 70 year which is projected to be achieved.

National Priorities These targets were identified during the Department of Health’s 2008-2011 planning round.

Target 2009/10 2008/09 2007/08 2006/07 Comments Apr–Sep Guaranteed access to a No data Achieved Under Achieved This indicator is currently primary care available Achieved under development for Appendix 2 Target 2009/10 2008/09 2007/08 2006/07 Comments Apr–Sep professional within 24 2009/10, following a hours and to a primary change in the indicator care doctor within 48 methodology. hours. Data is expected to be based on the national GP survey of patients (selected questions) which will become available January 2010. Substantially reduce No data Achieved Achieved Achieved As reported to the Board

Page 80 mortality rates by 2010 available previously, an action plan from cancer is in place to ensure a downward trend in mortality rates is sustained. Breast Cancer No data Achieved Achieved Achieved Annual figure – Screening available measured over a 3 year period Breast Feeding Achieved Achieved Achieved Achieved Initiation 49.4% 35% Reduce the under-18 No data Achieved Achieved Achieved Annual figure conception rate by available 2010, as part of a broader strategy to improve sexual health. Chlamydia Screening Under Achieved Failed Under Based upon year to date Achieved 17% Achieved position, target is at risk Appendix 2 Target 2009/10 2008/09 2007/08 2006/07 Comments Apr–Sep of under-achievement. Recovery trajectories are undergoing validation to meet target. Experience of Patients No data Satisfactory Satisfactory Satisfactory Annual survey available Increase the Achieved Achieved Achieved Failed This data is a snap-shot participation of problem 1,855 1,859 taken at May 2009. drug users in drug treatment programmes by 2008; and increase

Page 81 year on year the proportion of users successfully sustaining or completing treatment programmes. Incidence of C.Difficile Achieved Achieved Not Not September figure is Projected 522 Applicable Applicable currently 187. Straight 374 projection suggests we will remain within target. All age all cause No data Achieved Not Not Annual figure mortality available Applicable Applicable CVD mortality rates No data Achieved Achieved Achieved Annual figure available Commissioning CAMHS Achieved Under Not Not Marked at 12 out of 16 14 Achieved Applicable Applicable 2008-09. Now at 14 out 12 of 16. Would be achieved, based on Appendix 2 Target 2009/10 2008/09 2007/08 2006/07 Comments Apr–Sep 2008-09 threshold. Immunisation No data Achieved Not Not Data is submitted available Applicable Applicable annually. Halt the rise in obesity No data Data not Achieved Achieved This is a measure of the among children by available returned number of children who 2010, as part of a have had their height and broader strategy to weight recorded. The tackle obesity in the percentage measured population as a whole. should be 85% or higher of eligible children in the 2 age groups.

Page 82 Stroke Care Achieved Under Not Not 61% Achieved Applicable Applicable 46% Ensure that by 2008 Achieved Achieved Under Under Admitted Pathways nobody waits more than Admitted Admitted Achieved Achieved target of 90% has been 18 weeks from GP 92.2% 90.8% achieved Apr-Sept 2009 referral to hospital Non- Non- at 92.2%. treatment. Admitted Admitted 96.8% 95.6% Non-Admitted Pathways target of 95% has also been achieved Apr-Sept 2009 at 96.8%.

Reduce adult smoking Achieved Achieved Achieved Failed August figure is currently rates by 2010. Projected 3,530 1,358 which is 60 above 3,305 target. Projection suggests we will achieve Appendix 2 Target 2009/10 2008/09 2007/08 2006/07 Comments Apr–Sep target. Access to Primary No data Under Not Not This indicator is currently Dental Services available Achieved Applicable Applicable under development for 222,344 2009/10, following a change in the indicator methodology.

Maintain a maximum Achieved Achieved Achieved Achieved waiting time of one 98.3% 99.8% month from diagnosis to treatment for all

Page 83 cancers. Pregnant women: 12 No data Under Not Not The definitions have week appointment available Achieved Applicable Applicable changed materially for 2 2009/10. There are no thresholds to score against. We continue to work with both GHNHSFT and NHSG Care Services to improve all elements of this indicator. Maintain a two week No data Achieved Achieved Achieved As previously reported to maximum wait from available the Board, recording urgent GP referral to methodology is under first outpatient review in line with appointment for all national guidance. Due urgent suspected to the impact, the result Appendix 2 Target 2009/10 2008/09 2007/08 2006/07 Comments Apr–Sep cancer referrals. of this will have an effect on performance, it is not possible to accurately assess achievement at this stage. Maintain a maximum No data Achieved Achieved Achieved As previously reported to waiting time of two available the Board, recording months from urgent methodology is under referral to treatment for review in line with all cancers. national guidance. Due to the impact, the result

Page 84 of this will have an effect on performance, it is not possible to accurately assess achievement at this stage. NHS staff satisfaction No data Under Not Not Annual Survey data available Achieved Applicable Applicable

Appendix 3 Care Quality Commission Assessment 2008/09 Summary of Results Comparison of PCT results across the South West

Somerset NHS Devon NHS NHS Bristol NHS NHS Dorset NHS NHS Swindon NHS NHS Wiltshire NHS NHS Somerset NHS Torbay Care PCT Care Torbay NHS Gloucestershire NHS NHS NorthSomerset NHS NHS BathNorthEast & NHS NHS Plymouth Teaching NHS Page 85 NHS Bournemouth Poole & NHS NHS SouthGloucestershire NHS

Scilly Cornwall of Isles & NHS Quality of Good Excellent Good Fair Good Good Fair Good Good Good Good Good Good Fair Commissioning Meeting Core Almost Fully met Fully Partly Almost Fully Almost Ful ly Almost Fully Almost Almost Fully Fully Standards met met met met met met met met met met met met met Existing Almost Fully met Almost Fully Fully Fully Partly Almost Fully Fully Almost Almost Almost Almost Commitments met met met met met met met met met met met met met National Good Excellent Good Good Good Good Good Good Good Good Good Good Excellent Fair Priorities Quality of Good Good Good Good Fair Good Good Good Fair Good Fair Good Good Fair Financial Management

Note: Quality of commissioning is an overall score derived from: - Meeting core standards; Existing commitments and National Priorities. Appendix 3 Care Quality Commission Assessment 2008/09 Summary of Results

Gloucestershire Health Community Results

Great 2gether NHS Western NHS Foundation Ambulance Gloucestershire GHNHSFT Trust Service Quality of Services - provider N/A Good Excellent Weak

Quality of Commissioning Fair N/A N/A N/A Meeting Core Standards Almost met Almost met Fully met Almost met Page 86 Existing Commitments Partly met Almost met Excellent Not met

National Priorities Good Excellent N/a Weak

Quality of Financial Good Good Excellent Fair Management

Agenda Item 12

HEALTH, COMMUNITY & CARE SCRUTINY COMMITTEE

Date: 18 th January 2010

Report Title : Outcome of the Annual Performance Assessment of Adult Social Care Services.

Purpose of Report : To present the findings of the Care Quality Commission’s 2008/09 Performance Assessment of the County Council’s Adult Social Care Services.

Relevant Policy or Strategy: The assessment covers all aspects of the Council’s Adult Social Care Services.

When last seen by Scrutiny and outcome(s): The 2007/08 Performance Assessment was considered by the County Council’s Budget And Performance Scrutiny Committee in March and July 2009.

Officer Contact: Mark Branton - Director of Strategic Commissioning and Performance. Tel: (01452) 425105 E-mail: [email protected]

Background

Since its inception on the 1 st April 2009, the Care Quality Commission has taken over from the Commission for Social Care Inspection, responsibility for undertaken an annual performance assessment of all Council’s with Adult Social Care responsibilities. The assessment, as indicated below, is against the seven outcomes set out within Our Health, Our Care, Our Say plus a written assessment relating to Leadership and Commissioning and Use of Resources.

The full summary report is attached as an annex to this report but in terms of the seven outcomes, the judgements are:

Delivering Outcomes Assessment

Overall - The Council is performing: Well

Outcome 1: Improved health The council is performing: and emotional well-being Well

Outcome 2: Improved quality of life The council is performing: Well

Page 87

Outcome 3: Making a positive contribution The council is performing: Well

Outcome 4: Increased choice and control The council is performing: Adequately

Outcome 5: Freedom from discrimination and The council is performing: harassment Well

Outcome 6: Economic well-being The council is performing: Well

Outcome 7: Maintaining personal dignity and The council is performing: respect Adequately

In relation to the assessment for Leadership Commissioning the report comments that Gloucestershire’s council leaders and senior officers understand the challenges which the council will face in years to come. The council has made considerable progress in taking forward Putting People First, the Government’s initiative to reshape and modernise adult social services. The council works well with its partners particularly with Gloucestershire Primary Care Trust. This means people are increasingly likely to experience services which are joined up. It is also investing in and developing the capacity of the voluntary sector. This is leading to cost effective services run by local organisations who understand people’s needs.

For commissioning and Use of Resources, it notes that the council involves people using services and carers when developing and commissioning services. It has demonstrated competence in planning and commissioning services and has demonstrated an effective working relationship with service providers. It has worked creatively with Gloucestershire Care Providers Association to raise the quality of care services. It has provided funding so that established providers can support those who are struggling and took robust action through its contracting arrangements to improve the quality of care it purchased on behalf of people.

Mark Branton,

Director of Strategic Commissioning and Performance.

Page 88 Annual Performance Assessment Report 2008/2009

Adult Social Care Services

Council Name: Gloucestershire This report is a summary of the performance of how the council promotes adult social care outcomes for people in the council area. The overall grade for performance is combined from the grades given for the individual outcomes. There is a brief description below – see Grading for Adult Social Care Outcomes 2008/09 in the Performance Assessment Guide web address below, for more detail.

Poorly performing – not delivering the minimum requirements for people Performing adequately – only delivering the minimum requirements for people Performing well – consistently delivering above the minimum requirements for people Performing excellently- overall delivering well above the minimum requirements for people

We also make a written assessment about Leadership and Commissioning and use of resources Information on these additional areas can be found in the outcomes framework To see the outcomes framework please go to our web site: Outcomes framework You will also find an explanation of terms used in the report in the glossary on the web site.

Delivering Outcomes Assessment Overall Gloucestershire council is performing: Well

Outcome 1: Improved health and emotional well–being The council is performing: Well

Outcome 2: Improved quality of life The council is performing: Well

Outcome 3: Making a positive contribution The council is performing: Well

Outcome 4: Increased choice and control The council is performing: Adequately

Page 1 of 10

Page 89 Outcome 5: Freedom from discrimination and harassment The council is performing: Well

Outcome 6: Economic well-being The council is performing: Well

Outcome 7: Maintaining personal dignity and respect The council is performing: Adequately

Click on titles above to view a text summary of the outcome.

Assessment of Leadership and Commissioning and use of resources

Leadership

Gloucestershire’s council leaders and senior officers understand the challenges, which the council will face in years to come. They have anticipated the impact of having an increasingly elderly population and having less money to spend. They have responded to these with a programme called Building our Future. This aims to provide affordable, efficient and flexible services to meet the needs of people living in Gloucestershire.

The council has made considerable progress in taking forward Putting People First, the Government’s initiative to reshape and modernise adult social services. The council has worked very closely with people who use services, carers, the voluntary and private sectors in developing a blueprint for service delivery. The council is now ready to begin implementing the changes required to transform services.

The council works well with its partners particularly with Gloucestershire Primary Care Trust. This means people are increasingly likely to experience services which are joined up. It is also investing in and developing the capacity of the voluntary sector. This is leading to cost effective services run by local organisations who understand people’s needs.

The council has a well structured business planning process. This translates high level corporate vision into detailed, department level plans. This ensures plans are coordinated and good intentions are put into practice.

The council has good performance management systems. These enable it to identify areas where attention is required and help managers monitor projects and development plans.

The council maintains Investors in People accreditation and provides good development and training opportunities for both its staff and staff working in the independent sector. This means people in Gloucestershire are served by a competent workforce. The council needs to ensure that its workforce plan ensures there are enough staff to meet the needs of people requiring help, particularly people with learning disabilities.

Commissioning and use of resources

The council involves people using services and carers when developing and commissioning services. It has demonstrated competence in planning and commissioning services. A good example is the Big Plan, a recently produced strategic vision for people with learning disabilities. Page 2 of 10

Page 90 This provides a comprehensive analysis of the needs of people with learning disabilities in Gloucestershire. It picks up on areas which require attention and takes account of the latest policy and research in respect of people with learning disabilities. The council needs to ensure that partner agencies are fully included in such plans and that there is an effective analysis of future demand. In the past this has been an issue in respect of young people with disabilities who are moving across to adult services.

The council has good financial management systems and is aware of areas where there are budget pressures. For example it is changing how services are provided for people with learning disabilities in order to reduce the costs associated with residential care at the same time as enabling people to have greater independence.

It has been a pioneer in the development of the fair pricing tool for residential care for people with learning disabilities.

The council has demonstrated an effective working relationship with service providers. It has worked creatively with Gloucestershire Care Providers Association to raise the quality of care services. It has provided funding so that established providers can support those who are struggling.

In the past there has been serious concern about the quality of some of the care homes the council has used. In 2008/2009 the council took robust action through its contracting arrangements to improve the quality of care it purchased on behalf of people.

Page 3 of 10

Page 91 Summary of Performance

The assessment for 2007/8 downgraded Gloucestershire’s performance in respect of adult social care. In addition there was an inspection of services for people with learning disabilities. This concluded that the delivery of personalised services for people with learning disabilities was adequate and the council's safeguarding arrangements were poor.

Following an exchange of views, the commission’s judgements were accepted. The council has responded positively to the concerns identified both in last year's assessment and in the inspection of services for people with learning disabilities and as a result there has been general improvement.

In particular the council commissioned an independent review of its safeguarding arrangements. It has put in place a new safeguarding board, revised its operational procedures and required more effective engagement from its partner agencies. Similarly, the recently published strategy for people with learning disabilities addresses a number of the recommendations from both last year's performance assessment and the inspection of learning disability services.

Brief overview of performance.

Gloucestershire’s performance is a mixed picture. There are areas where the council is doing particularly well and where there is evidence that the council has been innovative, resulting in improved outcomes for the people living in Gloucestershire. There are other areas where the council needs to make improvements.

In terms of strengths, Gloucestershire County Council is good at engaging and reaching out to people. There are strong representative forums in place and village and community agents have been effective in working in rural and minority ethnic communities. The council has used participation officers to support people who might find it harder to have a voice in council affairs.

The council has improved the quality of life for many older people. The council has used the money and opportunities provided by the Partnership for Older People Project to improve the quality of life for the more vulnerable older people, particularly those living in care homes.

The council has increased its support to carers and has successfully introduced the carers’ emergency card scheme.

There are also areas where the council needs to improve. These are particularly in respect of providing good quality information and timely assessments. In 2008/2009 people had difficulty in making contact with the council’s helpdesk and there have been delays in providing assessments. These are areas that the council is addressing.

Page 4 of 10

Page 92 Outcome 1: Improved health and emotional well–being

The council is performing: Well

What the council does well.

In Gloucestershire people are benefiting from a wide range of initiatives which have been pursued by both the council and primary care trust. These include the use of health improvement facilitators in local communities, programmes to reduce weight, work to prevent older people having falls and encouraging activity for older people in care homes. People with learning disabilities are benefiting from having health action plans and additional support from their local GPs.

The council pioneered a village agent scheme to provide people living in rural communities with access to advice, support and services. Evaluation of the scheme demonstrated significant benefits and as a result it has become an established project. In addition a community agent scheme has been developed to provide a similar service to hard to reach and black and minority ethnic communities. Initial feedback suggests this new scheme is also proving to be successful.

The council and PCT have put in place a range of services to prevent people going into hospital and to help those people who go into hospital return to the community as soon as they can. Figures show that the council performs well in this area and surveys indicate people are pleased with the service they receive.

The council and the PCT have taken steps to support healthy eating and there is a programme called Gloucestershire Food Vision which provides advice and promotes the importance of having a balanced diet. Attention is being focussed on people who might be at risk of malnutrition, for example older people returning home from hospital. Accredited training has been provided for care home cooks and Age Concern Gloucestershire has recruited Meal Mates to support older people who are in hospital at mealtimes.

The council and PCT have adopted the national end of life strategy. They are focusing on training and rapid access to services to improve the quality of care for people who are dying.

What the council needs to improve. The council and PCT should optimise the working arrangements between enablement and Community Steps services. This would simplify the services and create more flexibility. In the longer term the council and PCT are planning to integrate these two services.

There should be effective monitoring on the take up of health action plans by people with learning disabilities to ensure these are being made available.

Page 5 of 10

Page 93 Outcome 2: Improved quality of life

The council is performing: Well

What the council does well.

Surveys suggest that the council provides a reasonable level of support to help people to live independently. In recent years it has been planning ahead to increase the opportunities for older people to live in extra care accommodation. Marina Court, an extra care scheme, became fully operational during 2008/9. This facility provides support for people living within the scheme and in the wider community.

The council has improved its response in providing equipment and adaptations on time and its performance is better than other councils. The council has also increased the level of telecare provision; this is equipment to support people living at home, for example using community alarms.

Supporting carers has been a priority for the council and PCT. Figures indicate that the council is generally doing well in providing services and advice to carers. There has been particular success with the rollout of the carer’s emergency card, which enables carers to get assistance at times of crisis. This has been really appreciated by carers and described by a carer as a “wonderful relief”. The council is also providing training for carers through the Caring with Confidence project. There have also been projects aimed to support particular groups of carers, for example the Asian Girls Group run by young carers.

There was a very successful carers’ conference in December 2008 which provided the council and PCT with a good opportunity to listen to and understand the needs of carers in Gloucestershire.

What the council needs to improve.

During the year there was an inspection of learning disability services. This concluded that there was little available for people with learning disabilities who were not receiving council funded services. It concluded that in general local services to support people with a learning disability were underdeveloped.

The council needs to ensure that there are universal services in place and be able to demonstrate that these provide opportunities for effective support to a range of people in need.

Outcome 3: Making a positive contribution

The council is performing: Well

What the council does well.

The council has been actively encouraging volunteering. The council funds volunteer centres to promote and support volunteering. The centres provide a matching service between people who want to volunteer and organisations looking for help. There have been some notable successes in the use for volunteers, for example in the archives department which has recruited older people and people with learning disabilities to assist in its work.

Page 6 of 10

Page 94 Gloucestershire has a good tradition of community engagement. The council has a number of long standing forums like the Gloucestershire Service Users Forum through which it involves local people in the development, running and evaluation of its services. The council has provided evidence of services which have been developed and commissioned with the full involvement of local people, for example the new community meals service, direct payments, the carers’ emergency card and advocacy services. The engagement of people using services, carers and community representatives in the development of Putting People First is noteworthy.

The council has a well-developed Local Involvement Network (LINk) which provides opportunities for local people and organisations to be formally represented. This enables there to be effective consultation with a range of public bodies.

The council uses participation officers to make links with, and develop the involvement of particular groups. One example is the participation officer for people with learning disabilities. This person supports a number of local groups across Gloucestershire. These groups provide representatives for Gloucestershire’s Learning Disability Partnership Board. The inspection of services for people with leaning disabilities concluded that although the people valued the support of the participation officer, they were not having a significant impact on council decisions. The council has been addressing this and point to a number of examples of the positive involvement of people learning disabilities in decision making, e.g. the decommissioning of learning disability placements at St Mary’s hospital.

What the council needs to improve.

Given the range of initiatives in place, no areas of improvement have been noted.

Outcome 4: Increased choice and control

The council is performing: Adequately

What the council does well.

People receive good support when contacting the council outside normal office hours. This was the conclusion of the inspection of learning disability services.

The council has made progress in increasing the take up of direct payments. The council has produced a clear and thorough guide for people who wish to use direct payments. This enables people to purchase their own care and have greater choice and control.

The independent mental capacity advocacy service is well established. An evaluation of the service found that it was appreciated by those who used it.

What the council needs to improve.

The quality of information provided by the council to the general public needs to improve and be more accessible. The inspection of services for people with learning disabilities concluded that the quality of information provided by the council was poor and as a result people were not aware of the services available to support them. Gloucestershire’s LINk identified similar issues for older people.

Page 7 of 10

Page 95 The council has upgraded its website and it is undertaking a review of customer literature which will be completed later in 2009. The council has also placed emphasis on providing information to carers and a specific carers’ website has been established.

The responsiveness of the contact centre needs to improve. During 2008/9 there were clearly problems with the service provided by the council’s contact centre. This was partly due to increased demand. As a result people have had to wait a long time to have their call answered and many people have hung up. The council has taken a number of steps to improve the service. More recent figures indicate the performance is improving however this needs to be sustained.

Waiting times for assessments need to be reduced. People requiring assessments have had to wait longer to receive one. There were particular problems for people with learning disabilities and those requiring occupational therapy. During 2008/9 increasing numbers of people were placed on a waiting or pending list for services. This has been a cause of concern. In the future people should receive a more efficient response.

Assessments, care plans and reviews for people with learning disabilities need to be person centred and reflect people’s views and aspirations. The inspection for people with learning disabilities concluded that plans for people with learning disabilities were not written from the point of view of the person concerned. Plans were unclear and did not cover aspects of care and support needed from other agencies. Some people told inspectors that they had not been listened to. There were also concerns about the planning for young people in transition between children’s and adult services.

The council needs to ensure the new pathway for transitions planning are embedded and underpinned by protocol which clarifies the expectations of the different agencies involved. The council needs to ensure that people have good access to support, are able to express their wishes and there is effective planning between health, education and social care for young people’s futures.

Support to carers of people with learning disability needs to improve, with increased availability of assessments and services. Whilst figures indicate that the council performs well in providing carers with assessment and services, the inspection for people with learning disability concluded that carers of people with a learning disability were not well supported. Inspectors found that there were insufficient assessments and not enough opportunities to have breaks.

Comprehensive and responsive advocacy services should be developed and made available. The council has addressed this by increasing investment in advocacy and is putting new contracts in place. The effectiveness of this will need to be evaluated.

Outcome 5: Freedom from discrimination and harassment

The council is performing: Well

What the council does well.

The council’s externally validated self assessment indicates that it has achieved level 4 of the equality standards. This places the council ahead of many other councils and means it has processes in place to promote equality and reduce discrimination.

Page 8 of 10

Page 96 The council has a dedicated equalities team which has promoted a number of initiatives to raise the profile of equality and diversity practice. The council’s equality team has undertaken a number of projects including community-based events in specific ethnic communities. It has also run a programme of fairness and diversity workshops targeted towards care providers in Gloucestershire.

The council’s community agent scheme is particularly noteworthy. This is a pilot project which is being independently evaluated. To date evidence shows that community agents have been able to help a number of vulnerable people in black and ethnic minority communities gain access to services which they would not normally have used.

The council has been a major partner in an initiative to combat hate crime. This has been a cause of concern in some communities.

What the council needs to improve.

The council should check that people who do not meet the criteria for access to services are able to receive access to support and assistance.

Outcome 6: Economic well - being

The council is performing: Well

What the council does well.

The council runs an effective finance and benefits advice service in conjunction with the Department of Work and Pensions. Year on year the team are securing more benefits for the people of Gloucestershire. Many people are offered the opportunity of face to face contact with advisors.

The council has a clear fair charging policy. The website and letters providing information have been improved following feedback from people using services.

Village agents are offering money saving advice to people in rural communities and helping people to gain access to specialist help and grants.

The council has a supported employment service to help people with disabilities gain and sustain employment. There is a fast track service to help people with learning disabilities to become more independent. The inspection of learning disability services concluded that people received good support from Gloucester Industrial Services and commended some of the initiatives undertaken.

What the council needs to improve. The council should check if carers have sufficient support to maintain or return to employment. There was little evidence of support during this year’s assessment although the carers’ card does provide some support.

The funding of continuing care for young people in transition to adult services should be clarified. This was identified as a problem during a review of transition arrangements.

Page 9 of 10

Page 97 Outcome 7: Maintaining personal dignity and respect

The council is performing: Adequately

What the council does well.

The council has undertaken an in depth review of its safeguarding arrangements. Following a critical inspection in 2008 the council brought in external consultancy to assist them to respond to the inspector’s recommendations. As a result a new adult safeguarding board will be established from September 2009. The procedures and training programmes have already been revised.

Gloucestershire has an established central vulnerable adults unit which is a source of advice and support. Its assistance is valued by staff, other agencies and care providers.

The central vulnerable adults unit maintains a register to ensure action is taken in situations where people are at continuing, unmanaged risk. It also holds monthly meetings about specific services to ensure there is action in response to concerns about institutional abuse.

The council has taken swift action to ensure no placements are made in poor services where people may be at risk. It is using its contractual powers to address shortfalls in poor services.

The council has been promoting the use of dementia care mapping as means of improving the quality of care provided to people with dementia and has encouraged the use of dementia link workers within care homes.

What the council needs to improve.

Safeguarding policy and practice has many areas which require substantial improvement. These include: x Effective engagement of other partners including the Police. x Effective governance, oversight and quality control. x Clear linkage with other safeguarding arrangements and wider community safety systems x Clarity and effective operationalisation of procedures x An effective, differentiated training strategy which meets the more complex needs of key staff groups e.g. local managers

Following an independent review these issues are being addressed. An action plan is in place and a new safeguarding board will become operational in September 2009. The procedures have been made clearer and there have been no concerns about the council’s response to safeguarding incidents since October 2008.

Page 10 of 10

Page 98 Agenda Item 15

Healthy Young Minds Matter Task Group

Final Report, December 2009

1. Introduction

1.1 NHS Gloucestershire, with the support of Gloucestershire County Council and the Children and Young People’s Partnership (CYPSP), is making improvements to services for children and young people with emotional and mental health difficulties and their families. These services are currently known as Child and Adolescent Mental Health Services (CAMHS).

The aim is to develop services which identify an individual’s needs and respond early, before they become more serious and complicated. The changes, which are intended to be in place from April 2011, will lead to services that are more joined up and provide a greater range of ways for children, young people and their families to be supported closer to where they live.

The scrutiny committees were invited in March 2009 to consider forming a short time-limited joint working party to engage with NHS Gloucestershire regarding this project, to ensure that the local engagement was comprehensive and inclusive. Due to the election the committees were unable to form anything immediately, and after the election there was a significant delay in determining whether scrutiny wanted to engage with this project. This meant that scrutiny committees missed an opportunity to have early involvement in the development of a service model. This task group was established in October 2009 to examine the involvement work in the early stages of the redesign project. However, there will still be the opportunity to comment on the proposed model and its implementation in the future.

2. Terms of Reference

o To understand the reasons for the redesign of the service

o To satisfy ourselves that the ‘hard-to-reach’ groups have been adequately consulted and engaged and to satisfy ourselves that they will not feel excluded by the new service model once it is implemented.

o To ensure that the services provide value for money, and take into account the views of a wide range of young people.

o To report findings back to the Health, Community and Care Overview and Scrutiny Committee and the Children and Young People Overview and

Page 99 Scrutiny Committee and make recommendations as appropriate to assist the robustness of the commissioning process and eventual outcome.

3. Membership

3.1 The task group was made up of members of the Health, Community and Care Overview and Scrutiny Committee and the Children and Young People Overview and Scrutiny Committee:

Ø Councillor Ron Allen

Ø Councillor Penny Hall

Ø Councillor Jan Lugg

Ø Councillor Shaun Parsons

Ø Councillor Brian Robinson

Ø Councillor Charmian Sheppard

Ø Councillor Duncan Smith

3.2 Councillor Duncan Smith was elected to chair the task group.

4. Methodology

4.1 The task group had a long genesis because the engagement process started at the beginning of the year, and the county council election prevented the scrutiny committees from being involved early on.

4.2 The task group held two meetings, at which the terms of reference were agreed, and the background information which had been provided was discussed. The group also heard from

Ø Linda Uren, Director Commissioning and Partnerships, Children and Young People’s Directorate

Ø Helen Ford, Performance Improvement and Development Manager, NHS Gloucestershire

Ø Caroline Smith, Community Involvement Manager, NHS Gloucestershire

4.3 Members were invited to attend a stakeholder information session on September 29 th . This session comprised an update and overview of the

Page 100 proposed model, and a group discussion about the model. The session was attended largely by staff from Gloucestershire County Council and NHS Gloucestershire who deliver CAMHS services and work with children and young people directly.

4.4 The task-group would like to thank the officers who attended its meetings to share their knowledge. The group would particularly thank Simon Bilous, Head of Commissioning, Children Young People and Maternity and his colleagues, for the briefing to the scrutiny committee chairs and the presentation to stakeholders in September 2009 which provided much of the background information for this review.

4.5 The task group discussed the following documents as part of their research:

o Briefing for Chairs of Children & Young People and Health Overview & Scrutiny Committees – July 2009

o Commissioning Strategy for Emotional Health and Wellbeing of Children & Young People (final version published January 2008)

o Children and Young People’s Plan 2009-12

5. Background to the Service Redesign Project

5.1 A detailed Commissioning Strategy for Emotional Health & Wellbeing of Children & Young People was developed during 2006/07. This was a multi agency project which involved:

o Identifying the needs of the children and young people of Gloucestershire

o Identifying the services and resources currently available and gaps that existed

o Identifying priorities for improvement and development

o Making recommendations for action

5.2 Both the Health and Children & Young People’s Overview and Scrutiny Committees received presentations and reports during the development of the strategy.

5.3 The Strategy identified priority groups of children and young people who are at greater risk of emotional and mental health difficulties. It also identified gaps in certain levels of service provision that needed to be addressed.

Page 101 5.4 Nationally, 10% of all children and young people have emotional difficulties. In Gloucestershire, this equates to approximately 1,200 children. There are around 2,500 children in the county with a Common Assessment Framework (CAF), with services provided by 80 multi-agency groups.

6. Progress to date

6.1 Child and adolescent mental health service provision has improved since 2007. The emotional health and wellbeing of children and young people remains a key priority at both at national and local levels. It is identified as a National Indicator for action as well as remaining in the new Children & Young People’s Plan for 2009-12.

6.2 The current service provision arrangements are restricting the ability to fully implement the local strategy. There are gaps in services and/or in the ways that they work together, for example the links across provision are not effective. The redesign project will result in a tendering route to commission the service into the future.

6.3 NHS Gloucestershire welcomes the continued interest and involvement of the scrutiny committees and hope it will build on earlier engagement. They have proposed that project updates are reported to Health, Community and Care Overview & Scrutiny via the NHS Gloucestershire Chief Executive report.

Page 102 7. Timeline

January 2009 the redesign project announced and communicated to all stakeholders

March 2009 a small working party established to arrange and co-ordinate local engagement for the project

April/May 2009 stakeholder events for clinicians, support staff and parents/carers. Members of the project team visited local groups to listen to their views, particularly groups which reflect the priority groups

July 2009 launch of online questionnaire, based on feedback received during April and May. One version for parents/carers and one for practitioners, asking people to prioritise areas for development as well as general comment and questions

September 2009 stakeholder events held to update stakeholders/parents/carers/public and demonstrate that NHS Gloucestershire listened to the views who contributed earlier

November 2009 Tender process launched, bids invited from service providers

January 2010 Pre-qualification of providers, followed by negotiation

October 2010 Contracts awarded. Service model developed further

April 2011 Launch and implementation of new service

8. Local engagement

8.1 NHS Gloucestershire plans to keep pace with the momentum of the project in terms of consultation by consulting at relevant points, rather than follow a traditional 12 week “formal” consultation model. Local engagement is being coordinated by a working party. Methods have included stakeholder events, school visits, questionnaires with children and the website launch. The focus has been on vulnerable people, Looked After Children, excluded groups, families in crisis, service provision in urban versus rural areas.

8.2 Parent and young people representatives are being encouraged to be involved throughout the process, by taking part in reference groups and involvement in the tendering process. The task group were satisfied that NHS Gloucestershire and Gloucestershire County Council have put a lot of thought

Page 103 into their engagement, and hope that this will be shown in the final service model.

9. The proposed service model

Level 1 - Patients will be seen in a variety of settings

Level 2 – Early support, will include children on the edge of the criteria, with links to the national scheme of improving access to psychological services

Level 3 – This will include multi-disciplinary teams of psychologists and a network of services to support a stepped care approach (inclusion, well-being etc). It will include substance abuse services, youth offending team, higher spectrum autism services. The Learning Disability service will expand to integrate with the Emotional Well- Being service.

Level 3 – Aims to reduce inpatient bed days by 70%.

Page 104 10. Conclusions

10.1 The group praised the engagement which has been carried out to date. Members felt that there has been adequate engagement to this stage of the process. The documentation provided to the task group, to stakeholders at engagement events and made available on the Healthy Young Minds Matter website (www.gloshealthyminds.nhs.uk ) is clear and easy to understand.

10.2 The group agreed that the structure of the new service makes sense, and looks sound from a layman’s perspective.

10.3 A task group involving members from the Health, Community and Care and Children and Young People Overview and Scrutiny Committees is a valid one and should be encouraged.

10.4 The task group agreed that there was little value to be added by reviewing the redesign project further at this stage because there is no opportunity to influence the tender process. The task group therefore makes the following recommendations:

Recommendation 1:

Ø That this group reforms in 12 months time, when the tender process has been completed and the contract has been awarded. This would allow scrutiny to comment on service development, and would allow members to satisfy themselves that the engagement with service users continues to inform this development. The terms of reference will be relevant to any future task group reviewing this project.

Recommendation 2:

Ø That a future task group could also look at all aspects of transition services ( services provided to adolescents as they cross over to adult services); parenting issues and support for adults, as well as support for children; and how support is put in place and how service users, families and care providers respond to the new services (when the service has been running for a few months).

Page 105 This page is intentionally left blank

Page 106