Agenda
Governing Body
Meeting to be held at 2pm on Thursday 28 January 2021 in the Board Room, Sanger House, Brockworth, Gloucester GL3 4FE
AGENDA
No. Item Lead Recommendation
1. Apologies for absence Chair Information
2. Declarations of interest Chair Information
3. Minutes of the Meeting held on Chair Approval 28 November 2019
4. Matters Arising Chair Discussion
Standing Items and Update Reports 5. Public Questions Chair Information
6. Clinical Chair’s Update Report Andy Seymour Information
7. Accountable Officer’s Update Mary Hutton Information Report
8. Performance Report Mark Discussion Walkingshaw & Cath Leech 9. Governing Body Assurance Christina Discussion Framework Gradowski
10. ICS Update Report Mary Hutton & Discussion Ellen Rule 11 Quality Report Marion Discussion Andrews-Evans Items for Approval 12. Forest of Dean Report Ellen Rule Approve
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 1 of 486 Agenda
13. Fit for the Future (FFTF) Output Micky Griffths Approve of Consultation: presentation
Items to Note: 14 Audit and Risk Committee Minutes 15. Primary Care Commissioning Alan Elkin Information Committee Minutes
16. Governance and Quality Julie Clatworthy Information Committee Minutes
17. Any Other Business (AOB) Chair
Date and time of next meeting: Thursday 26 March 2020 at 2pm in Board Room at Sanger House
A recording will be made of this meeting to assist with the preparation of the minutes. This recording will be made on an encrypted device owned by the CCG and will be held securely for a maximum of one week before being deleted.
2 of 486 Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 Tab 1 Item 1. Apologies for absence 1
Verbal
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 3 of 486 Tab 2 Item 2. Declarations of interest
2 Verbal
4 of 486 Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 Tab 2.1 Item 2.1 Declarations of Interest Register
Gloucestershire Clinical Commissioning Group Declarations of Interests Register - Governing Body Members REGISTER OF INTERESTS Name Current Position Relevant Business Interests Interest Type Direct or Date from To Actions Taken to mitigate 2020 Indirect Annual update Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Andrews-Evans Executive Nurse & Vice-Chair of Governors at Tutshill Non-Pecuniary Direct 2004 Present Not involved in decisions Marion Quality Lead C of E Primary School, Tutshill, that could result in Gloucestershire adddiomal services or resources for the school Co - Chair NHSCC Nurses Forum Non -Pecuniary Direct Jun-19 Present Not involved in decisions and member of the NHSCC Board relating to the CCG's membership of NHSCC
Bennett Caroline GP Liasion Lead - GP Partner Cotswold Medical Financial Direct 2005 Present Declare at meetings North Cotswolds Practice inc Dispensing Medication Locality
Member of GDOC which has a Financial Direct 2013 Declare at meetings contract with GHAC
Husband, Robert Orme, is a Indirect Indirect 2005 Present Declare at meetings consultant Anaesthetist, and Intensive Care at Gloucestershire Hospitals NHS Trust Clatworthy Julie Registered Nurse Standing member of Quality Professional Direct 2012 Present Consider and declare as Advisory Committee 2 at NICE appropriate as per CCG (appointed 2012), remunerated for policy expenses. Gloucestershire Health & Care Non financial- Direct Jun-20 Present Consider and declare as Council of Governors (as CCG Professional appropriate as per CCG Representative), from June 2020 policy
Member of GHFT Genomic Professional Direct Apr-20 Present Consider and declare as Medicine Steering Group appropriate as per CCG policy
Covid Vaccination Nurse. Professional and Direct Jan-21 Present Consider and declare as
University Hospitals Coventry & financial appropriate as per CCG Wawickshire NHS FT policy 5 of 486 5 of 2.1 6 of 486 6 of Tab 2.1 Item 2.1 Declarations of Interest Register
Covid Vaccination Nurse, Coventry Professional and Direct Jan-21 Present Consider and declare as & Warwickshire Partnership NHS financial appropriate as per CCG Trust Vaccination Hub policy Covid vaccination Nurse, South Professional and Direct Jan-21 Present Consider and declare as Warwickshire GP Federation financial appropriate as per CCG policy Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Registered Carer for relative with Personal Direct Present Consider and declare as Learning Disabilities and Physical appropriate as per CCG Disabilities policy Davies Joanna Lay Member - PPE Nothing to declare N/A N/A N/A Present Noted
Elkin Alan Lay Member - PPE Nothing to declare Not applicable Not applicable N/A Present None required
Fielder Lawrence GP Liaision Lead - GP Partner - Brunston Practice, Financial professional Direct 2015 May-20 Declare this interest where Forest Locality Gdoc shareholder, appropriate at meetings
Joint Director of Integration Forey Kim Nothing to declare Not applicable Not applicable N/A Present N/A Goodey Helen Director of Primary Nothing to declare Professional Direct Jan-19 Present Non voting member of the Care and Locality Governing Body. Declares Development. Non - this interest at each meeting Voting Director for Gloucestershire Health & Care Trust
Greaves Colin Lay Member - Gloucestershire Hospitals NHS Non-financial Direct 10/1/2016 Present Consider and declare as Governance Foundation Trust Council of professional appropriate as per CCG Governors (as CCG policy Representative), from 1 October
2016 Gwynn Alan GP Liaision Lead - I am a partner at Cirencester Financial professional Direct 2017 Ongoing Declare this interest where South Cotswolds Health Group appropriate at meetings Locality 2.1 Tab 2.1 Item 2.1 Declarations of Interest Register
Financial professional Direct I am a civilian GP contractor for the Ministry of Defence Haynes Will GP Liasion Lead - GP Partner for Hadwen Medical Financial Direct 1996 Present Declare and withdraw for Gloucester City, Chair Practice, which is a dispensing specific conflicts
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing of Musculo-skeletal practice CPG, Member of Audit Committee, Member of GB
Director of Glenvum Pharmacy Financial Direct 1996 Present Declare and withdraw for specific conflicts
Married to Sarah Vestey, Personal Indirect Jun-05 Present Declare and withdraw for Consultant Breast Surgeon at specific conflicts Gloucestershire Hospitals NHS Foundation Trust Hutton Mary Accountable Officer (left Gloucestershire ICS Lead - Financial Direct Aug-17 Present Consider and declare during & re-joined in Nov Gloucestershire CCG is part of the ICS discussions and 2020) STP. decisions
Daughter working for GHC Financial Indirect
Jordan Lesley Secondary Care Dr Anaesthetist at Royal United Non-financial professionalDirect 2000 2020 Declare Employee Royal Hospital, Bath Hospitasl Bath as appropriate
Le Roux Hein GP Liaison Lead / Salaried GP - Churchdown; Financial Feb-18 Present Consider and declare as Deputy Clinical Chair WEAHSN appropriate as per CCG from 5/07/2016 policy
West of England Academic Health Jul-16 Present Consider and declare as
Science Network - Primary Care appropriate as per CCG GP lead (from June 2015) policy 7 of 486 7 of 2.1 8 of 486 8 of Tab 2.1 Item 2.1 Declarations of Interest Register
GP Partner at Churchdown Financial Jul-20 Ongoing Consider and declare as appropriate as per CCG policy
Leech Cath Chief Finance Officer Husband is a Governor at New Personal Indirect 2/13/2018 Present None required College Swindon Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing
Sibling works for London School Personal Indirect 2/1/2020 None required of Hygiene
Sibling works for GHFT within Personal Indirect 2/1/2020 Present None required Clincial Coding Team
Marriner Peter Lay Member - Business Nothing to declare Not applicable Not applicableNot Applicable Present Noted
Miles Will GP Liaision Lead - Cheltenham GDOC (Countywide private Declare at meetings as provider) Part shareholder through appropriate and take
partnership shareholding (in line instruction from the chair
with most GPs in Gloucestershire) Financial Direct 2012 Present whether to participate
CFHCC Ltd (private company that owns and runs St Pauls Medical
Centre) Shareholder and Spouse
is shareholder Company closed
SMS Ltd (private company for any OOHs/locum) Director and Shareholder, spouse also a shareholder Company closed 2.1 Tab 2.1 Item 2.1 Declarations of Interest Register
Rule Ellen Director of Member of the NICE Technology Non-financial Direct, Present Declare and consider during Transformation and Appraisal Committee (Public professional. Personal, Indirect decision making. Interest to Service Redesign Appointment). NICE pay travel Percuniary be declared in any expenses but no remuneration is discussion that is directly received for committee related to committee role at attendance. Husband works as an NICE. Any short term Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing independent contractor for range contract which involves of organisations including direct engagement by any occasionally the NHS. PhD student NHS organization in at Bristol University – participant in Gloucestershire to be research related to PhD topic of approved by the Chair of the health economics and policy, part Audit Committee and the of Bristol Medical School which will CCG Accountable Officer receive funding from a range of prior to acceptance . All organisations to support research research will be subject to including private sector companies full ethics approval and no inked to health and care. data from the CCG will be used without appropriate research permissions being in place.
Scott Sarah GCC Director of Public Parent Governor at Gretton Non-financial Personal Indirect 9/1/2019 Present None required Health Primary School
Seymour Andy Clinical Chair Partner in Aspen Medical Practice Non-financial Direct 5/1/1993 Present Would not take part in professional decisions pertaining to this interest
Practice is member of GP provider Non-financial Direct 2010 Present Would not take part in organisation (Countywide) professional decisions pertaining to this interest
Wife is a Staff Nurse within GHFT Indirect Indirect 2/1/2015 Present Would not take part in
decisions pertaining to this interest 9 of 486 9 of 2.1 10 of 486 10 Tab 2.1 Item 2.1 Declarations of Interest Register
Aspen Medical Practice works in Non-financial Indirect 10/1/2016 Present Would not take part in the Aspen Centre and leases their professional decisions pertaining to this operating theatre to New Medica interest and also receive a share of the room rental from their occupation of several rooms. The space used Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing is all non-GMS space and I do not personally receive any financial benefit from these arrangements but partners do.
Ubhi (Dixon) Mala GP GP Partner Sixways Clinic Professional Financial Direct 2012 Present Declaring interests as appropriate at meetings
Married to Jonathan Dixon, GP Professional Financial Indirect 2013 Present Partner at Churchdown Surgery
I have a direct financial interest as Professional Financial Direct 2020 Present a Clinical Advisor to Etho, a medical informatics start-up I have been accepted as a ‘visitor’ Non-Financial Direct Dec. 2020 July 2021 for the British Medical Professional Interest Association’s Committee for Medical Managers (I believe this is until June or July 2021)
I am now also part of the BMA’s Non-Financial Personal Direct Dec. 2020 Present Network Interest
Professional Financial Indirect 2020 Present Interest as wife of Jonathan Dixon who is Medical Director of Etho 2.1 Tab 2.1 Item 2.1 Declarations of Interest Register
Walkingshaw Mark Director of Nothing to declare Not applicable Not N/A Present Noted Commissioning applicable Implementation Willcox Margaret Director of Adult and Nothing to declare Not applicable Not n/a N/A noted Social Care applicable
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Yerburgh Sheena GP Liasion Lead - Partner at Prices Mill Surgery Financial Direct 2010 Current Declare at meetings Stroud and Berkeley
Vale Locum at Yorleigh Surgery Financial Direct 2020 Current
Shareholder in Gdoc Financial Direct 2010 Current 11 of 486 11 2.1 Tab 3 Item 3. Minutes of the Meeting held on 26 November 2020
Gloucestershire Clinical Commissioning Group 3
Governing Body
Minutes of the Governing Body Meeting Held in Public at 2:00pm on 26th November 2020
Via MS Teams
Members Present:
Dr Andy Seymour AS Clinical Chair Dr Hein Le Roux HLR Deputy Clinical Chair Mary Hutton MH Accountable Officer Mark Walkingshaw MW Deputy Accountable Officer Peter Marriner PM Lay Member, Business Colin Greaves CG Lay Member, Governance Dr Marion Andrews-Evans MAE Executive Nurse & Quality Lead Cath Leech CL Chief Finance Officer Alan Elkin AE Lay Member, Patient and Public Experience Ellen Rule ER Director of Transformation & Service Redesign Helen Goodey HG Director of Locality Development & Primary Care Jo Davies JD Lay Member, Patient and Public Engagement Margaret Willcox MWi Director of Adult Care, GCC Sarah Scott SS Director of Public Health, GCC Lesley Jordan LJ Secondary Care Doctor Kim Forey KF Director of Integration Julie Clatworthy JC Registered Nurse Dr Mala Ubhi MU GP
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Dr Will Haynes WH GP Dr Will Miles WM GP 3 Dr Alan Gwynn AGw GP Dr Caroline Bennett CB GP
In Attendance: Gerald Nyamhondoro GN Governance Officer (taking minutes) Christina Gradowski CGi Associate Director of Corporate Affairs (Agenda Item 14) Becky Perish BP Associate Director, Engagement & (Agenda Item 6) Experience Katherine Holland KH Patient & Public Engagement Manager (Agenda Item 6) Althia Lyn AL Co-Chair of the Black Workers Network (Agenda Item 9) Hannah Gorf HGf Implementation Support Manager (Agenda Item 13)
1. Apologies
1.1 An apology was noted from Dr Sheena Yerburgh.
2. Declarations of Interest
2.1 The Chair advised that all members were required to declare relevant interests at every Governing Body meeting. The Chair also advised that it was in line with best practice to consider any potential conflict of interests at each meeting. The Chair presented the formal Register of Interests of members. The Chair stated that such interests were published in the public domain for the benefit of the public.
2.2 All GPs present declared a general interest of GPs in Primary HealthCare services. Members, excluding the GPs, considered the interests declared and concluded that the participation of GP members, with full rights of members, was not prejudicial to the proceedings, or to Gloucestershire
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Clinical Commissioning Group (thereafter “the CCG”), or in any other conceivable way. Therefore the GPs were not excluded from participating 3 or from contributing to the discussions during the meeting.
3. Minutes of the Meeting Held on 24th September 2020
3.1 Minutes of the meeting held on Thursday 24th September 2020 were approved as an accurate record.
4. Matters Arising
4.1 24.09.20, Item 13.2, Seasonal Influenza Plan 2020-2021 for Gloucestershire. TM explained that flu vaccines were now available for the county population immunisation programme and 5,000 vaccinations had been administered by community pharmacists since 1st September 2020. MAE stated that her team’s target was to have 30,000 people vaccinated. Item closed.
5. Public Questions
5.1 AS read out three public questions. The questions covered the same theme, namely community phlebotomy in the county, particularly in Cirencester. AS read out the CCG’s response to the questions and directed that both the questions raised and the response given be subsequently placed in the public domain for the benefit of the public. Action: Christina Gradowski (CGi) and Anthony Dallimore (AD).
6. Patient’s Story
6.1 BP delivered two Patient Stories covering diagnosis of bowel cancer diagnosed during the period of the Covid-19 pandemic. The stories outlined the respective experiences of two patients. BP confirmed that the two patients had given permission to the publishing of their stories in support of improving health delivery.
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6.2 Patient 1 3 6.2.1 Patient 1 was a 78 year old lady suitable for fast track referral. The patient noted that the health system preceding the pandemic period had been set up to support a positive patient experience as evidenced by the availability of the huge volume of valuable literature on post-hospital care and home care.
6.2.2 The patient commented that such literature had contributed to improving her experience. However in March 2020 when the pandemic added pressure on the health system, the patient experienced what she felt had been poor communication and this had had a profound impact on her health. The pandemic resulted in hospital staff having to deal with very fast changing circumstances.
6.2.3 The patient explained that the pressure upon health delivery was exacerbated by the limiting of the usual support from family and friends emanating from the Covid-19 restrictions.
6.2.4 The patient added that new pressures created communication breakdown which jeopardised her scheduled operation. The patient commended the effort of the hospital staff to mitigate the pressures deriving from the Covid- 19 pressures.
6.3 Patient 2:
6.3.1 The patient was a lady of working age, with a young family. The patient received chemotherapy to treat her cancer, and she described her experience with chemotherapy as tough. The patient commended the commitment of hospital staff. This is how she described her hospital experience: “I felt like a person, not a patient”.
6.3.2 The patient praised the contribution and effectiveness of MacMillan Next Step in aiding cancer treatment and patient support. The patient confirmed that the MacMillan team was very supportive in the patient’s long road to recovery.
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6.3.3 The patient stated that she felt very lucky to be in such a supportive health 3 environment. “I wonder if I was a single mother, living in another area, with little experience of receiving specialist care, whether I would have been able to report such a positive experience” the patient emphasised.
6.3.4 KH described the importance of directing the patients to information hosted on the information hubs as crucial to patient care and delivery of quality service.
6.4 RESOLUTION: The Governing Body noted the Patient Stories and the Stories’ value as a tool for improving health delivery.
Becky Parish and Katherine Holland exited the meeting at 2:15pm.
7. Clinical Chair’s Update Report
7.1 AS presented the report and described the report as a summary of key issues and updates arising during October and November 2020.
7.2 Primary Care Business Continuity
7.2.1 AS stated that Practices were providing full services in line with the NHS England/Improvement General Practice standard operating procedure. AS added that the CCG continued to support Practices, Primary Care Networks and health delivery partners in the Integrated Care System (ICS).
7.3 Primary Care Network Directly Enhanced Service (PCN DES)
7.3.1 AS described the PCN DES and summarised as follows:
Care Homes across the county had access to multi-disciplinary support; the Enhanced Health in Care Homes (EHCH) Working Group continued to meet with representatives from various sections of the
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health sector to enhance service delivery; the CCG supported the building of strong relationship between 3 primary care and Care Homes; the CCG was working with the county’s 15 PCNs to increase the workforce capacity in general practice through the utilisation of the Additional Role Reimbursement fund.
7.4 Integrated Locality Partnerships & Population Health Management
7.4.1 AS explained that the Integrated Locality Partnerships (ILPs) had begun meeting again in most areas across the county and ILP members were adopting a Population Health Management (PHM) approach to refresh and review data for their patient cohorts, and to collectively design interventions that proactively addressed the health and wellbeing of their respective communities.
7.5 Digital Implementation in Primary Care
7.5.1 AS outlined the leading role played by the county in the adoption of video consultation solutions. AS explained that the CCG and Practices are in the process of reviewing video platform solutions, with the intention of undertaking a countywide selection process before the end of 2020.
7.6 Workforce Support and Development
7.6.1 AS described the Catalyst Programme for mid-career GPs launched in Gloucestershire which aimed to re-invigorate GP passion for their chosen career path. AS added that the programme, facilitated by the training hub, offered virtual evening sessions and presentations from inspiring speakers.
7.6.2 AS stated that the CCG and its service delivery partners successfully bid for four Pharmacy Technician Apprenticeships from Health Education England (HEE). AS further clarified that two apprentices would be working in roles across the ICS. These would include placements in community retail pharmacies, Primary Care, hospital pharmacies and the CCG.
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7.7 Primary Care Estates and Facilities 3
7.7.1 AS explained that construction work on a brand new £10,000,000 health centre in Cheltenham began on 2nd November 2020. AS added that three Practices would move into the new building on completion and provide services to a population of around 25,000 patients. The building was scheduled to be completed about winter 2021.
7.8 RESOLUTION: The Governing Body noted the contents of the Clinical Chair’s report.
8. Accountable Officer’s Update Report
8.1 MH gave an update on key issues that arose during the months of October and November 2020. MH explained that the CCG and its partners were seeking the views of the public on the Fit For The Future programme and encouraged feedback from the public.
8.2 MH emphasised that the CCG made every effort to mitigate Covid-19 infections and she reassured that the CCG and its partners were accumulating valuable information through methods that included studying patient experience.
8.3 MH described the progress made on the new community hospital for the Forest of Dean and explained that a consultation inviting the public to comment on the proposals for the new hospital started on Thursday 22nd October 2020. MH added that planning for the hospital was now at a stage where the proposals for the inpatient unit, outpatient services, urgent care, diagnostic services and other facilities on site could be discussed with the local community.
8.4 JC expressed a concern that the Forest of Dean consultation could be adversely impacted by the second wave of Covid-19 and this could Page 7 of 17
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potentially undermine progress of the programme. ER responded that the CCG and its partners were mindful of the risks to the programme and they 3 were working hard to mitigate the risks.
8.5 MH stated that Covid-19 presented many pressures to health services and the CCG and its partners were encouraged to continuously learn from the challenges brought by the pandemic and use the acquired information and knowledge to improve service delivery. Members discussed the contents of the report.
8.6 RESOLUTION: The Governing Body noted the contents of the Accountable Officer’s report.
9. Public Health Annual Report
9.1 SS and AL presented the report. The report described the adverse impact of exclusion on minority ethnic communities. AL presented statistics demonstrating the impact of Covid-19 on minority ethnic communities. SS stated that amongst other adverse factors, minority ethnic members of the community were more affected by the Covid-19 pandemic compared to the rest of the community.
9.2 AL stated that in Gloucestershire there were significant gaps in academic attainment by ethnic groups, with black pupils producing the poorest results. SS emphasised a need to advocate for zero tolerance of discriminatory practices. AL concurred and stated that there was a need to replace cultural practices that propagated structural racism.
9.3 AL explained that the evident under representation of ethnic minority people in organisations resulted in their exclusion from promotions and opportunities for self-actualisation. AL added that organisations should create an enabling environment that offered a platform to discuss and report race discrimination.
9.4 MH stated that the CCG and its ICS partners were running programmes to reduce inequalities and structural race discrimination. MH added that ICS
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partners should borrow and harness the tools and programmes employed by other communities outside the county. 3
9.5 SS suggested funding by the ICS of the BAME Oversight Board charged with supporting governance of transformation programmes designed to reverse exclusion.
9.6 RESOLUTION: The Governing Body noted the contents of the Public Health Annual report.
10. Quality Report
10.1 MAE presented and provided an overview of activity undertaken within the CCG to monitor and improve the quality of commissioned services. MAE gave a brief description of ‘Never Events’ and ‘Serious Incidents’ which occurred in the second quarter (Q2) of 2020/21 in the county hospitals. MAE described ‘Serious Incidents’ as adverse incidents that occurred in relation to NHS-funded services and care. MAE also described ‘Never Events’ as serious incidents that were entirely preventable because guidance or safety recommendations providing strong protective barriers were readily available on national scale.
10.2 MAE stated that the current update showed that there were three Never Events and 11 Serious Incidents reported by GHFT; she also said that there were no Never Events but 14 Serious Incidents reported by Gloucestershire Health and Care (GHC) Foundation Trust. MAE reassured that the Never Events and Serious Incidents were given appropriate attention and they were thoroughly investigated.
10.3 MAE explained that Patient Advice and Liaison Service (PALS) continued to offer a full service despite the Covid-19 pressures. Q2 recorded 250 individual contacts to the PALS service. Key themes included concerns regarding changes to phlebotomy services, in particular in the Cirencester area, and restricted access to Vitamin B12 injections.
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be provided in the new community hospital, in the Forest of Dean. MAE added that this consultation would be followed by a Citizens Jury in 3 January 2021. It was anticipated that after a period of considering the feedback from the consultations, decisions would be made at the CCG Governing Body meeting in March 2021.
10.5 MAE stated that the uptake of flu vaccinations at the time of presenting this report had exceeded the uptake during the same period of the previous years. MAE explained that a flu vaccination programme had been rolled out for schools.
10.6 MAE explained that the uptake of flu vaccinations across the county in the over 65 age group was around 80%, and this exceeded the national target of 75%. MAE added that NHS staff uptake at GHFT was around 58% overall but nearer 70% for patient facing staff.
10.7 MAE also explained that, at GHC, all staff uptake exceeded 65% and around 520 employees of GCC had been vaccinated. MAE summed up by stating that her team and the CCG partners were developing a mass vaccination programme for Covid-19 and they were creating a database to capture all staff trained on vaccination.
10.8 RESOLUTION: The Governing Body noted the contents of the Quality report.
11. Finance & Performance Report
11.1 Operational Performance
11.1.1 MW delivered the performance aspect of the report and reported that ICS ED 4-hour performance was 82.7%, which was short of the 90% target. MW stated that there continued to be pressure impacting on Accident & Emergency (A&E) 4-hour performance as a result of the Covid-19 pressures.
11.1.2 MW explained that while Gloucestershire had initially not seen large
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increases in Covid-19 admissions that numbers had begun to rise steeply at the end of October 2020, with modelling suggesting that cases would 3 continue to rise until mid or late November 2020. MW reiterated that this put considerable pressure on GHFT and other health and social care services.
11.1.3 MW explained that Out of Hours (OOH) services responded well to the pressures of the Covid-19 pandemic. MW also stated that Gloucestershire performance in Category 1 ambulance response time for October 2020 was 7.9 minutes against the 7 minutes target. MW clarified that the Year to Date (YTD) performance across Gloucestershire was 7.3 minutes on average. SWAST Performance across all geographical areas (South West) was 7.9 minutes in October, with YTD average of 7.3 minutes.
11.1.4 MW explained that Category 2 ambulance performance deteriorated from its strong position seen during the initial response to Covid-19 and in October 2020 the average time was 22.3 minutes against the 18 minute target.
11.1.5 MW stated that NHS111 calls increased by more than 100% during the first wave of Covid-19 before returning to expected levels during the lockdown period. MW emphasised that calls however increased from August 2020, compared to the 2019/20 baseline. MW added that in October 2020, calls answered within 60 seconds were 91.9%.
11.1.6 MW described how Out of Hours (OOHs) responded to the demands of the Covid-19 pandemic and explained that a significant amount of contacts were managed via telephone advice, supported by videoconferencing. MW also explained that there was a significant shift in how patients were managed, with reduced face to face and home visits being undertaken.
11.2 Cancer Performance
11.2.1 MW emphasised that cancer treatment remained a priority throughout the Covid-19 crisis. MW stated that cancer performance in the county continued to be strong and he further explained that the CCG’s 2-week
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cancer performance met the target of 93% in September 2020. MW added that all specialties met the 93% target with the exception of sarcoma and 3 Upper Gastrointestinal (GI) cancers. MW explained that urology performance increased to above 85% in September 2020.
11.3 Mental Health Overview
11.3.1 MW stated that Improving Access to Psychological Therapies (IAPT) access rates had stabilised following the significant decline which occurred during the Covid-19 first wave. MW explained that the decline in the wave resulted from disruptions caused by the redeployment of staff to support frontline services which suffered exposure to Covid-19 pressures. MW added that the decline in performance was exacerbated by some patients who chose to not complete therapy in the early stages of the Covid-19 outbreak.
11.3.2 MW explained that staff were now returning to their specialist duties resulting in the stabilising of services. MW added that September 2020 services were recovering and reaching the annual equivalent of 19.6% of the estimated target population accessing IAPT services.
11.3.3 MW stated that Continuing Heath Care (CHC) national performance against the 28-day target had returned to pre Covid-19 level by October 2020.MW cautioned that this area, however, risked deterioration due to some of the staff having been re-deployed to the frontline to help in the fight against the second wave of Covid-19.
11.4 Financial Performance Overview
11.4.1 CL presented the financial aspect of the report and stated that the CCG was operating under an interim financial regime for Month (M) 1-6. CL stated that M6 showed a breakeven financial position premised on anticipated top-up allocation from National Health Service England & Improvement (NHSE&I) who were undertaking a detailed review of top-ups for M6 for all organisations.
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11.4.2 CL clarified that M6 was the final month where the monthly claims process would be in operation, and she reiterated that reclaims for top-up would be 3 scrutinised closely for all organisations. CL also stated that it was anticipated that an external audit would be undertaken on behalf of NHSE&I to review the scope of claims made. CL stated that there was reasonable basis to anticipate that the CCG allocation would be realised.
11.4.3 CL stated that M7-M12 had a different financial regime and a fixed allocation would be given to the whole ICS. CL also stated that a system plan deriving from a close review of the financial requirements of the CCG and its ICS partners pointed toward a deficit of about £28,000,000. CL clarified that the CCG own deficit was projected to reach £12,500,000. CL added that the ICS M7-M12 plan had been submitted to NHSE&I and they were still reviewing the plan.
11.4.4 The M7- M12 plan submitted included planned expenditure on services to deliver additional elective activity, winter schemes and spend on schemes for the continued management of Covid-19.
11.4.5 CL gave an overview of the risks and mitigations associated with M7-M12. The risks included: potential shortfalls in reimbursement of Covid-19; top-up claims; prescribing volatility.
11.4.6 CL stated that the mitigation measures considered included that there would be no appointments made without identified funding and there would be no other controllable expenditure to be committed if no identified funding source was established. Members discussed and noted the contents of the report.
11.5 RESOLUTION: The Governing Body noted the contents of the Finance & Performance report.
12. Integrated Care System (ICS) Update Page 13 of 17
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12.1 ER presented the update and stated that the report provided an insight into 3 the progress being made in the ICS transformation programmes as measured against the system vision and priorities.
12.2 ER stated that since March 2020, the health and care system in the county had responded well to the Covid-19 pressures. ER explained that some of the ICS programmes’ focus had inevitably changed during the pandemic and certain activities had been accelerated or prioritised because of Covid- 19.
12.3 ER stated that, structurally, the response to Covid-19 was being delivered through Bronze Cell, Silver Cell and Gold Cell command structure, working in partnership with the Local Resilience Forum. ER added that the cell structures were designed to evolve to ensure that the system was able to respond to changing pressures.
12.4 ER stated that Covid-19 changed people’s lives and tested the county’s communities in ways that were never imagined before. ER added that Carers UK estimated that Covid-19 had led to an increase of 4.5million carers countrywide at the time of presenting this report. ER emphasised that with carers providing so much support to the community’s health and social care systems there was a need to identify, support and value carers in the county.
12.5 ER described the work of Clinical Programme Groups (CPGs) and their capacity for adaptability in the face of Covid-19 pandemic. ER gave an outline of consultations on Fit for the Future, Forest of Dean Community Hospital project and county hospital services transformation programmes. Members discussed the contents of the report.
12.6 RESOLUTION: The Governing Body noted the contents of the ICS report.
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13. Carers Survey Report 3 13.1 HGf presented the report and explained that a survey was carried out during August and September 2020 to understand the impact of Covid-19 on carers and consider tools that should be put in place to support the carers.
13.2 HGf stated that Covid-19 had resulted in increase of carers in the county from about 63,000 adult carers (based on the 2011 census) to about 100,000 carers during the pandemic. HGf reiterated that the ICS promoted open communication channels with carers to register carer needs and concerns. These channels included the keeping of and the updating of a daily log of carers’ concerns during lockdown, thus enabling the system to respondent rapidly to carer concerns.
13.3 HGf explained that the CCG used the GP Patient Survey to breakdown and analyse 273 carers’ responses. HGf described how caring pressures impacted on the health and social wellbeing of carers. HGf stated that there was evidence of increased use of anti-depressants and anti-anxiety medication during lockdown.
13.4 HGf emphasised the need to prioritise the vaccination of carers upon the rolling out of the Covid-19 vaccination programme. HGf also stated that gathered evidence confirmed that carers wished to be offered support to enable them to achieve a balance between their own social and health needs and supporting those they cared for.
13.5 CGi advised members that Hannah Gorf (HGf) was arranging a ‘Lunch & Learn’ session to be held on 9th December 2020 at 1:00pm via MS Teams. Members and staff were being invited. Action: Hannah Gorf (HGf).
13.6 RESOLUTION: The Governing Body noted the contents of the Carers Survey report.
14. Governing Body Assurance Framework (GBAF)
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had been disruptive to the smooth interaction with, and between Risk Leads, and this resulted in slippage in updating registers. CGi emphasised 3 that despite such setbacks the Governance team had managed to deliver 14 risk management training sessions and they aimed to reverse slippage by continuing to provide further training.
14.2 CGi presented the following key changes made to the GBAF risks: CD 8 (was QD11). SWAST identified a risk in the SW to patients due to call stacking. This risk had been transferred from the Quality to Commissioning Directorate risk register. The risk rating increased to 16 (Red). QD 14. Risk to population health and delivery of healthcare related services due to the impact of Covid-19. The increase in the risk scoring reflected the situation with Covid-19. This risk increased to 16 (RED). TSR 5. Risk that benefits were delayed due to short term pressures related to the Covid-19 pressure. The reference to financial benefits had been removed as this risk focused on benefits related to quality. QD 3. Risk to financial performance if prescribing costs were in excess of the agreed budget. This risk rating had been reappraised and reduced to 12 (Amber) taking into account the overall risk to the CCG’s finances (see F&ID 2). F&ID 2. Risk that the CCG would not meet its breakeven control total in 2020/21. This risk increased to 20 from 16 (RED).
14.3 GCi explained that Risk Leads had now updated the registers of their respective directorates. CGi added that a full review of all the changes made to the GBAF and the Corporate Risk Register would be presented before the Audit & Risk Committee on 8th December 2020. Members discussed the risks. Action: Christina Gradowski (CGi) and Lauren Peachy (LP).
14.4 RESOLUTION: The Governing Body noted the contents of the GBAF report.
15. Primary Care Commissioning Committee Minutes of the Meeting Held on 27th August 2020
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15.1 RESOLUTION: The Governing Body noted the contents of the Primary Care Commissioning Committee minutes. 3
16. Quality & Governance Committee Minutes of the Meeting Held on 13th August 2020
16.1 RESOLUTION: The Governing Body noted the contents of the Quality & Governance Committee minutes.
17. Audit & Risk Committee Minutes of the Meeting Held on 14th July 2020
17.1 RESOLUTION: The Governing Body noted the contents of the Audit & Risk Committee minutes.
18. Any Other Business
18.1 There was no other business raised.
The Governing Body meeting ended at 4:30pm
Date and time of the next Governing Body meeting: The next Governing Body meeting would be held at 2:00pm on Thursday 28th January 2021, via MS Teams.
Minutes Approved by Gloucestershire Clinical Commissioning Group Governing Body:
Signed (Chair):______Date:______
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Agenda Item 4
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Governing Body
Matters Arising – January 2021
Item Description Response Action Due Status with Date 26.11.20 Public Questions. AS read out This was actioned: We recommend closure CGi 28 Open Item 5.1 three public questions. The and Jan. questions covered the same AD 2021 theme, namely community phlebotomy in the county, particularly in Cirencester. AS read out the CCG’s response to the questions and directed that both the questions raised and the response given be subsequently placed in the public domain for the benefit of the public.
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26.11.20 Carers Survey Report. The Lunch & Learn session was held as HGf 28 Open Item 13.5 CGi advised members that planned. We therefore recommend closure Jan.
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Hannah Gorf (HGf) was 2021 arranging a ‘Lunch & Learn’ session to be held on 9th December 2020 at 1:00pm via MS Teams. Members and staff were being invited.
26.11.20 Governing Body Assurance The registers were presented before the CGi & 28 Open Item 13.5 Framework (GBAF). Audit & Risk Committee on 8 December LP Jan. GCi explained that Risk Leads 2020. We therefore recommend closure 2021 had now updated the registers of their respective directorates. CGi added that a full review of all the changes made to the GBAF and the Corporate Risk Register would be presented before the Audit & Risk Committee on 8th December 2020.
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4 Tab 5 Item 5. Questions from the Public
No questions from the public
5
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Agenda Item 6 Governing Body meeting
Meeting date 28th January 2020 Title Clinical Chair’s Report
Executive Summary This report provides a summary of key issues and updates arising during December 2020 and January 2021 for the Clinical Chair. Key Issues Key topics for this report: Business Continuity and Covid-19 Vaccination Programme in Primary Care 6 PCN DES ILPs and Population Health Management; Digital implementation; Workforce support and development; Care Quality Commission and mergers and PCN changes; Meetings December 2020 and January 2021. Conflicts of Interest None. Risk Issues: None. Original Risk Financial Impact None. Legal Issues (including None. NHS Constitution) Impact on Health None. Inequalities Impact on Equality and None. Diversity Impact on Sustainable None. Development Patient and Public None. Involvement Recommendation This report is presented for information and Governing Body members are requested to note the contents. Author Andy Seymour Designation Clinical Chair
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Agenda Item 6
Governing Body
January 2021
Clinical Chair’s Report
Primary Care Business Continuity and the COVID-19 Vaccination 1. Programme in Primary Care 6
1.1 In my last report, written at the end of October 2020, I mentioned a new national request for primary care to support the COVID-19 vaccination programme. I am delighted to state that within Gloucestershire general practice has been providing Covid vaccinations since the 16th December with Gloucestershire practices among the first in the country to do so albeit this has added to the significant workload pressure already felt.
1.2 Within the county we have ten approved Covid vaccination sites formed by PCN groupings (groups of practices working together). The sites are geographically spread across the county with hubs in Cheltenham, Gloucester, Stroud, Dursley, Tewkesbury, Moreton in Marsh, Cirencester and Cinderford. We are grateful to our partners for the loan of space within their buildings in some geographies and also to third sector partners for the supply of volunteers to support the delivery of the programme, for example volunteer car park marshals.
1.3 The PCN Sites have been working well collaboratively and at pace initially focussing on vaccinating the Joint Committee on Vaccination and Immunisation (JCVI) priority cohorts one and two which are residents in a care home for older adults and their carers and people aged 80 and over and frontline health and care workers. Some progress has also been made in vaccinating cohorts three and four, those over 75 and 70 respectively, as well as the clinically extremely vulnerable. Overall good progress is being made with second doses being rescheduled for the 12th week as per the latest guidance.
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1.4 The approval of the Oxford/Astra Zeneca vaccine has resulted in planning and delivery of vaccination to people who are housebound. .
1.5 Whilst we understand the desire to be vaccinated, we are asking patients and their families for their patience. GP practices will contact patients with information on clinics and how to book an appointment and the public are asked not to arrive at a venue for their COVID-19 vaccination unless they have a prebooked appointment.
2. Primary Care Network Directly Enhanced Service (PCN DES) 6
2.1 Understandably the focus of our Primary Care Networks in this period has been delivery of the COVID vaccination programme across the ten PCN sites as described above. The fantastic progress made in Gloucestershire with COVID vaccination has relied in no small part on the strength of the PCN model we have in our county. Practices have worked together, with our PCN Clinical Directors and their teams leading the response.
2.2 There has also been some relaxation of the PCN DES requirements from NHSE/I to support this work. While the expectations under the specifications for Enhanced Health in Care Homes and Supporting Early Cancer Diagnosis both rightly continue, where Clinical Pharmacist staff are supporting the COVID vaccination programme, the targets associated with delivering Structured Medication Reviews have been relaxed. Furthermore, additional support for Clinical Directors has been announced for January – March, which we will ensure all our PCNs benefit from in this period.
2.3 We have also been working with all our PCNs to maximise the Additional Roles Reimbursement (ARR) scheme for 2020/21 to support the COVID vaccination response. The ARR scheme aims to increase the workforce capacity in general practice, both to deliver the specifications required under the DES, as well as to increase access to general practice services for patients over the coming years. However, flexibilities allowed to utilise countywide underspend for COVID vaccination, combined with support from CCG and GHC staff, has allowed our PCNs to ensure they have sufficient workforce to deliver the vaccination programme while
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maintaining primary care services. We also continue to support our PCNs in planning to maximise the opportunity of the ARR funding for future years, ensuring no PCN gets left behind, with targeted support to those PCNs that most need additional resource.
2.4 Finally in relation to the DES, the Primary Care and Localities Directorate internal audit on the ARR processes, including both claims management and workforce planning, has been completed. This demonstrated substantial assurance across design and operational effectiveness measures, while identifying several areas of best practice in Gloucestershire. 6
3 Integrated Locality Partnerships & Population Health Management
3.1 Most recently some ILP meetings have taken a more operational approach for example in supporting delivery of the Covid-19 Vaccination Programme, or been postponed due to capacity pressures due to the ongoing pandemic response. ILP Partners remain engaged with ILP working, and are contributing to the development of ILP priority interventions.
3.2 ILP members across the county are continuing to adopt a Population Health Management (PHM) approach to determine patient cohorts and to collectively design interventions which proactively address health and wellbeing. For example in Gloucester ILP members are working alongside a local housing provider to identify individuals with respiratory conditions which may be exacerbated by poor housing. The project group has established a respiratory MDT structure and will be supporting an initial cohort of around 20 people to ascertain the most effective way to identify these individuals and make improvements to this wider determinant of health, to benefit individuals’ health and wellbeing as well as to reduce future healthcare requirements in this area. Evaluation points are planned at 6 and 12 months to review and consider whether wider rollout may be of value.
3.3 Whilst in its infancy as an ILP, Tewkesbury is well formed and progress is being made with the four priority areas of Healthy Lifestyles & Prevention, Mental Health, Social Isolation and Loneliness and Employment &
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Financial Stability. For each priority a task and finish group has been established with a local leader as chair and varied stakeholder organisations contributing to early discussions about how the PHM data will drive cohort selection and intervention design. The ILP has agreed to utilise the PHM approach to improving outcomes for its population.
3.4 We are currently developing a suite of products to progress the rollout of the Population Health Management approach since the completion of the ICS wide Population Health Management (PHM) development programme. These tools including our system development roadmap, Frequently Asked Questions, development programme case studies and 6 toolkit to progress through the PHM cycle will support engagement and consistency of system adoption to further accelerate our PHM capabilities towards a ‘business as usual’ transformation approach. It is our intention to appoint one PHM Champion for each of the six Places in Gloucestershire, to further support the spread across the ICS.
4 Digital implementation in Primary Care
4.1 Previously, I detailed the significant progress on digital transformation in Primary Care enabling staff to work more flexibly, as well as allowing clinical staff who are potentially vulnerable themselves to continue to work. Gloucestershire was particular successful in its adoption of video consultation, SMS - texts and e-consultation solutions with GPs in Gloucestershire using various tools more than colleagues in any other area in the region per capita. I also reported that as a county it would be beneficial to move in a consistent way to allow better support for the digital solutions and their use. It was hoped that this work would be completed by the end of 2020, but due to pressures on the health system has been delayed. However, the CCG issued a grid at the start of January outlining the features and benefits of each solution on the NHSE Framework. We will share the learning from North Cotswolds on their use of AccuRX, alongside asking each PCN their choice of solution. A PCN may also choose to remain with existing solutions and processes.
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4.2 The upgrade of the internal NHS network to Health and Social Care Network (HSCN), including bandwidth updates and additional resilience, continues apace in primary care and was due to complete by Christmas. However, there have been delays, due in the main to Covid 19. That said, currently out of the 101 sites (practices plus branch sites), 89 have been upgraded to HSCN and Windows 10 installed. Work on completing the remaining sites is ongoing.
5 Workforce support and development
5.1 An updated aggregated workforce plan to include additional roles to support the COVID vaccination programme (as mentioned in section 2.3 6 above) was submitted to NHSE/I in mid December. Future ARRS claims (from Feb 2021) will be processed through the new ARR claims portal which is now live.
5.2 To support workforce development in harder to recruit areas, the CCG is supporting a national campaign to recruit clinical pharmacists for the Forest of Dean. Discussions are ongoing with Gloucestershire Hospitals NHS Foundation Trust on potential rotational roles.
5.3 Planning is underway to set up peer networks for the ARRS roles. This will start with a physiotherapy group across the county to start in January 2021. A Social Prescribing Link Worker educational strategy is also under development which will allow for better retention of these roles in Gloucestershire. Elements include clinical supervision, a lead SPLW role across the county and additional training both formal and informal.
5.4 Gloucestershire CCG and Gloucestershire Primary Care Training Hub have been active since late 2019 in bringing together stakeholders across the wider ICS to understand the workforce impact of the news ARRS professions coming into primary care. Approval has been received to recruit part time (0.2wte) workforce development leads for both Pharmacy and Physiotherapy for a 12 month period, to further this work.
5.5 Colleagues from the Gloucestershire CCG and the Gloucestershire Primary Care Training Hub are scoping the creation of a GP Flexible Pool in county. Each STP/ICS area across the country will be able to access
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funding for set up which can be used to implement a digital software platform, which will be mobile ready, to assist with immediate and short term locum requirements.
6. Care Quality Commission (CQC) for General Practice, mergers and changes to Primary Care Networks
6.1 There have been no new CQC reports issued since my last update. Four GP Practices in Gloucestershire have a CQC overall rating of “Outstanding”, the majority (66) have a rating of “Good” and two have a rating of “Requires Improvement”. 6
6.2 There have been no completed contractual mergers to report since my last update.
7. Meetings
A summary of the key meetings I have (virtually) attended between 27 November 2020 and 27 January 2021 are:
27 Nov Regional COVID-19 Clinical Leads Meeting
27 Nov MPs Briefing Meeting
01 Dec STP/ICS Clinical and Professional Leaders’ Network Meeting
03 Dec ICS Executive Meeting
03 Dec Lay Members Briefing Meeting
04 Dec Regional COVID-19 Clinical Leads Meeting
07 Dec Child Friendly Glos - Launch
07 Dec Structures Meeting
08 Dec South West Chairs Meeting
08 Dec AO/Chairs Meeting
10 Dec Leadership Gloucestershire
11 Dec Regional COVID-19 Clinical Leads Meeting
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11 Dec MPs Briefing Meeting
17 Dec Clinical Directors Meetings
18 Dec Regional COVID-19 Health Gold Group Meeting
18 Dec Regional COVID-19 Clinical Leads Meeting
21 Dec Regional COVID-19 Health Gold Group Meeting
22 Dec South West Chairs Meeting
05 Jan South West Chairs Meeting 6 05 Jan MPs Briefing Meeting
07 Jan ICS Executive Meeting
08 Jan Regional COVID-19 Clinical Leads Meeting
08 Jan MPs Briefing Meeting
12 Jan Health Overview and Scrutiny Committee Meeting (HOSC)
12 Jan Health Chairs Meeting
14 Jan LMC Main Meeting
15 Jan Regional COVID-19 Clinical Leads Meeting
18 Jan ICS CEOs Meeting
19 Jan South West Chairs Meeting
21 Jan ICS Board
22 Jan Regional COVID-19 Clinical Leads Meeting
22 Jan MPs Briefing Meeting
26 Jan Joint Meeting of Adult Social Care and Communities Scrutiny Committee and Gloucestershire HOSC
27 Jan ICS NED & Lay Member Network Meeting
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Recommendation
This report is provided for information and the Governing Body is requested to note the contents. .
6
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Agenda Item 7 Governing Body meeting
Meeting date 28 January 2021 Title Accountable Officers Report
Executive Summary This report provides a brief update on some of the key work which has taken place within the CCG during December and January. Key Issues Key topics for this report: Covid Vaccine mobilisation System Capacity Pressures as a result of Covid- 19 EU Exit planning Fit for the Future 7 Meetings attended 27 November to 27 January Conflicts of Interest None. Risk Issues: None. Original Risk Financial Impact None. Legal Issues (including None. NHS Constitution) Impact on Health None. Inequalities Impact on Equality and None. Diversity Impact on Sustainable None. Development Patient and Public None. Involvement Recommendation This report is presented for information and Governing Body members are requested to note the contents. Author Mary Hutton Designation Accountable Officer
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Gloucestershire Clinical Commissioning Group Accountable Officer’s Report
December 2020 – January 2021
1. Introduction
1.1 This report provides a summary of some of the key areas of focus over the past two months.
2. Covid-19 Vaccination mobilisation 7 2.1 As set out in the Clinical Chair’s report the mobilisation of the Gloucestershire Mass Vaccination campaign has been very successful and has been recognised both regionally and nationally. This has been due to the absolute commitment, energy and enthusiasm of our Primary Care Networks and our own CCG Primary Care Team and Gloucestershire Healthcare NHS Foundation Trust (GHFT) Hub.
2.2 As a CCG we are also continuing to do everything we can to support this historic effort, including through the leadership and support from our Primary Care Team and through the role many of our own clinically qualified staff are playing in assisting in delivering vaccines. I’ve had the privilege of hearing many individual patients’ stories of what the receiving the vaccine means to them and I want to pay tribute to all of the staff involved.
We recognise that we are just at the beginning of this process and we will continue to support primary care colleagues as we move through each of the initial priority groups in turn.
3 Current System Capacity Pressures
3.1 There are significant and ongoing Covid-19 related pressures across all parts of the health and social care system in Gloucestershire, at the time of writing although levels of infection in
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the community continue to reduce, we are currently going through what the modelling suggests will be the peak in Covid-19 admissions to hospital.
We have been working with systems partners to take co-ordinated action in response to this in line with our Covid-19 surge planning.
In particular this has included:
Maximising the use of the Transfer of Care Bureau and Enhanced Independence Offer.
Commissioning of additional assessment bed capacity in care homes. 7 Opening additional community hospital capacity - supported by additional rehabilitation input.
Redeployment of Adult Social Care and Continuing Health Care assessors to support discharge and flow from both acute and community hospitals.
A doubling of ‘Home First’ capacity to support patients in their own homes.
A systematic review of all medically stable patients with a particular focus upon patients with an over 21 days length of stay, as well as seeking to maximise numbers of non-complex discharges.
Putting in place additional transport capacity.
We are anticipating that we will need to continue this focus for the next few weeks.
4. EU Exit Planning
4.1 Following approval of the UK/EU Trade Agreement on 24 December, the UK officially left the EU on 31 December 2020. In preparation for this event we worked closely with all of our local
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providers to ensure we had six weeks supply of:
medicines;
medical devices and clinical consumables;
non-clinical goods, such as food and linen.
4.2 We also ensured there were arrangements in place for clinical trials, research, clinical networks and General Data Protection Regulations to continue beyond the 31st December 2020.
4.3 We also provided reassurance to our staff from EU countries and we will continue to promote the Settlement Scheme to any staff joining us from the EU, and encourage them to apply for settled or pre-settled status. 7
4.4 The key messages we have communicated to Primary Care colleagues are to:
Prescribe and dispense medications as normal. Prescribing of additional medication following departure from the EU is not required
Not stockpile medicines, vaccines or supplies.
4.5 We have a process in place to escalate any issues that are impacting on patient care following departure from the EU, and want to provide assurance that we have not experienced any business critical issues to date
4.6 Going forward, if we did experience any business critical issues the following contingency arrangements have been put into place nationally:
Government Secured Freight Capacity - The Department for Transport (DHSC) has procured capacity from the freight framework, including all health supplies. This allows for 3,000 HGV vehicles bookings to be available per week on Ferries from Europe to the UK outside of the ‘Short Straits’ to bring
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urgent ‘Category 1’ goods into the UK.
Express Freight Service - DHSC has retained its Express Freight Service arrangements with 3 specialist logistics providers to support the urgent movement of medicines and medical products to care Providers and patients if other measures experience difficulties
5. Fit for the Future update
5.1 A full update will be provided at item 13 but I am pleased to be able to report that we closed the consultation closed in December.
The Interim Output of Consultation Report was published 11/01/21 7 and was discussed at the Health Overview and Scrutiny Committee, Integrated Care System Executives, Gloucestershire Hospitals NHS Foundation Trust Board and will be formally received at CCG Governing Body on 28/01/21.
A Citizens Jury is running from 19-28/01/21; the topic of which is “What are the most important findings of the public consultation that decision makers should take into account?”
Ongoing work includes further analysis of the qualitative survey responses, updating the Integrated Impact Assessment, options appraisal process for Colorectal location and work to draft the Decision Making Business Case (DMBC).
The DMBC will include a response to feedback from and issues identified in the consultation.
The DMBC is planned to be discussed and tabled for approval at CCG Governing Body meeting which will take place on 25/03/21.
6. Meetings
6.1 Meetings I have attended virtually from 27 November 2020 to 27
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January.
27 Nov Regional Strategic Coordinating Group Meeting (ReSCG)
27 Nov MPs Briefing Meeting
30 Nov South West System Leads Weekly Meeting
30 Nov LWAB/System People Board Chairs Meeting
01 Dec National ICS Network - STP & ICS Executive Leaders and Chairs Network Meeting
03 Dec South West Regional Chief Executives Meeting
03 Dec ICS Executive Meeting 7 03 Dec North Partnership Board
04 Dec Regional Strategic Coordinating Group Meeting (ReSCG)
04 Dec South West Regional People Board
07 Dec South West System Leads Weekly Meeting
07 Dec Child Friendly Glos – Launch
07 Dec NHSCC Roundtable Meeting
08 Dec Session for SW CEO’s
09 Dec Enabling Active Communities Meeting (EAC)
09 Dec Nightingale Legacy Programme Board
09 Dec NHSE/I - AO/Chairs Meeting
10 Dec South West Regional Chief Executives Meeting
10 Dec Leadership Gloucestershire
11 Dec Regional Strategic Coordinating Group Meeting (ReSCG)
11 Dec West of England AHSN Board Meeting
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11 Dec MPs Briefing Meeting
14 Dec South West System Leads Weekly Meeting
14 Dec County-Wide Volunteering Review Health Meeting
15 Dec BAME Network Meeting
16 Dec Joint ICS/STP Leaders and Chairs Session
17 Dec South West Regional Chief Executives Meetings
17 Dec Primary Care Commissioning Committee Meeting (PCCC)
17 Dec ICS Board 7 18 Dec Regional Strategic Coordinating Group Meeting (ReSCG)
18 Dec MPs Briefing Meeting
21 Dec Regional COVID-19 Health Gold Group Meeting
22 Dec Children’s Services Improvement Board
22 Dec Severn Network/ICS discussion
05 Jan MPs Briefing Meeting
07 Jan South West Regional Chief Executives Meeting
07 Jan ICS Executive Meeting
08 Jan Regional Strategic Coordinating Group (ReSCG)
08 Jan Regional Roadshow with Simon Stevens
08 Jan MPs Briefing Meeting
12 Jan South West Regional Chief Executives Meeting
12 Jan Health Overview and Scrutiny Committee Meeting (HOSC) 13 Jan Severn CEO Network Meeting
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14 Jan South West Regional Chief Executives Meeting
14 Jan ICS Development Site – South West – Gloucestershire Meeting
14 Jan NHSE/I National Mental Health Meeting
15 Jan Regional Strategic Coordinating Group Meeting (ReSCG)
15 Jan OSW Programme Board
18 Jan ICS CEOs Meeting
19 Jan South West System Leads Weekly Meeting
19 Jan ICS Outpatient Board 7
20 Jan ICS Network Executive Leaders Meeting
21 Jan South West Regional Chief Executives Meeting
21 Jan ICS Board
21 Jan ICS and STP Leaders Meeting
22 Jan Regional Strategic Coordinating Group Meeting (ReSCG)
22 Jan MPs Briefing Meeting
26 Jan South West System Leads Weekly Meeting
26 Jan Joint Meeting of Adult Social Care and Communities Scrutiny Committee and Gloucestershire HOSC
27 Jan ICS NED & Lay Member Network Meeting
27 Jan Severn CEO Network Meeting
7. Recommendations
This report is provided for information and the Governing Body is
Accountable Officer Report 20.01.21 Page 8
48 of 486 Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 Tab 7 Item 7. Accountable Officer’s Update Report
requested to note the contents.
7
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Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 49 of 486 Tab 8 Item 8. Performance Report Cover
Agenda Item 8
Governing Body
Meeting Date 28 January 2021 Title Finance and Performance Report Executive Summary The finance and performance report covers a review of performance to date (as available) and the financial position (month 9).
Key Issues This report covers the following key elements: 1.0 Scorecard
2.0 Performance dashboard and National Performance Summary
3.0 Better Care 8 3.1 Constitution updates 4.0 Leadership 4.1 Measurement
5.0 Sustainability 5.1 Resource Limit 5.2 Acute Contracts 5.3 Community 5.4 Prescribing 5.5 Mental Health 5.6 Primary Care 5.7 CHC 5.8 Other 5.9 Savings Plan 5.10 Savings forecast delivery 5.11 Risks & Mitigations 5.12 Cash drawdown 5.13 BPPC performance 5.14 Income & Expenditure. Risk Issues: The key risks are detailed within the report Original Risk Residual Risk
Financial Impact
50 of 486 Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 Tab 8 Item 8. Performance Report Cover
Legal Issues (including Section 223H of the Health and Social Care Act NHS Constitution) 2012 sets out the duty for CCGs to break even on their commissioning budget for both revenue and capital. GCCG is required not to exceed the cash limit set by NHS England, which restricts the amount of cash drawings that the CCG can make in the financial year. The CCG must also comply with relevant accounting standards.
Impact on Health N/a Inequalities
Impact on Equality and N/a Diversity
Impact on Sustainable N/a Development 8
Patient and Public N/a Involvement
Recommendation The Governing Body is asked to:
discuss and note the CCG’s performance including the impact of the COVID-19 response to date
discuss and note the CCG’s financial position and the inherent risks
Author Katharine Doherty
Andrew Beard Designation Performance Manager Deputy Chief Finance Officer Sponsoring Director Mark Walkingshaw – Deputy Accountable Officer (if not author) Cath Leech - Chief Finance Officer
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 51 of 486 52 of 486 52 Tab 8.1 Item 8.1 - Performance Report Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing
CCG Monthly Performance Report
1 January 2020 8.1 Tab 8.1 Item 8.1 - Performance Report Contents
This document is a highlight report which is presented to give the CCG Governing Body an overview of current CCG and provider performance across a range of national priorities and local standards.
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing COVID-19 has impacted performance against the majority of constitutional standards, and recovery is expected to take place over many months, with further impact anticipated due to continued COVID-19 infection rates nationally.
1.0 CCG Performance Overview 5.0 Sustainability 5.1 Resource Limit 2.0 Performance dashboard and National 5.2 Acute Contracts Performance Summary 5.3 Community 5.4 Prescribing 5.5 Mental Health 3.0 Better Care 5.6 Primary Care 3.1- 3.9 Performance updates 5.7 CHC 5.8 Other 5.9 Savings Plan 4.0 Leadership 5.10 Savings forecast delivery 4.1 Measurement 5.11 Risks & Mitigations 5.12 Cash drawdown 5.13 BPPC performance 5.14 Income & Expenditure 5.15 Balance Sheet
53 of 486 53 2 8.1 54 of 486 54 Tab 8.1 Item 8.1 - Performance Report 1.0 CCG Performance Overview
CCG NHS Oversight assessments for 2019/20 were published on 25th November 2020, with GCCG being rated “Good” overall based on assessment of Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing indicators covering 5 key areas:
• New Service Models • Preventing Ill Health and Reducing Inequalities • Quality of Care and Outcomes • Leadership and Workforce • Finance and Use of Resources
3 8.1 Tab 8.1 Item 8.1 - Performance Report 2.0 Performance Dashboard
4 Hour A&E 4 Hour A&E Category 1 Ambulance Category 1 Ambulance Delayed Transfers of Dec-20 Dec-20 December-20 December -20 Care (DToC) (System) (GHFT) Unscheduled (Gloucestershire) SWAST Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Care 80.0% 69.1% 8.2 mins 8.0 mins Reporting suspended nationally
Planned Care RTT Incomplete <18 weeks RTT 52 week breaches Diagnostics >6 weeks Diagnostics >6 weeks (YTD) RTT All Providers GHFT All Providers GHFT (All providers) (GHFT) . (All providers) (GHFT) Diagnostics November 1046 2020 71.3% 71.5% 1315 18.9% 14.4% 28.6% 24.8%
Cancer 2 Week 2 Week Waits 31 Day 1st 31 Day Waits 31 Day Waits 31 Day Waits 62 Day GP 62 Day 62 Day Dashboard Waits Breast Treatment Surgery Drugs Radiotherapy Referral Screening Upgrade (November 2020)
Performance (all Gloucestershire 91.2% 85.2% 96.7% 93.8% 100% 98.3% 82.3% 96.9% 82.4% patients)
GHFT 91.7% 86.0% 98.2% 100% 100% 98.0% 82.1% 96.9%78.4 84.6% Performance %
Access Recovery Dementia Estimated Diagnosis Rate IAPT (target 1.53%) (target 50%) Diagnosis (Target 66.7%)
(November 2020) (December
55 of 486 55 1.7% 55.1% 2020) 62.5% Arrow direction reflects performance4 from
previous month 8.1 56 of 486 56 Tab 8.1 Item 8.1 - Performance Report 2.0 National Performance Summary
Target Reporting Period National Gloucestershire
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing A&E 4 hour Dec-2020 80.5% 80.0% Ambulance – Cat 1 Dec-2020 7.5 minutes 8.8 minutes RTT – 18 week Nov-2020 68.2% 71.3% Diagnostics – 6 week Nov-2020 27.5% 18.9% Cancer 2ww Nov-2020 87.0% 91.2% Cancer 62 day Nov-2020 75.5% 82.3% Dementia Diagnosis Dec-2020 62.2% 62.5%
Performance against key standards continues to follow the national trends, however with the exception of A&E and ambulance Category 1 response times, Gloucestershire performance generally improves on the national position. There has been a significant decline in overall A&E performance nationally, with reduction in activity due to national lockdown measures not having the same impact on 4 hour performance as early in the year, when many areas saw a significant improvement in performance. December performance nationally has dropped by 4%, largely due to the continued rise in COVID-19 cases which is putting pressure on all parts of the NHS nationally. Locally, 4 hour performance remains a significant concern due to continued pressure on acute beds and flow through the hospital. Across all other standards both the national and GCCG position is a trend towards improvement – with the caveat that current performance positions are taken generally before the impact of the COVID-19 second wave has occurred. There is likely to be deterioration in the coming months across the majority of targets, before services have had the opportunity to recover further. Nationally, cancer services have struggled to improve on performance impacted in the first COVID-19
wave – emphasising the success of Gloucestershire’s cancer services in continuing to provide services throughout the
COVID-19 response and thereafter. 5 8.1 Tab 8.1 Item 8.1 - Performance Report COVID impact – unscheduled care activity
September October November December Year to Year to Year to Daily average Year to year 2019 2020 2019 2020 year 2019 2020 year 2019 2020 year change Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing change change change A&E attendances (all at GHFT) 441 363 82.3% 430 335 77.9% 436 304 69.7% 429 300 69.9% Emergency admissions (GCCG patients 171 178 104.1% 179 179 100.0% 179 174 97.2% 177 160 90.4% at GHFT)* MIIU attendances (GCCG patients at 223 126 56.5% 196 109 55.6% 192 91 47.4% 194 83 42.8% GHC sites) Community hospital admissions (GCCG 6.0 5.0 83.3% 6.6 5.9 89.4% 6.2 5.0 80.6% 5.8 5.5 94.8% patients at GHC sites) Calls to NHS111 (GCCG patients) 432 552 127.8% 423 475 112.3% 546 464 85.0% 579 491 84.8% SWAST calls (GCCG patients) 272 283 104.0% 270 273 101.1% 288 261 90.6% 304 276 90.8%
57 of 486 57
April 2019 6 December 2020 8.1 58 of 486 58 Tab 8.1 Item 8.1 - Performance Report 3.1 System Overview Unscheduled Care
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8 8.1 Tab 8.1 Item 8.1 - Performance Report 3.1 System Overview Unscheduled Care Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing
59 of 486 59 9 8.1 60 of 486 60 Tab 8.1 Item 8.1 - Performance Report 3.1 Unscheduled Care - 4 hour A&E Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing
In December, Gloucestershire Hospitals NHS Foundation Trust (RTE) saw 69.1% of patients in 4 hours of less in a Type 1 setting. Gloucestershire STP saw 80.0% of patients in all settings within 4 hours. Of the 113 providers with Type 1 A&E service, GHFT ranked joint 93rd. Gloucestershire STP ranked Gloucestershire STP ranked 22nd of the 41 STPs in overall percentage of attendances within 4 hours and 31st of the 41 STPs with Type 1 activity. Last month the STP ranked at 24th for overall attendances and 33rd for Type 1 activity. This is a significant improvement in ranking over the summer months, particularly in terms of system performance, indicating that nationally many areas are struggling to deliver consistent 4 hour performance as COVID-19 cases rise again. In Gloucestershire COVID+ve admissions have been rising steadily throughout November and December, with COVID+ve occupancy in the acute and community hospitals higher than during the first wave in the spring. This is contributing to a challenging situation in the acute hospital, particularly with bed occupancy and flow through the hospital, and the need to constantly reconfigure services and hospital areas to ensure patients can be appropriately separated to avoid infection. Despite some reduction in activity across ED as a total, the GRH site remains busy as the majority of reductions have been in MIIU
attendances. Admissions have reduced slightly in December compared to December 2019 levels, however a slightly longer average
length of stay, due to patient acuity and increased difficulty in discharge for some patients has led to bed occupancy levels remaining at a
high level.
10 8.1 Tab 8.1 Item 8.1 - Performance Report GHFT ED and MIIU activity
2nd England national England national lockdown lockdown CGH temporary National tier 3rd England National tier restrictions change to Type 3 restrictions national lockdown introduced unit reintroduced Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing
First easing of lockdown measures
While the first COVID-19 national lockdown coincided with a significant drop in ED attendances at both the GRH and CGH sites, this impact has not been seen so markedly in any subsequent period of national or local restriction. The temporary changes at CGH have resulted in a lower activity level, which predominantly driven by ambulance/ GP referrals into ED but also reflects a lower number of walk in attendances as well. Overall MIIU attendances have reduced significantly across all sites in the county, reflecting that patients may be less likely to attend with e.g. sports injuries during lockdown periods, but also that patients could be avoiding healthcare settings. Since the 3rd national lockdown was introduced on the 4th January 2021, there has been a suggestion that activity has declined again at both GRH and CGH, however it is too early to tell if this will be sustained.
61 of 486 61 10 8.1 62 of 486 62 Tab 8.1 Item 8.1 - Performance Report 3.1 Unscheduled Care - NHS111 Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing
NHS111 calls have been volatile in 2020 as a result of the COVID-19 pandemic. Overall call volumes have returned to closer to expected levels in the last few months, however with November and December calls not seeing the increase that 2019 did, despite the launch in December of “Think NHS111” – aimed to encourage patients to contact NHS111 first rather than walking into ED. This may be the result of continued COVID-19 restrictions, so continued monitoring will assess patient uptake and outcome in the coming months. Work is continuing around strengthening the validation of ED and ambulance dispositions from NHS111 to reduce unnecessary ED attendances and ambulance call outs, with Practice Plus now reaching 70% of ambulance and ED dispositions. While ambulance dispositions have remained relatively stable, ED dispositions have continued to drop month on month since the proportional peak seen in June 2020. Validation of emergency care dispositions will also be supported by additional “off pathways” clinical validation (Highnam model), where ED dispositions are validated by GPs external to NHS111 to ensure the most appropriate pathway is recommended. This trial is already proving successful, with a downgrade rate for dispositions of around 80%.
In December, calls answered within 60 seconds remained relatively stable with 86.6% of calls meeting the target.
11 8.1 Tab 8.1 Item 8.1 - Performance Report 3.2 Unscheduled Care - Ambulance Category 1 Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing
December 2020 saw a marked deterioration in ambulance response time performance across all response categories. GCCG performance in Category 1 was 8.8 minutes on average, with SWAST overall performance at 8.3 minutes. Total incident numbers were similar to the August-October 2020 period, with 8549 unique incidents in December. This is lower than December 2019 levels, perhaps reflecting continued effects of national COVID-19 restrictions. Overall incident outcomes remained broadly similar to previous months, with 52.9% incidents conveyed to an ED or MIIU. There has been a slight increase in total calls originating from the NHS111 service (equating to a 1.5% increase proportionally for all activity compared to full YTD). This may be indicative of changes in patient behaviour due to the “Think NHS111” campaign, alternatively may also reflect higher patient acuity, as an increased % of NHS 111 originating calls went on to be conveyed to ED than in previous months.
63 of 486 63 12 8.1 64 of 486 64 Tab 8.1 Item 8.1 - Performance Report 3.2 Unscheduled Care - Ambulance Category 2 Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing
Category 2 response time performance decreased significantly in Gloucestershire in December having held stable through the autumn months. GCCG December average Category 2 response time was 27.2 minutes, against total SWAST performance of 27 minutes. This reflects an increasingly challenged position for SWAST, where demand on the service has not reduced significantly, but staff absence and time lost to handover delays has increased. This has led to increased pressure, particularly in Gloucestershire where the category 2 response time had remained lower than the SWAST average throughout most of 2020/21 to date, but now is in line with the regional average.
This deterioration has been seen nationally, with notable press attention on the increasing ambulance response times
across the country, and large rises in handover delays seen at most acute hospital sites.
13 8.1 Tab 8.1 Item 8.1 - Performance Report 3.2 Ambulance handover delays Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing
Handover delays in Gloucestershire are primarily at the GRH site since June 2020 due to the temporary downgrade of CGH to an MIIU. Since August 2020, there has been an slight increase in total handover delays, but overall time lost has increased more significantly. In line with the national picture, handover delays of more than 1 hour have
increased substantially since the start of December, reflecting increased pressure on flow through emergency
departments due to COVID-19.
65 of 486 65 14 8.1 66 of 486 66 Tab 8.1 Item 8.1 - Performance Report 3.2 Delayed Transfers of Care Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing
From March 2020, national reporting of DToCs has been postponed by NHSE/I to support trusts by removing some reporting requirements to free up staff capacity. This has meant that GHFT are not currently fully reporting all delays and validating the position, however delays are contributing to a rising number of patients medically stable at GHFT, which in turn is causing challenges with flow of patients through the acute hospital. GHFT have seen an increase in the number of days patients remain in acute beds whilst medically stable for discharge (MSFD), linked with delays in onward care pathways, and new reporting to reflect this is being designed. In order to reduce the number of patients in hospital who are MSFD we have been working as a system to increase the proportion of patients who are discharged straight home (with support where necessary), increase assessment bed capacity (so patients can have their Adult Social Care/Continuing Health Care assessment outside of hospital) and increase capacity in community hospitals.
In community settings, delayed transfers of care have remained low in the community hospitals, however DToCS have
begun to rise in mental health inpatient settings from the low point seen during the COVID-19 lockdown period.
14 8.1 Tab 8.1 Item 8.1 - Performance Report 3.2 Long Stays in the acute hospital Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing
Long stay monitoring has been updated to look at the proportion of total stays in acute hospitals where beds are occupied by patients with a length of stay (LOS) over 7, 14, and 21 days. At GHFT, the proportion of long stay patients dropped in comparison to the 2019 baseline during the initial COVID-19 surge, however has risen to above 2019 levels from the summer of 2020 onwards. Having risen to the highest point just before the Christmas period in December 2020, there has been a decrease in the proportion of long stay patients in all 3 LOS brackets into January 2021. This reflects continued efforts in the acute trust to keep the flow of patients through the hospital moving, and has been supported by significant expansion in assessment bed capacity. As of the 14th January there were 115 patients with a LOS over 21 days in GHFT, of whom 51 were medically stable (the majority were still unwell). Note that despite the proportion of patients with a stay of over 21 days remaining above the 2019 baseline level, the physical number of patients with a stay of over 21 days remains similar to 2019
levels. This is due to reductions and constrictions in the GHFT bed base as a result of COVID-19 social distancing
67 of 486 67 16 and infection control measures. 8.1 68 of 486 68 Tab 8.1 Item 8.1 - Performance Report 3.3 System Overview - Planned Care
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16 8.1 Tab 8.1 Item 8.1 - Performance Report 3.4 Planned Care - Diagnostic >6 weeks Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing
Overall performance in November continues to improve on the April/ May position for the CCG however remains significantly above the <1% of patients waiting more than 6 weeks for a diagnostic test standard at 18.9% (lowest performance level was May at 47.7%). This improvement in performance has been primarily driven by the GHFT position, which has improved this month to 14.1%, with around 300 fewer patients waiting more than 6 weeks for a diagnostic test compared to October. While for the CCG only Electrophysiology across all diagnostics met the standard, this was primarily driven by out of county performance, as GHFT has cleared the backlog in a numbers of tests, meeting the standard in: MRI, CT, Non Obstetric Ultrasound, Dexa Scan, Audiology Assessments, Electrophysiology, and Peripheral Neurophys. Endoscopy remains an area of concern, however November data shows activity returning to much higher levels than previously in the financial year. Suspected cancer patients requiring endoscopic diagnostics are triaged and prioritised for these test, and while there have been some delays, these have been minimised and are expected to reduce further with the implementation of FIT triage in primary care.
Due to the second surge of the COVID-19 pandemic, it is likely that diagnostics performance will be significantly impacted
69 of 486 69 once again in the coming months. 17 8.1 70 of 486 70 Tab 8.1 Item 8.1 - Performance Report 3.4 RTT
• Performance for November against the RTT standard is 71.3% for GCCG patients (% of the patient waiting list for
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing consultant led treatment waiting under 18 weeks). GHFT performance was 71.5%. Performance has held steady to the October position, but is likely to decline in the coming months as elective work is severely affected by the second wave of COVID-19. • While long waits have increased significantly since the start of the COVID-19 pandemic, the numbers of patients waiting more than 52 weeks has stabilised, with only a slight rise in 52 week breaches seen. There were 1315 over 52 week waits for the CCG, 1046 of which were at GHT. The majority of breaches are in T&O and “other” (mostly comprising Upper and Lower GI surgery). • The overall waiting list position at GHFT has also remained stable, with a slight decrease in total patients waiting for treatment in November 2020 compared to October – again, this position is likely to deteriorate with cancellation of elective work to support
the COVID-19 response.
18 8.1 Tab 8.1 Item 8.1 - Performance Report 3.5 2ww Overview Cancer Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing
71 of 486 71 19 8.1 72 of 486 72 Tab 8.1 Item 8.1 - Performance Report 3.5 System Overview Cancer
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20 8.1 Tab 8.1 Item 8.1 - Performance Report 3.5 System Overview Cancer Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing
73 of 486 73 21 8.1 74 of 486 74 Tab 8.1 Item 8.1 - Performance Report 3.6 Cancer - 2 week waits Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing
GCCG performance in November 2020 against the 2ww target declined slightly to 91.2% (October was 95.8%). There were 191 breaches in total, with the majority of the breaches occurring in the Breast pathway (88). Breast referrals have continued to be higher than 2019 levels in the last few months, which in combination with staff sickness has put pressure on the specialty at GHFT, a recovery plan is in place which includes the use of GLANSO clinics to support the clearance of the backlog and a capital bid for a new ultrasound machine to improve capacity. Other specialties failing to meet the 2ww standard were Sarcoma (1 breach), Lower GI (31 breaches), and Skin (31 breaches). The Lower GI specialty pathway has been severely impacted by COVID-19, with endoscopy capacity remaining below 2019 levels, and is likely to be further impacted by the second wave of COVID-19 . FIT triage has now been rolled out to primary care (go lived 23rd November), which will help improve patient experience and reduce
the pressure on endoscopy. GLANSO lists for endoscopy to reduce the scoping backlog are also being run where
possible.
22 8.1 Tab 8.1 Item 8.1 - Performance Report 3.7 Cancer - 62 days Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing
CCG performance met all first and subsequent treatment targets in November 2020, with activity for cancer treatments remaining broadly in line with 2019 levels and higher than many other trusts nationally. Against the 62 day referral to treatment standard, 82.3% of patients were treated within 62 days of a GP 2ww referral, with 96.9% of patients referred via a screening programme and 82.4% of consultant referred patients treated in this timeframe. Screening activity has increased significantly from the low numbers seen throughout the COVID-19 pandemic, but may again be impacted by the second surge in the winter months. For GP referred patients, there were 28 breaches: 2 in Breast (93.3%), 4 in Gynaecological (33.3%), 6 in Haematological malignancies (25.0%), 1 in Head & Neck (75.0%), 9 in Lower GI (57.1%), 2 in Lung (87.5%), 1 in Other (75.0%), and 3 in Urology (85.7%). Urology performance has significantly improved on its position in 2019, now meeting the 62 day standard, however referrals remain lower than previous levels which may imply some patients have not accessed their GP in the pandemic. Lower GI breaches are caused mainly due to patients being treated now they have received an endoscopic diagnostic following delays due to the endoscopy restrictions in the first COVID wave.
104 breaches
In November 2020 there were 4 104 day breaches for treatment for GCCG patients; 1 Gynaecological, 1 Haematological, 1 “Other” and 1 Breast
cancer patient. The overall patient waiting list for patients over 62 days is now just over 100, well below pre-COVID levels, and lower than the 75 of 486 75 23 150 target agreed with NHSE as part of the “Phase 3” recovery plan. 8.1 76 of 486 76 Tab 8.1 Item 8.1 - Performance Report 3.8 System Overview: Mental Health - IAPT
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25 8.1 Tab 8.1 Item 8.1 - Performance Report 3.8 Mental Health - IAPT
IAPT access rates had stabilised following the significant decline which occurred during the COVID response period, and in November 2020
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing have reached the annual equivalent of 20.5% of the estimated target population accessing IAPT services. This meets the planned levels for the end of 2019/20 and demonstrates the recovery in access rates following the first COVID surge. The service has reconfigured to allow continued provision of group therapy for IAPT via online services such as MS Teams, which allows patients a greater choice for their therapy. With additional restrictions and a new national lockdown in place, it may be challenging to sustain these levels in coming months.
Recovery rates for the IAPT service were also negatively impacted in the early part of the COVID response as patients chose to not complete therapy and due to the need to reorganise the service some sessions were cancelled. From June onwards however, the service has achieved the national recovery standard of 50% of those patients completing therapy moving to recovery, with the November recovery rate at 55.1% - which is an excellent result and compares extremely favourably with other services nationally.
77 of 486 77 26 8.1 78 of 486 78 Tab 8.1 Item 8.1 - Performance Report 3.9 Continuing Health Care - Referrals Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing
From 1st September, the COVID interim funding pathway has changed, so that now acute discharges requiring assessment or interim care follow a COVID discharge pathway. This will be funded for up to 6 weeks per patient by NHSE to facilitate discharge and will include end of life referrals from the acute, who would previously have been Fast Track patients, as well as other bed based pathways (for example non-weight bearing beds). As acute end of life discharges are not currently counted in the Fast Track numbers, it appears Fast Track referrals are lower than in 2019/20, however this is likely due to the change in pathway reflecting only community Fast Track referrals rather than a true reduction in numbers. All other referrals into CHC had returned to the pre-COVID process, with positive and negative checklist referrals at a similar level to the pre-COVID average in October 2020. November and December saw a slight drop in the number of positive and negative referrals, however Fast Track referrals from the community increased in December. The large number of positive checklists received in September 2020 reflects the patients who had previously been “interim COVID funded” from March 2020-August 2020 and received a positive checklist indicating that a full CHC assessment would be required. The full cohort of previously COVID interim funded patients are now being assessed to determine ongoing care and funding requirements. For this cohort, funding will continue centrally from NHSE until March 31st 2021, but all patients must be
assessed by this date. There is a dedicated team set up within CHC who are working in collaboration with Adult Social Care to
move appropriate patients onto other funding streams. 27 8.1 Tab 8.1 Item 8.1 - Performance Report
3.9 Continuing Health Care Assessments completed in 28 days
Referrals Concluded % Referrals Concluded within 28 days Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing
From 1st September national monitoring of the 28 day target for assessment time was reintroduced, with all referrals made from this time subject to the target. This also includes patients who were previously interim COVID funded but have had a positive checklist completed. In December 68 referrals were concluded, 46% within the 28 day timeframe – this is a similar level of activity to the pre-COVID average level and a slight dip in performance from the pre-COVID average of 53% concluded within 28 days. The ongoing work of the CHC team in assisting the COVID discharge pathway, in conjunction with the increase of assessments that have built up during the COVID response will likely impact performance through the coming months – there are currently 168 CHC cases waiting for assessment.
The assessment of interim COVID funded patients, and CHC cases which were deferred during the March-August period, has led to a number of outstanding assessments. Additionally, there are significant numbers of patients discharged under the COVID discharge scheme who also require assessment. The team currently project to complete all deferred assessments by February 2021. 79 of 486 79 28
8.1
80 of 486 80 Tab 8.1 Item 8.1 - Performance Report
Green Indicator Component Narrative Measure 4.0 Leadership (slide 1 of 3) Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Staff and OD Plan Turnover Rate: The report highlights that turnover for Dec has member Staff Survey increased to 13.20% form 12.45%. practice Turnover engagement Vacancies Staff in Post: Staffing levels for Dec – 306.36 FTE equating to a total Sickness headcount of 369. PDP/Training Leavers by Reason: There have been 6 new starters and 6 leavers for
Dec. Over the last 12 months there have been 48 leavers (40.12 FTE) and 59 starters (50.07 FTE).he report identifies 48 leavers over the 12 month period, the main reason for leaving over the last 12 months – 21 leavers due to promotion. Sickness Absence Rate: The data is indicating that short term absence has increased slightly from 0.88% to 1.00%. Long term absence has increased slightly to 1.00% from 0.97%. Sickness by Reason: For Dec 20 absence due to anxiety/stress has increased to 26.18% from 17.81%. The unknown sickness reason accounts for 29.57%. The overall cost of absence for Dec is £18,699 an increase of £4,139 with a total of 231 days lost (200.88 FTE) over 22 occurrences. This equates to 118 days (4 occurrences) for long term
sickness and 113 days (18 occurrences) for short term sickness.
29 8.1 Tab 8.1 Item 8.1 - Performance Report
Green
Indicator Summary and headline evidence/ examples (slide 2 of 3) 1. Probity and The CCG has put4 in .0place strongLeadership clinical and non clinical leadership across all areas of the ICS, recent developments include Governance investment in GP Provider leads to support local delivery and Integrated Locality Partnerships and Primary care Networks. ICS Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing governance structures include CCG staff in senior leadership roles in all areas of the programme alongside provider leadership roles ICS work programmes progressing with outcomes being seen in a number of areas, including cancer, MSK and eye health and also across health and wellbeing projects such as the daily mile and the community wellbeing service. HR and OD plan aligns to that of the ICS and is overseen by the HR/OD group who meet quarterly. There is a refreshed workforce and OD strategy, setting out establishment of the Gloucestershire Local Workforce Action Board (LWAB) to oversee the enabling workstream for the ICS. Further modelling is being undertaken on the current workforce and future changes and challenges, stage two of the workforce capacity plan has commenced. 2. Staff The CCG effectively engages with staff members with a Joint Staff Consultative Committee and an annual staff survey. The survey Engagement had a response rate of 79% which was positive. The CCG participated in the national staff survey in 2019 and the National Coordination Centre for the NHS staff survey published three sets of reports an Overall Summary, Full Report and Directorate reports. The three key improvement themes from the reports have focused on the quality of appraisals, team working and line management. There were positive results in terms of staff morale, recommendation of the CCG as a place to work and the organisation’s approach to staff health and wellbeing. Detailed reports and action plans will be submitted to the Quality and Governance Committee for review. 3. Workforce Race WRES data forms part of the CCG’s annual Equality and Engagement report, reported to the Quality and Governance Committee. Equality The 2018 annual report ‘An Open Culture’ will be considered by the Governing Body in March and published.
4. Effective The 2018/19 360 survey results show that 99% of respondents responded positively when asked to rate the effectiveness of their Working working relationship with the CCG, maintaining our scores from 2017. 91% of stakeholder rated the CCG positively on Relationships effectiveness as a local system leader, i.e. as part of an Integrated Care System (ICS). 94%. Of stakeholders confirmed that the CCG considers the benefits to the whole health and care system when taking a decision. The report included a host of very positive comments from all stakeholders and especially from GPs about the support and help they are given by the Primary Care Team. NHSE did not run this survey in 2019. 5. Compliance with The CCG is committed to embedding involvement in all areas of its commissioning activity and is able to provide clear evidence of statutory guidance progress against the 10 key actions including through the annual report, feedback website pages, communication engagement on patient and strategies and plans, consultation report, AGM and equality impact assessments. ICS engagement, first stage complete, Forest of
public participation Dean consultation completed and preparation underway for One Place Business case consultation, patient participation in urgent
care pathway design workshops this spring secured.
81 of 486 81 30 8.1 82 of 486 82 Tab 8.1 Item 8.1 - Performance Report
Indicator: Summary and headline evidence/ examples Green
6.1 Leadership ICS five year plan, developed from the FYFV signed off by all partners. CCG operational & financial plans developed from the STP plan, start4 point.0 April 2017Leadership. ICS work programme developing using(slide the agreed3 of 3) governance structure. The CCG is working with practices on developing their PCN structure and supporting the development of the ILPs. There is a strong relationship between the locality and the CCG through Integrated Locality Partnerships currently under development and the Primary Care Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Networks. Specific examples of good practice include several primary care events Commissioning event, Locum event, Productive Time etc. and an annual rolling programme of GP Practice visits and varied communication methods such as What’s New This Week and G Care. CCG OD plan focus on staff development and includes strong emphasis on formal appraisal including PDPs. There is co-ordinated staff training including financial training at all levels including Governing Body and all budget holders. Gloucestershire health and social care partners have been awarded the status of an Integrated Care System in recognition of its mature and collaborative working relationships system wide. 6.2 Quality of There is a clear governance structure in place which enables a focus on quality, performance delivery including contracts and Leadership finance within the Q&G, Audit & Risk Committee, Governing Body business meetings and the formal bi monthly Governing Body. Information is reported to each committee with a focus on key area of risk as well as the overall performance / finance position. The Governing Body is well sighted on financial and performance issues with regular informal and formal reporting. Meetings are well documented to evidence the level of discussion and challenge. Governing Body members expertise range from governance, clinical, financial, commercial and patient experience enabling a strong challenge.
6.3 Leadership The Governing Body has a clear constitution, policies, set roles and responsibilities which enable them to effectively challenge. A Governance recent review has been undertaken of the risk management process with a dedicated Risk Management workshop organised for Governing Body members and senior managers, which focused on risk appetite. Further changes have been implemented with the Audit & Risk Committee taking responsibility for assuring the GB on risk management. Each committee carries out a self assessment annually to inform future development.. The CCG has a robust corporate governance framework including policies, committee structure and monthly reporting to the GB on financial & performance risk including those within providers and contracts. External expert advice is taken where required e.g. legal advice on a judicial review. Clean external audit reports since inception. Internal audit annually cover transactional areas as well as developmental areas and are reported to Audit & Risk Committee, clinical audits and internal audits focusing on clinical areas are reported to the Quality and Governance Committee.
6.4 The ICS has a clear governance structure supported by a MOU which has been agreed by all partners, this is currently being Transformational updated. The Governing Body receives bi-monthly ICS reports which provide updates on key achievements, performance and Leadership areas of focus. Providers also report on ICS achievements to their respective boards. For example, partners are involved in
progressing the One Place programme to develop the urgent care system to improve the patient experience. A dedicated team
has been put in place to drive this project. The Gloucestershire Local Workforce Acton Board is working through key workforce
priorities, funding opportunities and evaluating R&R initiatives. 31 8.1 Tab 8.1 Item 8.1 - Performance Report
5.0 Sustainability - Month 09 Red YTD FOV YTD Running FOV Running Income and (Surplus)/ (Surplus) Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Expenditure Deficit /Deficit costs costs (see * below) In Year (£23k) * £6,103k * (£35k) (£16k)
Cumulative (£23k) * £6,103k * (£35k) (£16k)
YTD % YTD FOT % FOT Savings Savings Savings Savings Savings Programme £0k Cash 0% £0k 0% BPPC drawdown FOT capital
BPPC Cash TBC% 100% £190k (30 days) drawdown FOT Other M1-M7 Capital Metrics
97.4% 100% £295k
83 of 486 83 * The performance above is based on the assumption that the CCG will receive full reimbursement for costs outside 32
of the funding envelope relating to Hospital Discharge programme and Flu. 8.1 84 of 486 84 Tab 8.1 Item 8.1 - Performance Report 5.1 Sustainability – Executive Summary (1 of 2) • The CCG submitted a plan for M7-12 for a deficit of £12.4m. Subsequently, an additional allocation of £4m has been received toFOV assist surplus in reducingYTD Running the planned costs deficitFOV Running to £8.4m. costs Combined STP YT FOV surplus YTD Running costs OV Running costs Combined STP Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing • Additional funding outside the current financial envelope is available for the Hospital Discharge Scheme, Flu and COVID 19 vaccination programmes and some Independent Sector activity. As yet no additional funding has been so the financial position assumes all funding is received. • A year to date surplus and forecast deficit variance has been reported as per the table below:
YTD Forecast Variance Over/(Under) spend Over/(Under) £000 £000 £9,510k £25,154k I&E position 2,318 8,444 Less:- Add’l Funding due in addition to M7- (2,341) (2,341) 12 allocation Cash FOT Capital BPPC drawdown FOT capital M9 Summary Position when additional (23) 6,103
funding is included (not yet received)
• Within this forecast variance are costs of £2.3m relating to HDP, Flu, COVID vaccinations and Independent Sector for which the CCG will receive additional funding and therefore improve our position from £8.4m to £6.1m deficit. (see section 5.1).
• The CCG has continued to pay over 95% of invoices by value and volume within 30 days.
33 8.1 Tab 8.1 Item 8.1 - Performance Report 5.2 Sustainability – Interim Financial Regime
• Savings plans have been suspended for the period as the focus has been on the response to the
pandemic. FOV surplus YTD Running costs FOV Running costs Combined STP YT FOV surplus YTD Running costs OV Running costs Combined STP
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing • M6 was the final month where the monthly claims process was in operation and the final top up claims have now been received in full.
• An external audit is underway by Deloittes on behalf of NHSE/I which is reviewing the scope of claims made for COVID and review our prescribing forecasts to 30th September 2020. The audit concentrates on a number of transactions (incl Hospital Discharge Programme) and will review the governance, substance of the transaction and validate whether such spend represents a legitimate incremental cost in line with national COVID guidance . • In line with the national financial framework for M7-12 a system plan for this period was developed and submitted. This£9,510k showed a system£25,154k deficit of £28.4m for M7-12 2020/21. Within this position, the CCG position was a deficit of £12.4m. As reported last month, this plan has since been reduced to £8.4m. Cash BPPC FOTFOT capital Capital • The M7-12 plan submitted includesdrawdown planned expenditure on services to deliver additional elective activity, winter schemes and spend on schemes for the continued management of COVID within services. • On a monthly basis, a review of the financial position is undertaken to identify both risks and opportunities. Work is, also, ongoing to assess the recurrent position and to identify areas of efficiency or to improve productivity.
85 of 486 85 34 8.1 86 of 486 86 Tab 8.1 Item 8.1 - Performance Report 5.3 Sustainability – Resource Limit
The CCG’s confirmed allocation as at 31st December 2020 is £1,022.9m. However, this full year allocation is still categorised as wholly non-recurrent from a national perspective. The current Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing total includes all top-up/COVID reimbursement approved relating to M06.
£’000 Description 1,021,701 Total Allocation for April to November 2020 YTD QIPP FOT QIPP 99 Long Covid-19 Funding - to support the development of assessment clinics 81 Elective recovery / managing capacity funding -50 SWASFT£9,510k Regional£25,154k Winter Funds - HALO Correction 212 Primary care practice fellowship and mentor schemes 25 Ageing Well - EHCH training and development funding Cash 288 Diabetes FOT Capital BPPC drawdown FOT capital 477 Discharge Funding 42 SMI Outreach 9 SW Region Leadership Development programme 10 Clinical Leads Oximetry @Home
14 CYP Respite
1,022,908 Total
35 8.1 Tab 8.1 Item 8.1 - Performance Report 5.4 Sustainability – Acute
ACUTE SERVICES Total Forecast Trend YTD surplus FOV surplus YTD Running costs BudgetFOV Running costsVariance Combined STP
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Key £000 Over/(Under) Indicates a favourable movement in the month spend Indicates an adverse movement in the month £000 ACUTE SERVICES Summary 475,226 (930) Add’l Funding due in addition to M7-12 allocation 449 (Acute IS) TOTAL ACUTE POSITION (481)
Acute Commissioning (net spend after GCC income) (23) • The reported position is based on the current position where NHS providers are on on block payments, these payments were included in the budget setting for M7-12. Non Contract Activity 0 • Non Contract Activity is significantly reduced due to all NHS Trusts receiving payments from their host CCG rather than issuing invoices to each responsible commissioner CCG. The only
expenditure being incurred relates to either private providers or from those in devolved
assemblies. 87 of 486 87 8.1
88 of 486 88 Tab 8.1 Item 8.1 - Performance Report 5.4 Sustainability – Acute (cont’d)
Planned Care (incl AQPs) (573)
YTD surplus FOV surplus YTD Running costs FOV Running costs Combined STP
• The activity performed by Newmedica and other private providers has reduced below planned Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing levels . Although activity may rise in the remainder of the year, this is not anticipated to reach budgeted levels. COVID Expenditure (346) • A review of expenditure and accruals has been undertaken and any over and under accruals are being reflected within the CCG position. 8.1 Tab 8.1 Item 8.1 - Performance Report 5.5 Sustainability – Community
COMMUNITY SERVICES Total Forecast Trend YTD surplus FOV surplus YTD Running costs BudgetFOV Running costsVariance Combined STP Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Key £000 Over/(Under) Indicates a favourable movement in the month spend £000 Indicates an adverse movement in the month
COMMUNITY SERVICES Summary 89,301 (81)
• Gloucestershire Health & Care contract is being paid on a block arrangement each month, the position against this contract is a forecast of breakeven. • The CCG continues to underspend in community services due to a low take up in telehealth which continues the trend of previous years. The forecast relates to “business as usual” activity, telehealth relating to the COVID Virtual Ward is a separate contract and budget line to the main contract.
89 of 486 89 38 8.1 90 of 486 90 Tab 8.1 Item 8.1 - Performance Report 5.6 Sustainability – Primary Care Prescribing
PRESCRIBING Total Forecast Trend YTD surplus FOV surplus YTD Running costs BudgetFOV Running costsVariance Combined STP
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Key £000 Over/(Under) Indicates a favourable movement in the month spend Indicates an adverse movement in the month £000
PRESCRIBING Summary 93,736 435
• The latest data from NHS Business Services Authority (NHS BSA) received relates to September. When compared with the previous year, the cumulative position shows a 6.39% increase in spend (7.3% increase in the month).
• The year to date impact of No Cheaper Stock Option (NCSO) to September is £1.35m, this is £0.8m higher than the same period in 2019/20.
• Forecast impact of NCSO in October is expected to reduce to a similar level in October 2019. No
adverse movement has been included related to the estimated impact of EU Exit.
39 8.1 Tab 8.1 Item 8.1 - Performance Report 5.7 Sustainability – Mental Health MENTAL HEALTH SERVICES Total Forecast Trend Budget Variance Key YTD surplus FOV surplus YTD Running costs £000FOV RunningOver/(Under) costs Combined STP
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Indicates a favourable movement in the month spend Indicates an adverse movement in the month £000 MENTAL HEALTH SERVICES Summary 104,063 (237)
Mental Health Commissioning 0 • Gloucestershire Health & Care mental health element of the contract is paid on a block basis as per all NHS Providers. Learning Disabilities 348 • Activity has increased and also some complex packages have been reassessed which has led to additional costs being forecast; the budget was based on information that was available at the time the budget was set. LD placement expenditure can change at short notice due to the nature of the care required Mental Health Non Contract Activity (325) • As with Acute NCAs, costs only relate to private providers and those within devolved assemblies. In addition, under the national financial framework, no block contracts are paid in M7-12 for providers of less than £250k in a full year; AWP falls into this category. Acquired Brain Injury (141)
•
91 of 486 91 The patients that were in the Brain Injury Rehabilitation Unit (BIRU) have now been either
40 discharged or fall outside the CCG’s commissioning remit and no further activity has occurred. 8.1 92 of 486 92 Tab 8.1 Item 8.1 - Performance Report 5.8 Sustainability – Delegated Primary Care (excl Prescribing)
DELEGATED PRIMARY CARE Total Forecast Trend YTD surplus FOV surplus YTD Running costs BudgetFOV Running costsVariance Combined STP
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Key £000 Over/(Under) Indicates a favourable movement in the month spend Indicates an adverse movement in the month £000
DELEGATED COMMISSIONING Summary 95,647 (1,416)
• The underspend against this budget is primarily due to additional roles within Primary Care Networks (PCNs) where income additional to that originally included in the M7-12 budget has now
been included in the forecast to cover accelerated recruitment.
• Participation payments are showing spend below budgeted levels.
41 8.1 Tab 8.1 Item 8.1 - Performance Report 5.9 Sustainability – Other Primary Care (excl Prescribing)
OTHER PRIMARY CARE Total Forecast Trend YTD surplus FOV surplus YTD Running costs BudgetFOV Running costsVariance Combined STP
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Key £000 Over/(Under) Indicates a favourable movement in the month spend Indicates an adverse movement in the month £000
OTHER PRIMARY CARE Summary 37,004 662 Funding outside the envelope (Flu) (316) Funding outside the envelope (COVID vaccine) (87) TOTAL OTHER PRIMARY CARE POSITION 259
• Other Primary Care is currently forecast to overspend, however, this position includes additional COVID related expenditure on flu and COVID vaccine preparation costs which will be reimbursed by NHSEI, if this expenditure is excluded the position is an overspend of £259k. • There are some gains relating to supply of Oxygen where prices have been held by the CCG’s supplier (Air Liquide) • The overspend includes some COVID expenditure that had not been budgeted for in the M7-12 plan.
93 of 486 93 42 8.1 94 of 486 94 Tab 8.1 Item 8.1 - Performance Report 5.10 Sustainability – Continuing Healthcare and Placements
CONTINUING HEALTHCARE (CHC) Total Forecast Trend YTD surplus FOV surplus YTD Running costs BudgetFOV Running costsVariance Combined STP
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Key £000 Over/(Under) Indicates a favourable movement in the month spend Indicates an adverse movement in the month £000
CHC Summary 75,214 2,325 Funding outside the envelope (HDP) (2,387) TOTAL CHC POSITION (62)
• Within this area are the costs for Hospital Discharge Programme which are reimbursed by NHSEI on a claims basis. The CCG has requested funding of £2,387k for M07 – M09 in this category which relates to Hospital Discharge Schemes 1 and 2.
• Within the overall position there are some overspends, these relate to an increasing number of
personal health budgets and the costs of some LD related CHC placements.
43 8.1 Tab 8.1 Item 8.1 - Performance Report 5.11 Sustainability – Other
OTHER PRIMARY CARE Total Forecast Trend YTD surplus FOV surplus YTD Running costs BudgetFOV Running costsVariance Combined STP
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Key £000 Over/(Under) Indicates a favourable movement in the month spend Indicates an adverse movement in the month £0009
OTHER Summary 49,100 (124)
Recharges NHS Property Services Ltd 19 • The overspend in this area relates to additional charges for handback of sites for Cinderford and St Bedes; this means that the CCG will no longer incur any future charges for void space in these buildings. NHS 111 (188) • The underspend against the NHS111 contract is due to lower than anticipated COVID recharges by the supplier.
95 of 486 95 44 8.1 96 of 486 96 Tab 8.1 Item 8.1 - Performance Report 5.12 Sustainability – Corporate
DELEGATED PRIMARY CARE Total Forecast Trend YTD surplus FOV surplus YTD Running costs BudgetFOV Running costsVariance Combined STP
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Key £000 Over/(Under) Indicates a favourable movement in the month spend Indicates an adverse movement in the month £000
CORPORATE Summary 11,984 (16)
• As per NHSE/I guidance the CCG has included a forecast estimate for annual leave outstanding at
the year end.
• The above underspend is due to Property Services credits relating to Sanger House charges.
45 8.1 Tab 8.1 Item 8.1 - Performance Report 5.13 Sustainability - Savings Plan
• 2020/21 savings schemes have not been formally progressed during the current
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing period due to the COVID response within services.
• Some projects highlighted as potentially contributing to previously identified savings targets (such as on-line consultations for outpatients) have been progressed as an integral element of the system’s response to COVID.
• Further work is underway to review work undertaken as part of the response to Covid-19 to understand the ongoing benefits resulting from this work and whether these can be rolled out to other areas. Other work is looking at opportunities that align with the COVID recovery plans.
97 of 486 97 46 8.1 98 of 486 98 Tab 8.1 Item 8.1 - Performance Report 5.14 Sustainability – Financial Risks & Mitigations overview
• Additional costs of potential further COVID related activity • Potential shortfalls in reimbursement of COVID and top-up claims Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing • Prescribing volatility (incl COVID, Cat M and NICE FAD issues) Risks • Extent of Transformation funds in baseline/to be received • No reserves to cover additional cost pressures in year • Major slippage in delivery of saving solutions • Recurrent expenditure levels exceeding 20/21 allocation
• Potential receipt of 100% funding for top-up and COVID costs • Balance sheet reviews • No controllable expenditure to be committed if no identified funding source Mitigations • All commitments against new allocations to be identified
• No appointments made without identified funding
• Developments - release subject to Core Group sign off.
47 8.1 Tab 8.1 Item 8.1 - Performance Report 5.15 Sustainability – Expenditure relating to COVID 19
• From M1-6 COVID spend was fully reimbursed by a Top up which totalled £17.4m. M07 onwards any COVID expenditure must be offset by COVID budgets set for the period M7-12. Hospital Discharge Programme (HDP) and Flu are outside of this funding envelope and the CCG will receive additional Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing allocations for these elements. • HDP and Flu totals £2m for M7&8 which is within our spend profile but no assumption for income has been made therefore any additional allocation will improve the CCG position.
99 of 486 99 48 8.1 100 of 486 100 Tab 8.1 Item 8.1 - Performance Report 5.16 Sustainability – Cash Drawdown Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing
At the end of December, £803m had been drawn down in line with the forecast under the
emergency cash funding regime due to the pandemic.
The cash balance at the end of December was £2.4m
49 8.1 Tab 8.1 Item 8.1 - Performance Report 5.17 Sustainability – BPPC performance (30 Days) (1 of 2) Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing
101 of 486 101 50 8.1 102 of 486 102 Tab 8.1 Item 8.1 - Performance Report 5.17 Sustainability – BPPC performance (2 of 2)
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing All public sector organisations have been asked by the Treasury to pay try to invoices, where there is no dispute, within 7 days as a response to the Covid-19 Pandemic.
The current average payment timescales are shown below:
Average of new BPPC Days APR MAY JUN JUL AUG SEPT OCT NOV DEC NHS 9.5 9.7 10.2 10.1 8.5 10.4 13.4 12.1 7.8
NON NHS 15.1 12.6 12.0 11.3 11.3 11.5 12.3 12.3 12.1
Grand Total 13.6 12.0 11.8 11.2 10.9 11.5 12.4 12.3 11.9
51 8.1 Tab 8.1 Item 8.1 - Performance Report 5.18 Sustainability – I&E Position for Month 09 – December Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing
• The M06 Top up was fully reimbursed in M08. • Within this Forecast Variance is a pressure of £2.3m relating to HDP, Flu, COVID vaccinations and Independent Sector which should receive additional funding and therefore improve our position from £8.4m to £6.1m deficit.
103 of 486 103 52 8.1 104 of 486 104 Tab 8.1 Item 8.1 - Performance Report 5.19 Sustainability – Statement of Financial Position M09
Closing Opening Position as at Position as at 31st December 2020 1st April 2020 £000 £000 Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Non-current assets: Premises, Plant, Fixtures & Fittings 131 199 Total non-current assets 131 199 Current assets: Trade and other receivables * 57,401 5,917 Cash and cash equivalents 2,370 45 Total current assets 59,771 5,962
Total assets 59,902 6,161
Current liabilities Payables (62,884) (48,508) Provisions (1,122) (1,413) Total current liabilities (64,006) (49,921) Non-current assets plus/less net current assets/liabilities (4,104) (43,760)
Non-current liabilities Total non-current liabilities 0 0
Total Assets Employed: (4,104) (43,760)
Financed by taxpayers' equity: General fund * (4,104) (43,760) Total taxpayers' equity: (4,104) (43,760)
* Cash Paying10 months NHS SLA by Month 9 has led to £59m in prepayments under Trade and Other Receivables, it
has also caused a temporary positive general fund
53 8.1 Tab 8.1 Item 8.1 - Performance Report Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing
If you require more information than the data provided in the Monthly Performance Report or Accompanying Scorecard please contact: Performance Department - [email protected]
105 of 486 105 54 8.1 Tab 9 Item 9. Governing Body Assurance Framework Cover
Governing Body Meeting in Public
Meeting Date 28th January 2021 Title 1. Risk Management Report 2. Governing Body Assurance Framework
Executive The Governing Body is ultimately responsible for risk Summary management and ensuring that the CCG has a risk aware culture that is embedded across the organisation. A risk management report and the Governing Body Assurance Framework are reported to each Governing Body meeting. The Audit and Risk Committee has delegated authority from the Governing Body to oversee the structure, system and processes for risk management and to scrutinise and challenge risks.
The last Audit and Risk Committee was held on 8th December 2020 and is now not due to meet until 8th March 2021. However significant work has been 9 undertaken on the risk registers by each Directorate which has been reviewed by the Core Leadership Team. The updated GBAF was sent to the Audit and Risk Committee via email for virtual review and sign off. This means that the CCG can ensure that risk reviews and updates are dynamic and timely rather than slowed down by the schedule of committee meetings.
All risk leads are reminded to specifically highlight any major changes to the risk within the risk review comments including any reasons as to why these changes have occurred so that the Governance Team can track the changes and report these to the Audit and Risk Committee.
There is an agreed process of risk reviews with risk leads. Those changes are tracked and included in detailed reports for the Audit and Risk Committee which has delegated authority from the Governing Body to review and scrutinise risks. However for the 1
106 of 486 Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 Tab 9 Item 9. Governing Body Assurance Framework Cover
Governing Body this report highlights the more significant changes that have been made to risk and the rationale. This allows the Governing Body to concentrate on key risk changes.
Key Issues The following changes have been made to the GBAF risks but will be formally reviewed and approved where required by the Audit and Risk Committee on 8 March 2021:
o F&ID 10 (AMBER): Gloucestershire HSCN migration is behind schedule and may not complete by deadline. Risk score has changed from 16 (RED) to 12 (AMBER). Risk reviews explain the change in the score. These are the two reviews that were not picked up on the report (the latest one is on the attached report): . 7 of the 91 practices are currently on N3 awaiting migration. These are all waiting on BT for resolution. There is 9 no financial risk to the CCG but there is operational risk for the 7 practices who are on slower N3 lines. . 92% of migrations have taken place. 5 practices are in exception due to delivery issues with BT e.g. a new line needing planning to dig up the road and 2 practices failed the migrations and have been rescheduled. ID 21 (AMBER): Memory Assessment Service (MAS) has a backlog of in excess of 700 outstanding assessments (previously ID14 & ID15): Risk ID 14 + ID 15 were combined to form ID 21 in November 2020 and this change was reviewed at Audit and Risk Committee on 8th December 2020. CD 2 (RED): Risk of non-delivery of reduction in delays for patients who are clinically ready for hospital discharge: Recent surge in Covid-
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19 is impacting on provider services and significantly restricting patient flow. TSR 5 (RED): Risk that benefits are delayed due to short term pressures related to the Covid incident: Due to Covid-19 the risk reflects ‘medium-term pressure’.
Risks no longer on GBAF. Score has been reduced below a 12. F&ID 7 (AMBER): Data Landing Portal (DLP): All local data flows from providers in to CCG's must come via the DLP from April 20: In December the Risk Lead changed the current risk score from a 12 to an 8. Providers were DLP compliant although there remained some issues which are being worked through.
Management of None identified Conflicts of Interest 9 Risk Issues: The absence of a fit for purpose CRR & GBAF could result in risks not being identified, acted upon, and reported and gaps in control / assurances not being identified and addressed.
Original Risk 12 (3x4) Residual Risk 4 (1x4) Financial Impact See finance risks Legal Issues (including NHS Constitution) Impact on Health None Inequalities Impact on None Equality and Diversity Impact on None Sustainable Development Patient and Public Not applicable Involvement
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Recommendation The Governing Body are asked to consider and note the key changes to risks highlighted in this report: The GBAF Risk Report The GBAF
The Author Lauren Peachey and Christina Gradowski Designation Governance Manager and Associate Director of Corporate Affairs Sponsoring Cath Leech Director Chief Finance Officer (if not author)
9
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Report Date 18 Jan 2021
Risk Status Open Commissioning Directorate, Corporate Governance & HR Team, Finance & Information Directorate , Integration Directorate, Primary Care & Locality Development, Quality Directorate, Risk Registers Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Transformation & Service Redesign Directorate Risk Level
Control Status Existing
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1.Commission high quality, innovative services
Risk Risk Ref Risk Description Cause & Effect Original Risk Risk Control Control Assurance (Overall Overall Current Risk Action Required Action Progress Notes Target Risk Registers Rating Assurance) Assurance Rating Status Priority Assurance Level Finance & F&ID 10 Gloucestershire HSCN Cause I = 4 L = 4 Close monitoring of project delivery with BT Progress calls with CITS and Partial I = 4 L = 3 Ongoing discussions with BT and Outstandi 06 Aug 2020 I = 4 L = 1 Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Information migration is behind schedule All NHS organisations need to 16 and CITS by CCG project management BT and NHS Digital 12 NHSD to escalate the practice ng Practice 4 Directorate and may not complete by migration to the new HSCN network resources and Director. Assurance migrations migrations were deadline by September 2020. Historic issues Date: 06 Aug Person Responsible: Fiona delayed due to a Risk Owner: Cath Leech with a supplier, COVID impacts and 2020 Robertson delay in delivery of project delivery issues have put this the firewall by BT. Risk Lead: Fiona Robertson delivery at risk. Assurance By: To be implemented by: 12 Jan Practices have 2021 Last Updated: 11 Jan 2021 Effect Fiona now started to be Robertson migrated with an Latest Review Date: 06 Jan Large financial penalties and dual estimate of approx 2021 running costs after August 2020 if not implemented. Risk of bottleneck 30 sites being Latest Review By: Fiona slowing down network traffic, migrated by end of Robertson impacting productivity and service August. Weekly Last Review Comments: aim offerings. escalation to reduce this risk to an 8 by meetings taking end of next month as 7 sites place with BT and are remaining to be migrated. NHSD All are waiting on actions from Additional engineering resource Implemen BT. There is no financial risk to being provided to the project ted the CCG Person Responsible: Fiona Robertson To be implemented by: 17 Jul 2020
Finance & F&ID 13 JUYI-The breadth of clinical Cause I = 3 L = 4 Engage with TPP and JUYI Solution architect Ongoing monitoring for I = 3 L = 4 Implement alternative method for Outstandi I = 3 L = 2 Information data available through TPP The only available method of obtaining 12 to monitor for and generate proposal for availability of GP Connect 12 receipt of dataset ng 6 Directorate strategic reporting extract is primary care and community data is by alternative method of receiving data structured data. Dependency Person Responsible: Una Rice limited using a tool designed for reporting on supplier and NHSD purposes To be implemented by: 31 Jul Risk Owner: Cath Leech 2021 Risk Lead: Una Rice Effect some important clinical data is not Last Updated: 06 Jan 2021 being displayed in JUYI . (JUYI project Latest Review Date: 04 Nov risk log - risk 15) 2020 Latest Review By: Una Rice Last Review Comments: Recent discussion with TPP - Care Connect API available from June 2021
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Risk Risk Ref Risk Description Cause & Effect Original Risk Risk Control Control Assurance (Overall Overall Current Risk Action Required Action Progress Notes Target Risk Registers Rating Assurance) Assurance Rating Status Priority Assurance Level Integration ID 21 Memory Assessment Service Cause I = 3 L = 4 A countywide primary care pathway is being Remains ongoing - GP now Partial I = 3 L = 4 Monthly mettings with MAS Outstandi I = 3 L = 2 Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Directorate (MAS) has a backlog of in Due to Covid 19 the Memory 12 developed to assist with co-diagnosis – a trial supporting the pilot across the 12 service leads being arranged to ng 6 excess of 700 outstanding Assessment Service (MAS) was commenced in South Cotswolds during County to test and learn the Assurance agree the trajectory and check it’s assessments (previously ID14 closed to new referrals from 23rd September 2020 pathway. Date: 05 Nov on track. To review recovery plan & ID15) March 2020. Staff were redeployed to 2020 and its effectiveness. Risk Owner: Kim Forey Priority One services. Redeployed Person Responsible: Helen staff were phased back into the Assurance By: Ballinger Risk Lead: Helen Ballinger service to full capacity by August 2020 Clare Foster but remained closed to new referrals. To be implemented by: 29 Jan Last Updated: 23 Dec 2020 Meet monthly with Memory Assessment (MAS) Monthly data received and The service reopened to new referrals 2021 service leads to review progress & analysed via BI team Latest Review Date: 06 Jan in September 2020 this added to the performance against the trajectory and There is a need to spread the Outstandi 2021 waiting list which is in excess of 700 recovery plan. learning from South Cots ng Latest Review By: Clare people waiting for an assessment. Dementia Co-diagnosis Pathway Progress in this area will be assured by Progress is reviewed monthly Partial Foster Effect to Primary Care supporting GP's in Commissioners. and an overall MAS service Dementia Diagnosis Rate has dropped PCNs using the PDSA approach. Last Review Comments: review is being commenced in Assurance below the NHS Target of 67% and Risk reviewed - no change - partnership with GHC. Date: 05 Nov Person Responsible: Helen there is a lengthy waiting list for next update scheduled w/b 2020 Ballinger 18th January 2021. assessment for diagnosis. To be implemented by: 29 Jan Assurance By: 2021 Clare Foster Upskilling of Matrons to enable Outstandi 13 Nov 2020 Report to Core in January 2020 Holly Detre will report to Core them to complete co-diagnosis ng The upskilling of in January 2021 on the MAS matrons is taking Review. Person Responsible: Helen Ballinger place on a Reviewing the National model – checking old Attended NHSEi webinar in Partial monthly records for previous test results to help with December 2020 on Ensuring To be implemented by: 29 Jan supervision basis. diagnosis. High Quality Dementia Assurance 2021 Diagnosis - Learning will be Date: 05 Nov Developing video consultations Outstandi shared alongside the MAS 2020 Person Responsible: Helen ng review. Ballinger Assurance By: Clare Foster To be implemented by: 29 Jan 2021
3.Transform services to meet the future needs of the population, through the most effective use of resources
Risk Risk Ref Risk Description Cause & Effect Original Risk Risk Control Control Assurance (Overall Overall Current Risk Action Required Action Progress Notes Target Risk Registers Rating Assurance) Assurance Rating Status Priority Assurance Level
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Risk Risk Ref Risk Description Cause & Effect Original Risk Risk Control Control Assurance (Overall Overall Current Risk Action Required Action Progress Notes Target Risk Registers Rating Assurance) Assurance Rating Status Priority Assurance Level Commissionin CD 2 Risk of non-delivery of Cause I = 4 L = 4 'Activity, Flow & Bed Planning' Bronze Cell risk Partial I = 4 L = 4 Implementation of NHSEI ECIT Outstandi I = 3 L = 4 Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing g Directorate reduction in delays for patients Seasonal activity and surges in 16 register, monitoring and collaborative actions, 16 plan focussing on Home First and ng 12 who are clinically ready for attendance leading to operational using learning from COVID-19 response Assurance D2A. NOTE: this is an ongoing hospital discharge pressures across the system in terms Date: 27 Jul action ie currently on track Risk Owner: Mark of discharge processes. leading to 2020 Person Responsible: Sharon Walkingshaw some bottlenecks and trends and Nicholson themes that require mitigation for Assurance By: Risk Lead: Sharon Nicholson resilience of Flow. Penny Fowler To be implemented by: 01 Feb 2021 Last Updated: 06 Jan 2021 Effect Development Action Plan through AFPB Partial Latest Review Date: 14 Dec Poor patient experience. longer length Bronze Cell to Silver - includes commissioning Additional onward care capacity Outstandi 2020 of stay and delays in patients requiring increased onward care provision (assessment Assurance purchased: assessment beds, ng beds form the emergency department. beds, PoC & spot purchase), change to criteria Date: 14 Dec PoC and spot purchase Latest Review By: Penny for admission to Community Hospital beds, 2020 Fowler Person Responsible: Sharon pause to CHC assessments Nicholson Last Review Comments: Assurance By: Second COVID surge Penny Fowler To be implemented by: 01 Feb 2021 impacting on provider services Development AFBP section of Surge & Partial and significantly restricting Sustainability Plan based on 4 scenarios & Implementation of the updated Outstandi patient flow using learning from COVID-19 response Assurance Hospital discharge Policy and ng Date: 30 Jun operating model (HM Gov August 2020 2020) and associated governance framework requirements NOTE: Assurance By: this is an ongoing action ie Penny Fowler currently on track Development of link Activity and Bed Planning Partial Person Responsible: Sharon Bronze Cell with COVID-19 Recovery Nicholson Assurance To be implemented by: 01 Feb Date: 30 Jun 2021 2020 'Activity, Flow & Bed Planning' Outstandi 04 Aug 2020 Assurance By: Bronze Cell monitoring and ng Note: this is an Penny Fowler collaborative actions, using ongoing action learning from COVID-19 response. with regular review Monthly UEC Programme Group, with Partial NOTE: this is an ongoing action at AFBP meetings escalation to Bi-monthly A&E Delivery Board with review at AFBP meetings ie Assurance currently on track Date: 09 Aug Person Responsible: Sharon 2019 Nicholson Assurance By: To be implemented by: 01 Feb Lauren 2021 Peachey Task and finish groups will be set Implemen 07 Jan 2020 NHSEI ECIT (Emergency Care Improvement Partial up by exception to unblock any ted Task and finish Team) development of plan focussing on potential delays in progress. groups are set up Home First and D2A Assurance Person Responsible: Julia Doyle with system Date: 14 Dec partners, as 2020 To be implemented by: 08 Mar appropriate, to 2020 unblock system Assurance By: flow. Penny Fowler Oversight of delivery of these work streams to Partial be undertaken through Bronze Capacity Flow and Planning Cell accountable to Silver and Assurance Gold command until stood down Date: 30 Jun 2020
Assurance By: Penny Fowler
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3.Transform services to meet the future needs of the population, through the most effective use of resources
Risk Risk Ref Risk Description Cause & Effect Original Risk Risk Control Control Assurance (Overall Overall Current Risk Action Required Action Progress Notes Target Risk Registers Rating Assurance) Assurance Rating Status Priority Assurance Level Report weekly into the Regional NHSE Weekly Partial A&EDB/ICS Board to receive Implemen 13 Jan 2020 Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Operational Look Forward (WOLF) call to reports on all work streams ted Plan for discuss themes and trends,best practice and Assurance identified from UEC Summit monitoring key share learning. Date: 03 Sep including Top 3 priorities plus workstreams has 2020 plans on a page for ED been developed Attendance & Hospital Admission 03 Dec 2019 Assurance By: Avoidance, Improving Patient Flow Sharon and Living Well Ageing Well. update 09/08/2019 Nicholson Urgent & Person Responsible: Julia Doyle Emergency Care Sitrep submitted daily (24/7) to NHSE/I if Partial To be implemented by: 08 Mar Summit facilitated specified poor performance triggers have been 2020 with met - sitrep includes local system actions to Assurance representation deliver recovery Date: 28 Jul across health & 2020 social care partners. Three Assurance By: high priority Penny Fowler system actions System Escalation Calls based on agreed Escalation call gives Partial developed with Operational Escalation Levels (OPEL) assurance to system partners supporting actions Framework levels and agreed organisational that all effort is being Assurance to enable delivery actions, including new discharge pathways to undertaken to support patient Date: 30 Jun during 2019/20. meet new national guidance flow. Pathways re written to 2020 Oversight of delivery of these work Implemen 30 Apr 2020 meet Covid+ discharge streams to be undertaken through ted Implemented now guidance for ASC, CHC and Assurance By: Bronze Capacity Flow and Acute Trust. Penny Fowler also covers all Planning Cell accountable to case reviews Weekly systemwide Partnership Meeting, Partial Silver and Gold command until complex and out weekly hospital reviews of patients with stood down of area 14/21+ day LOS Assurance Person Responsible: Sharon 07 Jan 2020 Date: 24 Apr Nicholson 2020 Associate Director To be implemented by: 30 Apr of Commissioning Assurance By: 2020 has developed a Penny Fowler performance monitoring system for all programmes reporting into A&EDB. Escalation to Bi-monthly A&E Implemen Delivery Board as required ted Person Responsible: Sharon Nicholson To be implemented by: 30 Jun 2020 Development AFBP section of Implemen Surge & Sustainability Plan based ted on 4 scenarios & using learning from COVID-19 response Person Responsible: Sharon Nicholson To be implemented by: 20 Jul 2020
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3.Transform services to meet the future needs of the population, through the most effective use of resources
Risk Risk Ref Risk Description Cause & Effect Original Risk Risk Control Control Assurance (Overall Overall Current Risk Action Required Action Progress Notes Target Risk Registers Rating Assurance) Assurance Rating Status Priority Assurance Level Further development of SHREWD Implemen Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing (eg COVID, local service re- ted organisation) to support system partners to work together more effectively to resolve issues impacting on patient flow Person Responsible: Maria Metherall To be implemented by: 31 Jul 2020 Oversight of delivery of these work Implemen streams to be undertaken through ted Bronze Activity & Bed Planning Cell Person Responsible: Sharon Nicholson To be implemented by: 31 Jul 2020 AFPB section in Surge & Implemen Sustainability plan NOTE: series ted of deadlines through process - currently on track Person Responsible: Sharon Nicholson To be implemented by: 28 Aug 2020
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3.Transform services to meet the future needs of the population, through the most effective use of resources
Risk Risk Ref Risk Description Cause & Effect Original Risk Risk Control Control Assurance (Overall Overall Current Risk Action Required Action Progress Notes Target Risk Registers Rating Assurance) Assurance Rating Status Priority Assurance Level Commissionin CD 3 Risk of non-delivery of NHS Cause I = 4 L = 4 Bi-monthly review of 4 hour wait performance Review in A&EDB of 4 hour Partial I = 4 L = 4 Implementation & impact of Outstandi I = 4 L = 2 Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing g Directorate Constitution standard for - Operational challenges 16 data in A&EDB with key system partners, wait performance data for 16 Systemwide UEC Recovery Plan ng 8 maximum wait of 4 hours - Increased demand including NHSE/I Type1 A&E department & Assurance overseen by weekly UEC Bronze within the Emergency Effect Type 3 MIIUs provided by Date: 19 Aug Cell meetings NOTE: this is an Department - Delays to patient care GHFT or GHC 2020 ongoing action ie currently on Risk Owner: Mark - Negative patient This includes reviewing the track Walkingshaw experience/outcomes impact of COVID-19 and in Assurance By: Person Responsible: Jeannette - Reputational damage the context of temporary Penny Fowler Hudson Risk Lead: Jeannette Hudson reconfigurations of A&E and Last Updated: 07 Jan 2021 MIIUs To be implemented by: 01 Feb 2021 Latest Review Date: 07 Jan CCG lead for development and Partial 2021 implementation of systemwide collaborative Bi-monthly A&EDB with system Outstandi UEC Recovery Plan Assurance partners NOTE: meetings held bi- ng Latest Review By: Penny Date: 01 Oct monthly - currently on track Fowler 2020 Person Responsible: Jeannette Last Review Comments: In Hudson current Covid environment Assurance By: there is a focus on service Penny Fowler To be implemented by: 01 Feb 2021 sustainability with system Daily (24/7) review of SHREWD data; system Partial partners. Escalation Calls based on OPEL and Urgent & Emergency Care Bronze Outstandi Revisiting all recovery plans systemwide organisational actions agreed Assurance Cell (currently weekly) monitoring ng and redefining the focus of the Date: 24 Apr and collaborative actions, using UEC Bronze Cell. 2020 learning from COVID-19 response. NOTE: this is an ongoing action Assurance By: with review at UEC meetings ie Penny Fowler currently on track Demand within ED being controlled via new Partial Person Responsible: Jeannette developments that have been created in Hudson response to COVID 19. Public are however Assurance To be implemented by: 01 Feb being reminded to use services when they Date: 29 Apr 2021 have an emergency need 2020 Introduction of SHREWD will Implemen 13 Jan 2020 Assurance By: enable early and accurate ted Review of Maria identification of which parts of the SHREWD impact Metherall system are under pressure, during 'winter' improving the flow of patients period to be Development of Urgent & Emergency Bronze Partial across all pathways and reducing undertaken as part Cell, linking with COVID-19 Recovery - focus the time spent on future of Debrief session. on recovery, restoration & reform. Meetings Assurance conference calls to discuss currently weekly. Date: 30 Jun capacity management. 2020 Person Responsible: Julia Doyle Assurance By: To be implemented by: 08 Mar Penny Fowler 2020 Escalation to Bi-monthly A&E Delivery Board Partial
Assurance Date: 14 Dec 2020
Assurance By: Penny Fowler Monitoring implementation and impact of Partial Surge & Sustainability Plan Assurance Date: 14 Dec 2020
Assurance By: Penny Fowler
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3.Transform services to meet the future needs of the population, through the most effective use of resources
Risk Risk Ref Risk Description Cause & Effect Original Risk Risk Control Control Assurance (Overall Overall Current Risk Action Required Action Progress Notes Target Risk Registers Rating Assurance) Assurance Rating Status Priority Assurance Level Oversight of delivery of these work streams to Partial A&EDB/ICS Board to receive Implemen 13 Jan 2020 Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing be undertaken through ICC accountable to reports on all work streams ted Plan for Silver and Gold command until stood down Assurance identified from UEC Summit monitoring key Date: 30 Jun including Top 3 priorities plus workstreams has 2020 plans on a page for ED been developed Attendance & Hospital Admission 03 Dec 2019 Assurance By: Avoidance, Improving Patient Flow Penny Fowler and Living Well Ageing Well. 09/08/19 Urgent & Emergency Care Report daily into the NHSEI Regional Partial Person Responsible: Julia Doyle Summit facilitated Operational Centre (ROC) calls To be implemented by: 08 Mar with Assurance 2020 representation Date: 01 Dec across health & 2020 social care partners. Three Assurance By: high priority Penny Fowler system actions Sitrep submitted daily (24/7) to NHSE/I if Partial developed with specified poor performance triggers have been supporting actions met (eg sub 80% 4hr wait performance, 12 Assurance to enable delivery hour DTA breach) - sitrep includes local Date: 28 Jul during 2019/20. system actions to deliver recovery 2020 Oversight of delivery of these work Implemen 13 Jan 2020 streams to be undertaken by UEC ted Plan for Assurance By: Programme Group as agreed Penny Fowler monitoring key June 2019. workstreams has Working with system partners to mitigate risks Partial Person Responsible: Julia Doyle been developed and monitor performance in view of temporary 03 Dec 2019 GHFT reconfiguration of EDs Assurance To be implemented by: 08 Mar Date: 30 Jun 2020 09/08/19: 2020 Introduction of UEC Programme Assurance By: Group to have Penny Fowler multiagency oversight of progress against work streams. Implemen 14 Jan 2020 Task and finish groups will be set ted Increase in risk up by exception to unblock any rating due to potential delays in progress. deteriorating Person Responsible: Julia Doyle performance picture. To be implemented by: 08 Mar 2020 13 Jan 2020 System calls have increased to facilitate flow Further development of SHREWD Implemen (eg COVID, local service re- ted organisation) to support system partners to work together more effectively to resolve issues impacting on ED wait times Person Responsible: Maria Metherall To be implemented by: 30 Jun 2020
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3.Transform services to meet the future needs of the population, through the most effective use of resources
Risk Risk Ref Risk Description Cause & Effect Original Risk Risk Control Control Assurance (Overall Overall Current Risk Action Required Action Progress Notes Target Risk Registers Rating Assurance) Assurance Rating Status Priority Assurance Level Escalation to Bi-monthly A&E Implemen Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Delivery Board as required ted Person Responsible: Maria Metherall To be implemented by: 30 Jun 2020 Development of Urgent & Implemen Emergency Bronze Cell, linking ted with COVID-19 Recovery - focus on recovery, restoration & reform Person Responsible: Maria Metherall To be implemented by: 10 Jul 2020 Development Surge & Implemen Sustainability Plan based on 4 ted scenarios & using learning from COVID-19 response Person Responsible: Maria Metherall To be implemented by: 20 Jul 2020 UEC team lead on developing Implemen Surge & Sustainability plan NOTE: ted series of deadlines through process - currently on track Person Responsible: Maria Metherall To be implemented by: 28 Aug 2020 Development of Systemwide UEC Implemen Recovery Plan NOTE: this is an ted ongoing action ie currently on track Person Responsible: Maria Metherall To be implemented by: 01 Dec 2020
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3.Transform services to meet the future needs of the population, through the most effective use of resources
Risk Risk Ref Risk Description Cause & Effect Original Risk Risk Control Control Assurance (Overall Overall Current Risk Action Required Action Progress Notes Target Risk Registers Rating Assurance) Assurance Rating Status Priority Assurance Level Commissionin CD 4 Risk of failure to reduce Cause I = 4 L = 4 Adherence to NHSE/I escalation and reporting Partial I = 4 L = 4 Implementation & impact of new Outstandi I = 4 L = 2 Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing g Directorate demand and prevent Failure to implement agreed plans to 16 processes 16 Systemwide UEC Recovery Plan ng 8 avoidable emergency acute reduce avoidable ED attendances and Assurance overseen by weekly UEC Bronze attendances and admissions admissions Date: 24 Jul Cell meetings NOTE: this is an Risk Owner: Mark Effect 2020 ongoing action ie currently on Walkingshaw ED attendances and admissions track Assurance By: Risk Lead: Jeannette Hudson above planned levels Person Responsible: Jeannette Poor patient experience / outcomes Penny Fowler Hudson Last Updated: 07 Jan 2021 CCG lead for development and Partial To be implemented by: 01 Feb Latest Review Date: 07 Jan implementation of systemwide collaborative 2021 2021 UEC Recovery Plan Assurance Date: 01 Oct Progress Think NHS111First Outstandi 07 Jan 2021 Latest Review By: Penny 2020 initiative via collaborative working ng Think NHS111First Fowler to meet NHSE requirements successful GoLive Last Review Comments: In Assurance By: NOTE: this is an ongoing action on 01Dec20. current Covid environment Penny Fowler with review at Steering Group Direct booking meetings ie currently on track there is a focus on service Daily (24/7) review of SHREWD data; system Partial from 111 to sites is sustainability with system Escalation Calls based on OPEL and Person Responsible: Jeannette operational in partners. systemwide organisational actions agreed Assurance Hudson GRH, CGH and Revisiting all recovery plans MIIUs. Continued Date: 24 Apr To be implemented by: 01 Feb and redefining the focus of the 2020 development of UEC Bronze Cell. 2021 DoS pathways. Assurance By: 14 Dec 2020 Penny Fowler NHS111 Initiative Development of Urgent & Emergency Bronze Partial GoLive 01Dec20 Cell, linking with COVID-19 Recovery - focus Continue development of Cinapsis Outstandi 14 Dec 2020 on recovery, restoration & reform. Meetings Assurance to include additional specialties ng Roll-out to 10 currently weekly. Date: 30 Jun and features specialties 2020 NOTE: this is an ongoing action with review at Bronze Cell Assurance By: meetings ie currently on track Penny Fowler Person Responsible: Jeannette Directory of Services (DoS) provision of Partial Hudson accurate and complete information to support appropriate use of pathways Assurance To be implemented by: 01 Feb Date: 24 Jul 2021 2020 Bi-monthly A&EDB with system Outstandi partners NOTE: meetings held bi- ng Assurance By: monthly - currently on track Penny Fowler Person Responsible: Jeannette Escalation to Bi-monthly A&E Delivery Board Partial Hudson To be implemented by: 01 Feb Assurance 2021 Date: 01 Dec 2020 Urgent & Emergency Care Bronze Outstandi Cell (currently weekly) monitoring ng Assurance By: and collaborative actions, using Penny Fowler learning from COVID-19 response. NOTE: this is an ongoing action Monitoring implementation and impact of Partial with review at UEC meetings ie Surge & Sustainability Plan currently on track Assurance Date: 14 Dec Person Responsible: Jeannette 2020 Hudson To be implemented by: 01 Feb Assurance By: 2021 Penny Fowler
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3.Transform services to meet the future needs of the population, through the most effective use of resources
Risk Risk Ref Risk Description Cause & Effect Original Risk Risk Control Control Assurance (Overall Overall Current Risk Action Required Action Progress Notes Target Risk Registers Rating Assurance) Assurance Rating Status Priority Assurance Level Oversight of delivery resides within the ICS Partial Introduction of SHREWD will Implemen 13 Jan 2020 Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing bronze cells and work that is underway to enable early and accurate ted Review of support COVID 19 response. This will be Assurance identification of which parts of the SHREWD impact overseen by Tactical Silver and Gold Date: 30 Jun system are under pressure, during 'winter' 2020 improving the flow of patients period to be across all pathways and reducing undertaken as part Assurance By: the time spent on future of Debrief session. Penny Fowler conference calls to discuss capacity management. Promotion & continued development of Partial Cinapsis to support referring clinicians to use Person Responsible: Julia Doyle appropriate patient pathways, with focus on Assurance To be implemented by: 31 Mar care closer to home Date: 24 Jul 2020 2020 Task and finish groups will be set Implemen 13 Jan 2020 Assurance By: up by exception to unblock any ted Plan for Penny Fowler potential delays in progress. monitoring key Promotion and continued development of Partial Person Responsible: Julia Doyle workstreams has been developed SHREWD data to inform on current status of To be implemented by: 31 Mar indicators relating to UEC Assurance 2020 Date: 24 Jul 2020 A&EDB/ICS Board to receive Implemen 13 Jan 2020 reports on all work streams ted Plan for Assurance By: identified from UEC Summit monitoring key Penny Fowler including Top 3 priorities plus workstreams has plans on a page for ED been developed Report daily into the NHSEI Regional Partial Attendance & Hospital Admission 03 Dec 2019 Operational Centre (ROC) calls Avoidance, Improving Patient Flow Assurance and Living Well Ageing Well. 09/08/19 Urgent & Date: 01 Dec Emergency Care 2020 Person Responsible: Julia Doyle Summit facilitated To be implemented by: 31 Mar with Assurance By: 2020 representation Penny Fowler across health & social care Sitrep submitted daily (24/7) to NHSE/I if Partial partners. Three specified poor performance triggers have been high priority met - sitrep includes local system actions to Assurance system actions deliver recovery Date: 28 Jul developed with 2020 supporting actions to enable delivery Assurance By: during 2019/20. Penny Fowler Think NHS111 First initiative Partial Oversight of delivery of these work Implemen 14 Jan 2020 streams to be undertaken by UEC ted Risk has been Assurance Programme Group as agreed reduced as activity Date: 30 Jun June 2019. has not met the 2020 Person Responsible: Julia Doyle predicted demand during December To be implemented by: 31 Mar Assurance By: 2019. 2020 Penny Fowler 13 Jan 2020 Plan for monitoring key workstreams has been developed. Escalation to Bi-monthly A&E Implemen Delivery Board as required ted Person Responsible: Maria Metherall To be implemented by: 30 Jun 2020
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3.Transform services to meet the future needs of the population, through the most effective use of resources
Risk Risk Ref Risk Description Cause & Effect Original Risk Risk Control Control Assurance (Overall Overall Current Risk Action Required Action Progress Notes Target Risk Registers Rating Assurance) Assurance Rating Status Priority Assurance Level Further development of SHREWD Implemen Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing (eg COVID, local service re- ted organisation) to support system partners to work together more effectively to resolve issues impacting on ED attendances & admissions Person Responsible: Maria Metherall To be implemented by: 30 Jun 2020 Implementation of Think NHS111 Implemen First initiative ted Person Responsible: Maria Metherall To be implemented by: 20 Jul 2020 Development Surge & Implemen Sustainability Plan based on 4 ted scenarios & using learning from COVID-19 response Person Responsible: Maria Metherall To be implemented by: 20 Jul 2020 Launch of Think NHS111 First Implemen Steering Group ted Person Responsible: Maria Metherall To be implemented by: 04 Aug 2020 UEC team lead on developing Implemen Surge & Sustainability plan ted NOTE: series of deadlines through process - currently on track Person Responsible: Maria Metherall To be implemented by: 28 Aug 2020 Development of Systemwide UEC Implemen Recovery Plan NOTE: this is an ted ongoing action ie currently on track Person Responsible: Maria Metherall To be implemented by: 01 Dec 2020
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3.Transform services to meet the future needs of the population, through the most effective use of resources
Risk Risk Ref Risk Description Cause & Effect Original Risk Risk Control Control Assurance (Overall Overall Current Risk Action Required Action Progress Notes Target Risk Registers Rating Assurance) Assurance Rating Status Priority Assurance Level Commissionin CD 5 Risk of failure to comply fully Cause I = 4 L = 4 CCG Public awareness campaign to Partial I = 4 L = 4 Fortnightly meetings with NHSE/I Outstandi 26 Aug 2020 I = 4 L = 3 Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing g Directorate with NHS Constitution Operational challenges in dealing with 16 encourage patients to attend booked 16 NOTE: this is an ongoing action ie ng Meetings in place 12 standards for planned care the level of referral demand and appointments Assurance currently on track and will continue waiting times clearance of backlog of patients Date: 20 Aug Person Responsible: Christian for foreseeable Risk Owner: Mark waiting - exacerbated by impact of 2020 Hamilton future Walkingshaw COVID-19. Further increased risk due to second surge of COVID-19 Assurance By: To be implemented by: 01 Feb Risk Lead: Christian Hamilton 2021 Effect Penny Fowler Last Updated: 06 Jan 2021 - Delays to patient care Clinical validation and prioritisation of patient Partial 'Elective Recovery' Bronze Cell Outstandi 07 Nov 2020 Latest Review Date: 24 Dec - Negative patient experience/ clinical waiting lists, plus regular contact with patients monitoring and collaborative ng ERC continue to 2020 outcomes Assurance actions, using learning from monitor recovery - Increasing health inequalities Date: 20 Aug COVID-19 response. NOTE: this and latest COVID Latest Review By: Christian - Financial penalties (suspended 2020 is an ongoing action with review at impact. Recovery Hamilton during COVID response) Bronze Cell meetings ie currently is also monitored Last Review Comments: - Reputational damage Assurance By: on track weekly at the Surge 2 impact continues to Penny Fowler Person Responsible: Christian Adapt and Adopt impact on elective services Elective Recovery bronze cell oversight and Partial Hamilton Steering group. and is threatening to impact escalation Elective on cancer surgery over the To be implemented by: 01 Feb performance is on Assurance 2021 xmas/new year period. System Date: 20 Aug track and mostly actions to improve flow and 2020 back to pre- bed availability continue. COVID levels with Escalation to Silver and Gold Assurance By: the exception of cells in place. IS contract with Penny Fowler MRI which has Winfield has been extended to had equipment 31st March 2021 to support Regular contract and performance Partial failure issues. reduction of >52wk waiters. management governance in place to review performance and associated recovery plans. Assurance Implement all aspects of the Cancelled Date: 23 Jul RAPID prostate pathway 2020 Person Responsible: Christian Hamilton Assurance By: Penny Fowler To be implemented by: 31 Mar 2020 Reporting to NHSE/I on waiting times - currently fortnightly Commission additional short term Implemen 09 Mar 2020 capacity to reduce the >52 week ted Activity now fully Schemes to maximise use of available service Partial waits using funds from NHSE/I booked until the capacity and source additional capacity from end of March 2020 range of providers Assurance Person Responsible: Christian Date: 20 Aug Hamilton 2020 To be implemented by: 31 Mar 2020 Assurance By: Penny Fowler Planned Care section in Surge & Implemen Sustainability plan NOTE: series ted Work with primary care to manage referral Partial of deadlines through process - demand to secondary care currently on track Assurance Person Responsible: Christian Date: 23 Jul Hamilton 2020 To be implemented by: 24 Aug Assurance By: 2020 Penny Fowler
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3.Transform services to meet the future needs of the population, through the most effective use of resources
Risk Risk Ref Risk Description Cause & Effect Original Risk Risk Control Control Assurance (Overall Overall Current Risk Action Required Action Progress Notes Target Risk Registers Rating Assurance) Assurance Rating Status Priority Assurance Level Commissionin CD 8 SWAST have identified a risk Cause I = 4 L = 4 Governing Body Governing Body to receive Positive I = 4 L = 4 Investment in 111 to enable Outstandi I = 4 L = 2 Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing g Directorate in the SW to patients due to - Ambulance demand increases to 16 Risk Register and provide 16 additional clinical validation of Cat ng 8 call stacking (was QD11) levels where SWAST are unable to appropriate challenge Assurance 3 &4 calls that would have been Risk Owner: Mark respond within appropriate timescales. Date: 18 Sep passed through to SWAST. Walkingshaw Effect 2020 Person Responsible: Jeannette Risk Lead: Rob Mauler - Patients may wait longer for an Hudson ambulance Assurance By: Last Updated: 12 Jan 2021 Rob Mauler To be implemented by: 01 Feb - Patients may be exposed to increase 2021 Latest Review Date: 12 Jan risk of harm Quality and Governance Committee Quality and Governance Positive 2021 Committee to receive Risk Develop SWAST local and Outstandi Register and challenge Assurance regional demand management ng Latest Review By: Rob Date: 18 Sep actions and transformational plans Mauler 2020 Person Responsible: Jeannette Last Review Comments: 111 Hudson and Off Pathways validation Assurance By: now in place to help support a Rob Mauler To be implemented by: 01 Feb 2021 reducing in activity. Demand SWAST Contract Meetings established contract Positive Management Plan continues management structure New and additional resources Implemen to be implemented along side ted Assurance Person Responsible: Rob Mauler the SW transformation plan. Date: 23 Dec 2020 To be implemented by: 31 Mar 2020 Assurance By: Implement 'Think 111' Implemen 14 Dec 2020 Penny Fowler Person Responsible: Jeannette ted Think NHS111 SWAST Quality Risk Assurance Group QRAG to review risk and Positive Hudson Initiative GoLive report to CCGs 01Dec20 To be implemented by: 31 Dec Assurance 2020 08 Jun 2020 Date: 18 Sep Work continues to 2020 progress, especially through Assurance By: the use of Rob Mauler contractual leavers such as CQUIN in 111.
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3.Transform services to meet the future needs of the population, through the most effective use of resources
Risk Risk Ref Risk Description Cause & Effect Original Risk Risk Control Control Assurance (Overall Overall Current Risk Action Required Action Progress Notes Target Risk Registers Rating Assurance) Assurance Rating Status Priority Assurance Level Finance & F&ID 4 Local Digital Roadmap Unable Cause I = 4 L = 3 Digital Executive Steering Group Positive I = 4 L = 3 Strategy refresh & review Outstandi 15 Jan 2020 I = 4 L = 1 Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Information to Be Delivered Financial and workforce resources 12 12 including review of resourcing ng ICS Digital 4 Directorate Risk Owner: Cath Leech may not be available to deliver the Assurance requirements of each organisation Strategy required scope of the programme and Date: 13 Jan taking into account changes developed and Risk Lead: Tim Clarke projects within the STP. 2020 resulting from covid-19 response agreed by ICS Last Updated: 06 Jan 2021 Effect Person Responsible: Tim Clarke Executive Steering Assurance By: Group. Now each Latest Review Date: 06 Jan Roadmap not completed with Tim Clarke To be implemented by: 31 Mar organisation will 2021 corresponding impact on delivery and 2021 services ICS Digital Delivery Group Reporting to ICS Digital Positive put through own Latest Review By: Tim Clarke Executive Steering Group and governance, Last Review Comments: each organisation Assurance before coming to Going through prioritisation Date: 23 Oct ICS Board for sign process as part of Operational 2019 off. Planning process. 23 Oct 2019 Assurance By: Strategy refresh Alex Webb commenced to review resourcing over the next few years. Secure national funding when Outstandi 15 Jan 2020 available ng Ongoing action. Person Responsible: Tim Clarke In 2019/20 funding has been secured To be implemented by: 31 Mar from national 2021 funds for GPIT, HSLI (towards document sharing, EPR implementation and MDTs in acute) and ePMA . Further bids are awaiting outcomes such as eRostering. 23 Oct 2019 Bidding for national funds in progress. Baseline activities and resources Implemen 15 Jan 2020 across the Digital, Data, and ted Draft of prioritise Technology areas. roadmap has been Person Responsible: Tim Clarke created as part of Digital Strategy. To be implemented by: 31 Mar Awaiting outcome 2020 of financial planning to confirm. Resource profiling is underway. 23 Oct 2019 Digital Workforce Group initiated
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3.Transform services to meet the future needs of the population, through the most effective use of resources
Risk Risk Ref Risk Description Cause & Effect Original Risk Risk Control Control Assurance (Overall Overall Current Risk Action Required Action Progress Notes Target Risk Registers Rating Assurance) Assurance Rating Status Priority Assurance Level Potential risk to delivery to be Implemen 15 Jan 2020 Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing escalated to the ICS Digital ted Risk escalated Executive Steering Group with and approach options to mitigate risk agreed, to then Person Responsible: Tim Clarke review resourcing requirements To be implemented by: 31 Mar following 2020 agreement of financial envelope for Roadmap delivery and further understanding of national funding. 23 Oct 2019 On going dialogue with Countywide IM&T Group.
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3.Transform services to meet the future needs of the population, through the most effective use of resources
Risk Risk Ref Risk Description Cause & Effect Original Risk Risk Control Control Assurance (Overall Overall Current Risk Action Required Action Progress Notes Target Risk Registers Rating Assurance) Assurance Rating Status Priority Assurance Level Finance & F&ID 5 Increased risk of cyber attacks Cause I = 4 L = 3 CCG Policies designed to reduce the The CCG has policies in Positive I = 4 L = 3 Additional Network improvements Outstandi 22 Jul 2020 I = 4 L = 1 Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Information Risk Owner: Cath Leech - Cyber Attacks are becoming more 12 probability of attacks place to reduce the probability 12 underway following GPIT & Acute ng Business cases 4 Directorate sophisticated and common place. and contracts with the CSU Assurance central funding awards. Business for the network Risk Lead: Tim Clarke CCG systems are at a greater risk of and CITs which include cyber Date: 23 Oct cases for investment in security upgrades have Last Updated: 04 Nov 2020 being compromised. security advice and services. 2019 measures are in development. been approved. Implementation Latest Review Date: 06 Jan Effect Person Responsible: Tim Clarke - Data accessed, lost or corrupted, Assurance By: ongoing. 2021 Alex Webb To be implemented by: 11 Dec causing system wide failure. 15 Jan 2020 Latest Review By: Tim Clarke 2020 Contracts with CSU & CITS to provide cyber Monthly reports to the LDR Positive Moving forward Last Review Comments: security advice and services Infrastructure Group and CCG with BT proposal Updated Cyber Plan is being Infrastructure Group. Assurance for a secure created and a review of Cyber Date: 22 Jul gateway. Response Plan. New tools are NHS Digital on-going 2020 Anti-Virus solution evidenced to be blocking assurance. renewal has attacks and identifying Assurance By: happened ahead weaknesses. Lauren of moving to a More work to do on new ICS Peachey countywide team set up and processes. solution in 2021. Vulnerability scanning completed for CCG, GHFT and GCS. Security Information & Event Management dashboards are complete. Asset discovery complete for GHFT, CCG & GPs. Internal DSPT and Cyber Outstandi 15 Jan 2020 Essentials+ external assessments ng Cyber Audit undertaken remediation is Person Responsible: Tim Clarke Amber, some slippage expected To be implemented by: 31 Mar due to complexity 2021 in Domain Admin. 15 Jan 2020 Dionach have undertaken assessments of organisations in the ICS. Further NHS Digital assessments are being booked in. Plans for Windows 10 roll out this Implemen 15 Jan 2020 year will include free Microsoft ted Implementation is monitoring reviewed by the complete of National Cyber Security Centre Microsoft Person Responsible: Tim Clarke Advanced Threat Protection To be implemented by: 01 Jan 2020
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3.Transform services to meet the future needs of the population, through the most effective use of resources
Risk Risk Ref Risk Description Cause & Effect Original Risk Risk Control Control Assurance (Overall Overall Current Risk Action Required Action Progress Notes Target Risk Registers Rating Assurance) Assurance Rating Status Priority Assurance Level Cyber Security plan and status Implemen 23 Oct 2019 Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing across the ICS reported into ICS ted GPIT Cyber Digital Delivery Group Security PiD and Person Responsible: Tim Clarke Windows 10 PiD submitted to To be implemented by: 04 Feb NHSE for approval 2020 Free NHS Digital Board level Implemen 15 Jan 2020 Cyber Security is being proposed ted GHC have to understand and support completed board Executives to fulfil their Board level GCHQ level cyber security Certified SIRO responsibilities. Training with the Person Responsible: Tim Clarke Director of Finance and To be implemented by: 28 Feb Technology senior 2020 management from Templar.
Templar training has also been delivered to the Hospital Trust Executive CIO and his senior technology team. The Executive CIO will then be delivering this training to the wider Trust Executive team and CCG Governing Group in February. 10 Dec 2019 Cyber security training has been arranged for the 20th February 2020.
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3.Transform services to meet the future needs of the population, through the most effective use of resources
Risk Risk Ref Risk Description Cause & Effect Original Risk Risk Control Control Assurance (Overall Overall Current Risk Action Required Action Progress Notes Target Risk Registers Rating Assurance) Assurance Rating Status Priority Assurance Level Mandated and proactive Implemen 15 Jan 2020 Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing assessments to highlight areas to ted GHC currently improve cyber security measures have achieved (ongoing through Cyber Essentials Cyber Essentials + and DPSR audits and +, with the aim of accreditation) achieving this in Person Responsible: Tim Clarke Primary Care and CCG by March. To be implemented by: 01 May 2020 DSPR annual checks inform the cyber security plan for the year. Actions are tracked through the Digital Delivery Group. 15 Jan 2020 GHC currently have achieved Cyber Essentials +, with the aim of achieving this in Primary Care and CCG by March.
DSPR annual checks inform the cyber security plan for the year. Actions are tracked through the Digital Delivery Group.
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3.Transform services to meet the future needs of the population, through the most effective use of resources
Risk Risk Ref Risk Description Cause & Effect Original Risk Risk Control Control Assurance (Overall Overall Current Risk Action Required Action Progress Notes Target Risk Registers Rating Assurance) Assurance Rating Status Priority Assurance Level Quality QD 14 Risk to population health and Cause I = 4 L = 4 Incident Control Centre (ICC) has been Managed as part of the ICC I = 4 L = 4 Establish the Gloucestershire Outstandi I = 4 L = 2 Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Directorate delivery of healthcare related - Increased volume of patients 16 established at the CCG (from the 28th are: 16 Operations Centre with a remit to ng 8 services due to the impact of requiring hospitalisation; February). - Twice daily calls led by cover Covid-19, Winter Planning & Covid-19 - Increased likelihood of staff absence regional team with other Brexit arrangements. due to sickness or necessity to self- CCGs in the South West Risk Owner: Marion Andrews- isolate; - Weekly 'System Call'; Model will be aligned at NHSEI Evans - Volume of infectious patients - Bed Modelling planning and region level Risk Lead: Marion Andrews- attending emergency department; meetings; Person Responsible: Marion Evans - Poor patient flow; e.g. if Community Andrews-Evans Last Updated: 12 Jan 2021 Hospitals and Care Homes are not able to accept patient transfers from To be implemented by: 01 Nov Latest Review Date: 12 Jan hospital, it will result in delayed 2020 2021 discharges; Establish an Incident Control Implemen 16 Mar 2020 - Requirement to isolate patients who Latest Review By: Rob Centre at the CCG ted ICC established. Mauler have Covid-19; - NHS supply chain pressures Person Responsible: Teresa Last Review Comments: resulting in orders not being fulfilled; Middleton Managers: Risk Reviewed Andy Ewens Effect To be implemented by: 28 Feb (Emergency - Poor patient experience; 2020 Planning Manager, - Failure to comply with national CCG) standards i.e. 4 hour wait time; Teresa Middleton - Potential for suspension of elective (Deputy Director procedures; of Quality/Chief - Increased Length of Stay for patients Pharmacist, CCG) who are not able to be transferred to Community Hospital or Care Home; July 20 Debrief underway and Implemen - Risk, due to health and social care audit review commencing in ted staff absences, that packages of care August. may not be delivered; Person Responsible: Marion -cross infection risk between staff and Andrews-Evans patients in hospitals settings. To be implemented by: 30 Sep 2020
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3.Transform services to meet the future needs of the population, through the most effective use of resources
Risk Risk Ref Risk Description Cause & Effect Original Risk Risk Control Control Assurance (Overall Overall Current Risk Action Required Action Progress Notes Target Risk Registers Rating Assurance) Assurance Rating Status Priority Assurance Level Transformatio TSR 2 (T11) Risk of financial cuts to Cause I = 3 L = 4 'Regular joint meetings and agreement of joint Assurance from Governing Partial I = 3 L = 4 A review of Public Health core Outstandi 11 Jan 2021 I = 2 L = 4 Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing n & Service services provided by public Cuts to Council budgets each year 12 work plans with links to H&WB Board. Body 12 offer due to take place in spring ng This action 8 Redesign health. This includes, and is (including Public Health) and Assurance 2019. remains ongoing. Directorate not limited to, public health increasing demand for services each Date: 22 Jul Person Responsible: Jo campaigns, smoking cessation year. 2020 Underwood services etc. Effect To be implemented by: 31 Mar Risk Owner: Ellen Rule Some reduction in service provision Assurance By: Ryan 2021 Risk Lead: Jo Underwood i.e. Public Health Nurses Brunsdon Any reductions to Public Health Outstandi 11 Jan 2021 Last Updated: 28 Jul 2020 Short term funding for Independent budget discussed at JCPE ng This action Latest Review Date: 11 Jan Domestic Abuse Advisors in meetings. remains ongoing. 2021 Emergency Department Person Responsible: Jo Latest Review By: Ryan Underwood Brunsdon To be implemented by: 31 Mar Last Review Comments: 2021 Risk reviewed on 6th Jan 21. Meetings are currently underway Outstandi 11 Jan 2021 No changes required and still to identify and model impact. CCG ng This action scored at 3x4. currently working with GCC to remains ongoing. identify opportunities to joint 18 Sep 2019 commission, pool resources and mitigate risk. 1. PHE appointed 2 substantive Person Responsible: Jo public health Underwood consultants one of To be implemented by: 31 Mar which is an 2021 additional post.
2. CCG has re- instated CCG/Public Health interface meetings to oversee delivery of the Public Health Core Offer and keep abreast of any funding cuts to Public Health budget and impact on service delivery. These will re-commence from January 2019. Public Health budget ring fence Implemen was removed in 2016. GCC is now ted responsible for Public Health budget. Person Responsible: Jo Underwood To be implemented by: 31 Mar 2021
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3.Transform services to meet the future needs of the population, through the most effective use of resources
Risk Risk Ref Risk Description Cause & Effect Original Risk Risk Control Control Assurance (Overall Overall Current Risk Action Required Action Progress Notes Target Risk Registers Rating Assurance) Assurance Rating Status Priority Assurance Level Transformatio TSR 5 (T10) Risk that benefits are Cause I = 4 L = 4 Internal Assurance. Budgets approved by the I = 4 L = 4 All projects to have clear baseline Outstandi 11 Jan 2021 I = 2 L = 2 Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing n & Service delayed due to short term The potential causes of delayed 16 Governing Body. Monthly performance 16 monitoring with agreed KPIs so ng This action 4 Redesign pressures related to the Covid implementation are numerous reporting to CCG Governing Body and pathways. remains ongoing. Directorate incident. because of the complexity of some of quarterly reporting to the CCG's Audit and Risk Person Responsible: Kelly 11 Jan 2021 Risk Owner: Ellen Rule the changes and the fact that, often, it Committee. Matthews requires multi agency, system-wide This action Robust project management planning and Budgets approved by the Positive Risk Lead: Kelly Matthews working to deliver the changes. To be implemented by: 31 Mar remains ongoing. reporting between the PMO & BI Teams. Governing Body. Monthly 2021 Last Updated: 11 Jan 2021 Effect performance reporting to Assurance Latest Review Date: 11 Jan Under delivery of planned savings CCG Governing Body and Date: 22 Jul CPG team are working closely to Outstandi 11 Jan 2021 2021 targets quarterly reporting to the 2020 understand and assure that there ng Projects now CCG's Audit Committee. is suitable capacity within the being reviewed Latest Review By: Ryan Assurance By: team, and currently reviewing the and priorities for Brunsdon Ryan current impact that the Covid phase 4 delivery. Last Review Comments: Brunsdon pandemic has had and continues Risk reviewed on 08/01. to have on capacity. Issues are Please note that short term being escalated when appropriate. pressure is now changing into Person Responsible: Kelly medium term pressure. Risk Matthews score to remain at 4x4. To be implemented by: 31 Mar 2021 Dashboard development to aid Outstandi 11 Jan 2021 project manager reporting. ng This action Person Responsible: Kelly remains ongoing. Matthews To be implemented by: 31 Mar 2021 Monthly monitoring with focus on Outstandi schemes/changes at risk of non- ng delivery with agreement on remedial action. Person Responsible: Kelly Matthews To be implemented by: 31 Mar 2021
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3.Transform services to meet the future needs of the population, through the most effective use of resources
Risk Risk Ref Risk Description Cause & Effect Original Risk Risk Control Control Assurance (Overall Overall Current Risk Action Required Action Progress Notes Target Risk Registers Rating Assurance) Assurance Rating Status Priority Assurance Level Transformatio TSR 6 Post Covid risk that some of Cause I = 3 L = 5 Regular CPG meetings are being held with I = 3 L = 5 Capacity issues to be identified Outstandi 11 Jan 2021 I = 2 L = 2 Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing n & Service our system partners are no System Partners including clinicians, 15 providers to understand any changes to 15 and discussed within meetings ng This risk remains 4 Redesign longer able to support or drive public health professionals and capacity. with providers. ongoing. Directorate ICS / CPG programmes and managers may have timewise Review of stakeholder engagement as Internal Assurance with the Partial Person Responsible: Kelly projects. This also includes constraints given additional / new projects re-establish themselves. Escalation of different clinical programme Matthews insufficient CCG programme responsibilities or that their priorities issues promptly. Alternative stakeholders group meetings and clinical Assurance staffing resource to facilitate have changed post Covid. To be implemented by: 31 Mar identified. Focus resource on biggest benefits programme board. A monthly Date: 22 Jul change or undertake 2021 Effect and in line with post Covid priorities highlight report is also 2020 corporate & programmes. Under delivery of programme produced for the ICS Projects continue to be monitored Outstandi 11 Jan 2021 Risk Owner: Ellen Rule deliverables Executive. Assurance By: against identified KPIs. ng This risk remains Risk Lead: Kelly Matthews Ryan Person Responsible: Kelly ongoing. Brunsdon Matthews 18 Sep 2020 Last Updated: 28 Oct 2020 To be implemented by: 31 Mar Risk reviewed by Latest Review Date: 11 Jan 2021 AJ & RB on 15/09. 2021 Updates made to Latest Review By: Ryan risk control actions Brunsdon required, and target risk. Last Review Comments: Risk reviewed on 08/01. Risk Capacity issues are being Outstandi 11 Jan 2021 to remain at a 3x5. escalated before becoming ng This risk remains significant. ongoing. Person Responsible: Kelly Matthews To be implemented by: 31 Mar 2021
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5.Work with our partners and staff to promote both the physical and mental health and wellbeing of patients, carers, staff and the public
Risk Risk Ref Risk Description Cause & Effect Original Risk Risk Control Control Assurance (Overall Overall Current Risk Action Required Action Progress Notes Target Risk Registers Rating Assurance) Assurance Rating Status Priority Assurance Level Quality QD 3 Risk to financial performance if Cause I = 3 L = 4 The primary care prescribing budget has been The primary care prescribing Partial I = 3 L = 4 Monitoring and engagement with Outstandi 28 Oct 2020 I = 3 L = 1 Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Directorate prescribing costs are in excess Cause: 12 agreed and will be monitored. budget has been agreed and 12 overspending GP practices. CCG ng The promotion of 3 of the agreed budget. Unexpected national price increases will be monitored. Assurance Medicines Management and CCG cost savings plans to generic medicines which have been Date: 28 Nov GP Leads will plan to visit these Risk Owner: Marion Andrews- continue. specified by NHSE/DoH as a result of 2019 practices or highlight the issue to Evans However, Covid- either community pharmacy contract their PCNs. 19 pressures on Risk Lead: Mark Gregory national negotiations or manufacturing Assurance By: Person Responsible: Mark top of increases in Last Updated: 13 Jan 2021 and supply problems. There have also Lauren Gregory usual GP been additional Covid-19 related Peachey workload Latest Review Date: 13 Jan prescribing cost increases during Q1 To be implemented by: 31 Mar pressures, plus 2021 2020/21 resulting from an increased 2021 reducing in the Latest Review By: Mark volume of inhaler prescribing. capacity of the Gregory Ongoing primary care covid response CCG prescribing pressures have limited the appetite Last Review Comments: See support team has and capacity of GP practices to divert hindered progress. updated cause and effect attention to proactively maximising summaries above. An appliance additional prescribing savings this prescribing review year. This work has been further nurse will limited by the redeployment of the commence in CCG pharmacy team to support the October 2020. Covid-19 vaccination programme. 17 Jul 2020 Effect Cost savings plans continue. Effect: Focus is being Potential overspend of prescribing given to other budget of which there are limited areas of mitigating actions that can be prescribing undertaken. This is due to the including ostomy relatively short time period of products with the communication between NHSE/DoH recruitment to the and CCG's to highlight the issue vs the post of Specialist actual impact coming into effect. Plus Nurse to ensure ongoing primary care Covid-19 effective associated pressures limiting the prescribing in this capacity for the achievement of area of patient significant additional prescribing care savings this year.
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6.Deliver strong leadership as commissioners ensuring good governance and financial sustainability
Risk Risk Ref Risk Description Cause & Effect Original Risk Risk Control Control Assurance (Overall Overall Current Risk Action Required Action Progress Notes Target Risk Registers Rating Assurance) Assurance Rating Status Priority Assurance Level Commissionin CD 1 Risk of legal challenge to Cause I = 4 L = 3 Compliance with UK and EU Public Contracts Positive I = 4 L = 3 Procurement Strategy (1 Outstandi 06 Jan 2021 I = 4 L = 3 Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing g Directorate procurement decision Challenge from bidders based on 12 Legislation 12 December 2018 to 30 November ng No further action 12 Risk Owner: Mark perceived: Assurance 2020) has now been extended to required in Walkingshaw - Tender process Date: 02 Oct 31 March 2021 by agreement with January 2021 - Financial assessment 2019 the Core Leadership Team. 01 Sep 2020 Risk Lead: David Porter - Technical/quality assessment NOTE 1: this is an ongoing Revised Last Updated: 06 Jan 2021 - Award criteria Assurance By: requirement and reviewed on a - Selection criteria David Porter monthly basis. procurement Latest Review Date: 06 Jan - Conflicts of Interest strategy is being 2021 Evaluation Process to determine the most Allows the Authority to Positive Person Responsible: David developed and will Effect economically advantageous tender offer. equitably and fairly select the Porter be included in the Latest Review By: David - Reputational damage most economically Assurance September or Porter To be implemented by: 01 Feb - Financial consequences advantageous offer in Date: 02 Oct 2021 November 2020 Last Review Comments: No - Operational disruption of services accordance with UK and EU 2019 Governing Body further action required in procurement (Public agenda January 2021 Contracts) legislation and Assurance By: GCCG procurement strategy. David Porter New Procurement Strategy in Implemen 04 Aug 2020 place from 1 December 2018 to 30 ted Management of Conflicts of Interest - Following GCCG Standards Positive A revised strategy November 2020. A revised will be put in place associated with Procurement Processes of Business Conduct Policy strategy will be put in place in the - Completion of Declaration of Assurance in the event of event of changes to current changes to current Interest forms (authority and Date: 02 Oct legislation. potential bidding 2019 legislation organisations) Person Responsible: David 22 Jul 2020 - Mandatory Conflicts of Assurance By: Porter A revised strategy Interest training David Porter To be implemented by: 01 Dec will be put in place - Conflicts of Interest Register 2018 in the event of published on GCCG external changes to current website (Completed legislation. Procurements page)
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6.Deliver strong leadership as commissioners ensuring good governance and financial sustainability
Risk Risk Ref Risk Description Cause & Effect Original Risk Risk Control Control Assurance (Overall Overall Current Risk Action Required Action Progress Notes Target Risk Registers Rating Assurance) Assurance Rating Status Priority Assurance Level Finance & F&ID 2 The CCG does not meet its Cause I = 4 L = 5 Assessment of all transfers validated and Assessment of all transfers Positive I = 4 L = 5 Assess impact of all transfers and Outstandi 03 Nov 2020 I = 4 L = 1 Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Information breakeven control total in One or a combination of: 20 quantified validated and quantified 20 ensure resource transfers match ng 20/21 plan 4 Directorate 2020/21 - Non delivery of transformational Assurance where appropriate submitted and Risk Owner: Cath Leech savings; Date: 22 Jul Person Responsible: Andrew design underway - Unplanned prescribing demand; 2020 Beard on intra-ICS Risk Lead: Andrew Beard - Growth and demand increases (incl variation process Last Updated: 29 Dec 2020 CHC and LD); Assurance By: To be implemented by: 31 Mar to ensure - Changes in commissioning Alex Webb 2021 neutrality of any Latest Review Date: 29 Dec responsibilities; Block contracts with Trusts agreed during Analysis of basis of block to Partial financial 2020 - Primary care expenditure in excess COVID period ensure clarity in approach movements. All of allocation. Latest Review By: Andrew between organisations re: Assurance inter-system - COVID-19 response not funded in Beard NHSEI top ups. Ensure that Date: 21 Jul adjustmenst to full no additional charges are 2020 follow national Last Review Comments: - Lack of contract monitoring data incurred outside of blocks process Reviewed on 29/12/20 - Temporary NHSEI financial regime Block approach extended to Assurance By: 09 Oct 2020 unsupportive of top-up requests and March 21 with controls on Lauren lack of clarity of transformational Block contract spend outside Peachey funding values extended - Inability to pursue savings Contract monitoring in place Monthly contract monitoring in Positive to 31 March 21 programme during COVID period place with current Assurance system planning Effect Date: 23 Jul exercise to inform This will result in the CCG not being 2020 updated value. able to meet its breakeven control total Variations in 2020/21. Assurance By: between - Increased prescribing costs; Lauren CCG/provider will - Increased expenditure on CHC and Peachey follow a national LD cases; variation process - Increased expenditure in Ensure that additional, appropriate funding is Monthly bridge analysis Partial (details tbc) commissioning. requested from NHSEI via the monthly top-up provided to NHSEI to support process and that all excess COVID-related COVID/top-up requests. Assurance Close monitoring of assumptions Outstandi 01 Dec 2020 costs are claimed for Ongoing contact with NHSEI Date: 10 Aug against initial plan ng M6 COVID/top-up re: funding decisions 2020 Person Responsible: Andrew rec'd in full from Beard NHSE. Some Assurance By: central review Andrew To be implemented by: 31 Mar issues flagged Beard 2021 nationally (pot'l Financial controls & processes in place CCG constitution including Positive retro review) Standing Orders, Prime 03 Nov 2020 financial Policies and Scheme Assurance System and of Delegation approved Date: 21 Jul organisational 2020 plans submitted for remainder of Assurance By: 20/21 which Lauren include assumed Peachey commitments for Financial plan aligned to commissioning Robust financial plan aligned Positive top- strategy to commissioning strategy. up/COVID/growth Once allocation has been Assurance for all system received from top-ups/COVID Date: 25 Sep partners budgets will be reinstated to 2019 expected plan (subject to receipt of further national Assurance By: guidance) Lauren M7-12 under development Peachey across system
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Governing Body Assurance Framework
6.Deliver strong leadership as commissioners ensuring good governance and financial sustainability
Risk Risk Ref Risk Description Cause & Effect Original Risk Risk Control Control Assurance (Overall Overall Current Risk Action Required Action Progress Notes Target Risk Registers Rating Assurance) Assurance Rating Status Priority Assurance Level ICS Solutions/Savings reviewed when Savings plans developed Partial Regular reporting to Governing Implemen 22 Jul 2020 Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing appropriate with appropriate governance Body, F & P Ctee and managers ted 21 July 2020 processes including Assurance Person Responsible: Alex Webb Monthly reporting monitoring Date: 23 Jul undertaken 2020 To be implemented by: 30 Oct against nationally 2019 set budgets with Assurance By: further detail on Lauren budgetary issues Peachey expanded by area. Robust cash monitoring with early warnings Robust cash monitoring with Positive 25 Sep 2019 early warnings Regular review of Assurance risks and Date: 23 Jul mitigations within 2020 overall financial position Assurance By: Lauren Budgets under constant review Implemen 22 Jul 2020 Peachey Person Responsible: Alex Webb ted 21 Jul 2020 Budget analysis To be implemented by: 30 Oct undertaken and 2019 reviewed against basis of centrally calculated budgets Bridge analysis constructed on an ongoing basis to identify COVID costs/potential issues in national expectations/ real under/over spends Ensure adequate Working capital Implemen 22 Jul 2020 and drawdown availability ted 21 Jul 2020 Person Responsible: Alex Webb Monthly cash forecasts To be implemented by: 30 Oct undertaken to 2019 include all projected expenditure (no cash limit for M1-4 but awaiting guidance thereafter) 25 Sep 2019 Ongoing cash monitoring and reporting to Governing Body including progress against Maximum Cash Drawdown limit
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Governing Body Assurance Framework
6.Deliver strong leadership as commissioners ensuring good governance and financial sustainability
Risk Risk Ref Risk Description Cause & Effect Original Risk Risk Control Control Assurance (Overall Overall Current Risk Action Required Action Progress Notes Target Risk Registers Rating Assurance) Assurance Rating Status Priority Assurance Level CCG QIPP plans monitoring Implemen 23 Jul 2020 Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing arrangements being refreshed ted System efficiency Person Responsible: Alex Webb plans being evaluated post- To be implemented by: 30 Oct CoVid to detemine 2019 the scale of transformation that occurred during the pandemic and how efficient the new revised pathways are in terms of patient access and cost of delivery. Where pathways have changed and become more efficient, then these will be included in the system efficiency plan for 2020/21 and 2021/22. 02 Dec 2019 No updates as of 02/12/2019 -AW
Quality QD 12 EU-Exit arrangements Cause I = 4 L = 3 LHRF Business group are co-ordinating the GCCG are fully engaged with Partial I = 4 L = 3 All providers have been asked to Implemen I = 4 L = 1 Directorate affecting some areas of Cause: 12 planing arrangements and liaising with the the NHSE EU Exit Planning 12 undertake risk assessments and ted 4 healthcare delivery - Due to the uncertainty surrounding LRF SCG. If no-deal by last week of Group. The CCG's Executive Assurance develop contingency plans.. They Risk Owner: Teresa EU Exit arrangements December 2020, then the Exec LHRF will co- Nurse is a member of the Date: 18 Sep have been asked to contact their Middleton These include: ordinate actions at an operational level. NHSE Local Health Resilience 2020 suppliers to make sure they also • supply of medicines and vaccines; and CCG are members of the LRF SCG. Forum (LHRF) and works with have plans in place. Risk Lead: Chris LLewellyn • supply of medical devices and CCG EU Exit lead will work with the LHRF at the Business Group who will Assurance By: Person Responsible: Teresa Last Updated: 18 Sep 2020 clinical consumables; the end of November, to plan potential ongoing be coordinating local planning Rob Mauler Middleton • supply of non-clinical consumables, arrangements to commence Jan 1st 2021. arrangements. Latest Review Date: 12 Jan goods and services; To be implemented by: 29 Mar 2021 • reciprocal healthcare; 2019 Latest Review By: Rob • research and clinical trials Observe information sources and Implemen Mauler Effect publications, Maintain links with ted Last Review Comments: Effect: the LHRF and early warning Risk Reviewed - shortages of certain medicines groups. and/or devices, requiring changes to Person Responsible: Chris product selection where possible, or LLewellyn alternative supplies to be sourced, which could cause significant delays to To be implemented by: 28 Aug treatments 2020
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7.Develop plans for proactive care focused on early intervention, prevention and detection of mental health and physical health conditions.
Risk Risk Ref Risk Description Cause & Effect Original Risk Risk Control Control Assurance (Overall Overall Current Risk Action Required Action Progress Notes Target Risk Registers Rating Assurance) Assurance Rating Status Priority Assurance Level Integration ID 20 Lack of Psychology resource Cause I = 3 L = 4 Reviewed monthly at the Rehab Steering I = 3 L = 4 Determine the position of the Implemen I = 3 L = 3 Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Directorate in Community Services which Covid pandemic has further exposed 12 Group and within the Covid Bronze Cell 12 Psychology Service post 2g and ted 9 deliver rehabilitiation the lack of access to psychological GCS merger for this group of Risk Owner: Kim Forey services which support people during patients. their rehabilitation. Risk Lead: Debbie Gray Person Responsible: Debbie Effect Gray Last Updated: 16 Dec 2020 A proportion of people will not derive To be implemented by: 31 Dec Latest Review Date: 06 Jan maximum effectiveness from physical 2020 2021 rehabilitation due to psychological barriers resulting in potentially Latest Review By: Clare increased use of health and social Foster care resources. Last Review Comments: Risk reviewed - no change - next update scheduled w/b 18th January 2021.
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9.1 Tab 10 Item 10. ICS Lead Update Report Cover
Agenda Item 10 Governing Body
Meeting Date 28 January 2021
Report Title Integrated Care System (ICS) Lead’s Update
Executive Summary This report provides an update on Gloucestershire Integrated Care System.
The report provides an insight into the progress being made in the ICS transformation programmes against the system vision and priorities and how this has changed and during the Covid-19 outbreak. Key Issues
Risk Issues: ICS programme risks are regularly reported to ICS Executive as a standing item. Original Risk (CxL) Residual Risk (CxL) Management of N/A Conflicts of Interest Financial Impact N/A 10
Legal Issues N/A (including NHS Constitution) Impact on Health The report supports the effort to reduce health Inequalities inequalities Impact on Equality The report positively impacts on improving and Diversity equality and diversity Impact on N/A Sustainable Development Patient and Public The report considers the matters of public Involvement engagement and is also submitted to the Health and Care Overview and Scrutiny Committee. Recommendation Governing Body/Board members are asked to note the content of the report.
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Author Emily Beardshall: Deputy ICS Programme Director
Sponsoring Director Ellen Rule: Director of Transformation & Service (if not author) Redesign
10
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January 2021 One Gloucestershire ICS Lead Report
1. Introduction
Since March 2020, the Health and Care system in Gloucestershire has been responding to the COVID-19 pandemic as a major incident. Our incident response has seen some changes to the way health and social care is being delivered to our population. The following report provides an update to Board and Governing Body members on the work of key programme and projects across Gloucestershire’s Integrated Care System (ICS) during this time.
Some of our programmes’ focus has inevitably changed during the pandemic and certain activities have been accelerated or prioritised because of the COVID-19 response. As numbers of Coronavirus positive cases continue to rise we will carry on focusing on demand on services including winter pressures and ongoing recovery from phases of the pandemic. This includes continuing to return to a new ‘business as usual’, restarting our programmes as appropriate, and reprioritising in light of the new environment we are operating in. Our Phase 3 plan in response to the NHS COVID-19 Pandemic Guidance has been submitted and this further outlines our future 10.1 plans.
From April 2020 we moved into the fourth year of our Sustainability and Transformation plan. One of the roles of the ICS is to improve the quality of Health and Care by working in a more joined up way as a system. One ‘silver lining’ of the COVID-19 incident is that we have many new examples of excellent system working and delivery of best practice during the past few months, which the ICS have captured and intend to build on as we move forward.
COVID-19 Response The incident response has been delivered through a bronze, silver and gold command structure, working in partnership with the Local Resilience Forum and co-ordinating the NHS response across partner organisations. As numbers of positive Coronavirus cases continue to rise the work of the cells carry on evolving to ensure that the system is able to respond to pressures over the forthcoming months and through ongoing recovery.
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COVID-19 Recovery Throughout December and January the number of patients with COVID-19 requiring admission has increased and all parts of the system are now under significant pressure with staff extremely tired. We expect hospital cases to continue to rise throughout January placing significant pressure on the system. The situation is being carefully monitored and we are responding to the changes in national guidance. As emphasised nationally everyone should continue to access planned and emergency health and care services as planned/required.
Our system continues to work on the recovery and restoration programme set out by the NHS which describes how health and care services will return to near normal levels of delivery. The Gloucestershire system has made very good progress in re-establishing services and promoting access to those services however there is recognition that services cannot return to previous operating models for a range of reasons: Loss of productivity due to increased need for infection control measures in all health and care services, which include but is not limited to extended use of PPE for staff and patients, additional requirements for cleaning between patients, social distancing measures limiting the use of services delivered to groups and access to facilities The ongoing additional support needed for people in the shielded and vulnerable categories, coupled with these services needing to be delivered through virtual means Managing increased winter pressures, including the second peak of COVID-19 and the potential for these to coincide with a future seasonal flu peak. 10.1
We will continue to provide as much routine activity as possible throughout the second peak of COVID-19. During the November outpatient and elective activity was at a good level compared with 2019. The more recent increase in pressure due to rising Covid levels will impact across all services.
During December we launched the ‘Help your GP surgery’ campaign which encourages the public to support primary care as they face immense ongoing pressures, juggling not only the usual business, COVID-19, flu vaccinations alongside playing an important role in the COVID-19 vaccination programme. More information can be found below; https://www.gloucestershireccg.nhs.uk/senior-doctors-say-help-your-gp-surgery-to-help-you/
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Focus on COVID-19 Vaccination Programme
On the 9th December we welcomed the news that the independent Medicines and Healthcare products Regulatory Authority (MHRA) had confirmed that one of the highly anticipated COVID-19 Vaccinations, the Pfizer/BioNTech vaccine had been approved for use. This approval follows months of rigorous clinical trials with over 40,000 global study participants and a thorough analysis of the data by scientists and experts at the MHRA who have concluded that the vaccine has met its strict standards of safety, quality, and effectiveness. The Government announced that the vaccine would be made available across the UK from the following week.
The Joint Committee on Vaccination and Immunisation (JCVI) have publishing its latest advice for the priority groups to receive the vaccine, including care home residents, health and care staff, the elderly and the clinically extremely vulnerable.
The NHS has decades of experience in delivering large scale vaccination programmes and extensive planning has been underway nationally and in our region to ensure we were ready to deliver the new vaccine once approved. These plans have now been put into action with GHFT the lead organisation
Gloucestershire has adopted an innovative model of community vaccination building on existing 10.1 expertise and strong local networks and partnerships. Primary Care Networks are involved in delivering vaccinations to their geographical population. GPs and community NHS teams in some areas of the county began administering COVID-19 vaccination to priority groups from mid- December. Starting with people over 80, the roll out of the vaccination programme will be expanded in the coming weeks and months to include other priority groups by age and people who are particularly vulnerable. Local people are being asked to wait for their GP surgery to contact them about local arrangements and timings.
Based on local arrangements, clinics will be in GP surgeries, community centres or hospitals and confirmed ‘Wave 1’ locations are
Cheltenham East Fire Station North Cotswold Hospital, Moreton in Marsh
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The Devereux Centre, Tewkesbury
Rosebank Surgery, Gloucester
Vale Community Hospital, Dursley.
Further sites supporting COVID-19 community vaccination in the county are now confirmed. They are:
Churchdown Community Centre Rowcroft Medical Centre, Stroud Old Cinderford Health Centre, Forest of Dean Cirencester Hospital Beeches Green Health Centre, Stroud.
Further information along with short films featuring day one at our vaccinations sites can be found here: https://covid19.glos.nhs.uk/index.php/2020/12/14/community-covid-19-vaccination-of-priority- groups-set-to-get-underway-from-mid-week/
This is a ground-breaking and a significant step forward in our response to COVID-19 – we now have a clear route forward for the country to get back to some semblance of normal. As of New Year’s Eve, over 5,000 frontline NHS, health and social care staff in the priority groups have so far received their first doses at the Edward Jenner Vaccination Hub at Gloucestershire Royal Hospital and over 20,000 people in community vaccination centres and care homes across 10.1 Gloucestershire.
The NHS says that the rate of vaccinations in the county should only increase as additional vaccine supplies are made available.
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OXFORD/ASTRAZENECA vaccine is authorised for use The Oxford/AstraZeneca vaccine has now been authorised for use in the UK from the beginning of January 2021. Based on best practice this will initially be in hospital hubs e.g. Gloucestershire Royal Hospital. It is then expected to be rolled out to local community vaccination centres shortly after, significantly increasing vaccine supply for priority groups.
Updated national guidance has also been published to advise increasing the spacing of second vaccine doses for both the new Oxford/AstraZeneca vaccine and the current Pfizer BioNTech vaccine. For the Oxford/AstraZeneca vaccine, guidance states that the second dose should be given after 4 weeks, but within 12 weeks of the first. Updated guidance for the NHS recommends that the second dose of the Pfizer/BioNTech vaccine is offered between 3 and 12 weeks following the first dose. Those people, who recently received their first vaccination and are due to receive their second dose in the next few weeks, may be contacted by the NHS to re-arrange their appointment later within the 12 week window. For those people receiving their first vaccination from 31 December 2020 an appointment to receive the second dose will be scheduled within 12 weeks.
Prioritising the first doses of vaccine for as many people as possible in priority groups will protect the greatest number of at risk people overall in the shortest possible time. The new national guidance does mean that some people who have already had their first dose will be asked to wait longer for their second dose of the vaccine, but this will be within the recommended time period. Whilst we recognise the inconvenience for some, we hope people will understand the rationale for 10.1 this. We are asking for the public’s support in working through this logistical challenge.
NHS leaders have praised the work of GP practice teams, NHS community services and volunteers in creating a successful infrastructure for community vaccination in double quick time and for getting the programme off to such a successful start. They have truly pulled out all the stops in the face of very challenging timescales. We now have a network of 10 community vaccination centres in place in the county. As a result, Gloucestershire is at the forefront of the COVID-19 community vaccination response and well placed to benefit from increased vaccine supply.
GP practice teams are continuing to provide day to day medical care for patients alongside their support for the community vaccination effort and we are urging local people to act with kindness and understanding when making contact with practice staff who are working under great pressure. We politely request that priority patients wait to be contacted about their vaccinations, including any
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rescheduling of appointments for second doses.
2.2. EnablingEnabling ActiveActive CommunitiesCommunities
The Enabling Active Communities (EAC) programme looks to build a new sense of personal responsibility and improved independence for health, supporting community capacity and working with the voluntary and community sector.
The development of the Gloucestershire Prevention and Shared Care Plan, led by Public Health England, aims to improve health and wellbeing. It recognises that a more efficient approach to
preventing ill health is very important. This will improve the health of the population and make an important contribution to the maintenance of sustainability in our ICS.
The programme continues to work on its recovery programme and we are pleased to report that In November 2020 we were successful in being awarded financial support from the Health Equalities Partnership seed funding from NHS E/I to take forward project(s) aligning with the national eight priority actions to address inequalities. Our bid focussed on place-based work in Gloucester City to improve connection between statutory and community (including VCSE) partners working with individuals and communities who experience worse health outcomes. Teams working as part of the
programme will have access to national learning sets providing peer support.
10.1 3. Clinical Programme Approach
The Clinical Programme Groups (CPGs) have all highlighted the impact of COVID-19 on the transformation programmes and continue to work through the incident and recovery phases. Where projects are able they are continuing to run but adapting their approach in light of COVID-19 restrictions. Where projects are unable to continue contingency plans have been drawn up and new methods of delivery put into place. There is also opportunity to fast track some work programme content (i.e. non face to face appointments). The Cancer, Diabetes, and Respiratory Clinical Programme Groups have a high priority within the COVID- 19 response given the impact on people with these conditions. Cancer performance has improved significantly where patients waiting for referral under the 2 week wait have been treated and Gloucestershire is exceeding national performance averages.
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Recovery priority areas continue to focus on:
Respiratory – COVID and Non COVID pathways
Cancer (including implementation of Faecal Immunochemical Test - FIT)
Frailty pathway
End of Life Care
Muscular Skeletal (MSK) Pathways
These areas have important links to;
Mental Health pathways including social prescribing
Diagnostics
Use of remote technology including digital methods for advice and guidance between GPs and hospital clinicians.
These will sit alongside the existing CPG priority areas. All pathways are keen to build on the momentum of changes made to date, for example the use of virtual appointments and are looking to prioritise patient and public involvement to inform substantiating or introducing new changes.
Focus on Better Births – Maternity Transformation Programme 10.1
The NHSE Maternity Transformation Programme (MTP) is now in year 4 of 5 as Better Births has been extended to 2025. Significant progress has been made to improve the quality and safety of maternity and neonatal services, as well as improving choice and experience for women. Working in partnership with women, their families and communities to co-design maternity and neonatal services together are key drivers to improve maternity and neonatal services further in Gloucestershire.
Gloucestershire Local Maternity System (LMS) was established following the recommendations of the national review of maternity services report Better Births (2016).The Gloucestershire LMS is one of 44 across the country and is a sub group of the ICS. The vision and membership of the LMS supports outcome based improvements in maternity and neonatal services. The LMS vision for Gloucestershire maternity and neonatal services is:
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“Working together in Gloucestershire so that every woman and their family have access to safe, high quality and personalised maternity care; giving babies the best possible start in life.”
The programme has 8 key work streams;
Due to COVID-19 the MTP was paused between April – July 2020 and is now in a recovery and
resume phase. Progress of note has been made to the following work streams;
Choice and Personalisation
Work is being undertaken on the development of a digital web-based app version of personalised care plans based on feedback received pre-COVID from a small pilot with women. Feedback was solely around functionality and how the template was not user friendly. We are therefore looking to increase accessibility by opting for a digital version, in line with original feedback. 10.1 We are looking at creating an e-form which will be routed to a specific email address based on the beginning of each woman’s postcode which will be aligned to continuity of carer teams. This will help provide more stream lined care and improved communication. The Maternity Voices Partnership has had a substantial increase in it’s following over the last quarter on social media. A lockdown report of people’s experiences was submitted to the Local Maternity System in September and an action plan is in development in response to the feedback.
Cultural Diversity We are reviewing our Operational policy for the BAME community in relation to COVID-19. This includes updating the communications sheet (used when a woman phones in to service) and relevant action cards which support this. We are looking at how we communicate with culturally diverse women in relation to COVID-19. We are planning to work with women that use services through the Maternity Voices ICS Lead’s Report 8
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Partnership to develop this further. Further information can be found here https://www.glosmaternityvoices.nhs.uk We are looking into options to translate different resources including postnatal information that takes the form of an animation film We continue to engage with different culturally diverse communities to understand their needs, adapt services to meet these needs, ensure communications reach them, and encourage engagement with various co-production projects.
Other system successes Urgent Care – successful implementation of NHS 111 booking into GRH Emergency Department. This allows the 111 team to book patients directly into the most appropriate hospital service if it is required. Work continues in terms of delivering the full Think 111 plan but it was a great achievement to get the direct bookings live.
Activity, Flow and Bed Planning– after a lot of work form the Digital work stream, including contributions from various partners in the system, we have achieved a successful link for staff to the Sunrise Electronic Patient Record (EPR) summary information in health care records. This has required a huge commitment from a number of colleagues and is another fantastic example of partnership working. There is still more work required to maximise the benefits but is a very positive development and step forward. 10.1
4. One Place, One Budget, One System
Public consultations for our hospital services transformation programmes, Fit for the Future and the Forest of Dean Community Hospital Programme closed on 17 December 2020. Views were sought from the public and staff on options for organising the following services: Acute Medicine (acute medical admissions) Gastroenterology inpatient services - medical care for stomach, pancreas, bowel or liver problems General Surgery – conditions relating to the gut. Specifically, emergency general surgery, planned lower gastrointestinal (colorectal) surgery and planned day case surgery Image Guided Interventional Surgery (IGIS) – where surgeons use instruments with live images to guide the surgery ICS Lead’s Report 9
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Trauma and Orthopaedic inpatient services (T&O) - diagnosis and treatment of conditions relating to the bones and joints. The consultation followed an extensive period of public and staff engagement. Residents were able to find information on how options for services were arrived at and the public engagement that supported it in a consultation booklet. Because of the current COVID-19 situation, the NHS reached out to people in a number of ways and offered a wider range of consultation activities, including on- line options. An information flyer was also delivered to every household in the county.
The consultation reached; Over 1700 members of the public and staff through virtual and socially distanced events, meetings, and telephone calls. Over 900 people have requested more in-depth information Just under 700 completed surveys were returned.
Feedback from the consultation will be published in early January 2021 and will be included in the next stage of our business case. An independently run online Citizens’ Jury will be held in late January 2021 which will also consider the feedback and make recommendations. 18 people from across Gloucestershire will be selected and paid to take part. Over 300 people have applied to be a member of the jury. A consultation review period will follow before decisions are made by the NHS in March 2021. 10.1 There is a new virtual engagement portal Get involved in Gloucestershire which is an online participation space where people can share views, experiences and ideas about local health and care services. This is accompanied by a short film clip of Dr Jeremy Welch describing Get Involved in Gloucestershire. The film can be found here https://www.youtube.com/watch?v=XYwaqb-e3lU Over 200 people have registered an interest in contributing to ongoing and future development of health and care services in Gloucestershire.
A New Community Hospital for the Forest of Dean A Consultation inviting the public to comment on the proposals for the new community hospital in the Forest of Dean closed on 17 December 2020. Planning for the new hospital in Cinderford and proposals for the inpatient unit, outpatient services, urgent care, diagnostic services, and other facilities on site have been discussed with the local community.
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The proposal is for a hospital which includes a 24-bed inpatient unit, urgent care facility, x-ray, ultrasound and endoscopy, and a range of consultation and treatment rooms for outpatient appointments. Experiences of providing care throughout the ongoing COVID-19 pandemic will also influence the final design, to minimise the risk of infections spreading and to allow for social distancing between staff and patients.
Feedback from the consultation is currently being collated and analysed.
5. Integrated Care System Development
As a Wave 2 Integrated Care System we are working towards increased integration to improve health and wellbeing, we believe that by all working better together, in a more joined up way, and using the strengths of individuals, carers and local communities, we will transform the quality of care and support we provide to local people. The System Development work stream captures the work to develop the overarching ICS programme. The responsibilities of this programme are as follows:
Provide Programme Direction to the Gloucestershire ICS Manage a Communications and Engagement approach on behalf of the ICS, including ensuring the Health and Social Care Act duties regarding significant services changes are met in relationship to the ICS Ensure the ICS has a robust resources plan in place that all ICS partners are signed up to and 10.1 that is aligned to organisational level plans. To ensure that the ICS has clear governance and performance management in place to ensure the system can manage and oversee delivery.
Due to the COVID-19 the 2020/21 the Publication of the Gloucestershire Long Term Plan (LTP) has been delayed. Some of the work-streams within the LTP have been accelerated in particular around staffing, outpatient care, digital streams & sustainability. This programme has submitted the system response to the national Phase 3 planning requirements that has set out the plan for Gloucestershire system over the next 6 months. The System Recovery Cell is leading ICS work on recovery and is particularly focused on bringing together all the feedback from the first wave of COVID-19 and ensuring that learning is understood and acted on as we work through the Winter period.
We are continuing to review priorities and focus on creating sustainable services through the
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Winter period. Greater integration between partners can be seen in the models we have developed to help support hospital discharges over the next six months. Alongside this we are now restarting much of our ICS programme of work in a more focused way using digital platforms to bring people together. We also continue to connect to other systems nationally and ensure we are sharing our strengths and learning from others as well as developing as a system working together.
At the end of November NHS England/Improvement launched an engagement on the future of Integrated Care Systems and their ongoing development. We are working as a system to review what this means for Gloucestershire as a well-developed ICS with strong system working. The system responded to the engagement with general support to the proposals but asking for further clarity in a number of areas; we are now begining to refine our Integration Implementation plan.
Congratulations We would like to congratulate Sonia Pearcey, Freedom to Speak Up Guardian at GHC, who has been awarded the MBE in the Queen’s Birthday Honours List. Sonia has been a nurse for 32 years and her MBE is in part due to her work in supporting Trust staff to speak up about anything that gets in the way of providing good care. We are delighted that one of our colleagues has received such recognition and thank Sonia for her ongoing contribution to the Trust and our system. Congratulations also to GHFT whose staff have received several awards including; National awards for the Electronic Patient Record (EPR) and COVID dashboard. Patient Experience Network National Awards 2020 for using insight to improve patient 10.1 experience and for the Patient Experience Manager of the Year The Florence Nightingale Award for Outstanding Contribution by a Nurse or Midwife in this year’s Health Quality Improvement Partnership (HQIP) was awarded to 2 Advanced Nurse practitioners.
6. Recommendations
This report is provided for information and Governing Body / Board Members are invited to note the contents.
Mary Hutton ICS Lead, One Gloucestershire ICS
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Agenda Item 11
Governing Body
Meeting Date Thursday 28th January 2021 Report Title Quality Report
Executive Summary This report provides assurance to the Governing Body that quality and patient safety issues are given the appropriate priority. Key Issues The Quality Report provides an overview of activity undertaken within the CCG to monitor and improve quality of commissioned services. The report highlights areas of strong performance and areas which may require increased surveillance. Risk Issues: Failure to secure quality, safe services for the Original Risk (CxL) population of Gloucestershire Residual Risk (CxL) Management of Not applicable Conflicts of Interest Financial Impact There is no direct financial impact Legal Issues Compliance with the NHS Constitution, NHS (including NHS Outcomes Framework and recommendations from Constitution) NICE and CQC. Impact on Health A focus on the delivery of equitable services for the Inequalities residents of Gloucestershire and which will reflect the diversity of the population served. 11 Impact on Equality There are no direct health and equality implications and Diversity contained within this report. Impact on Sustainable There are no direct sustainability implications Development contained within this report. Patient and Public There is no impact Involvement Recommendation The Governing Body is asked to note the contents of this report. Author Marion Andrews-Evans Designation Executive Nurse and Quality Lead Sponsoring Director Not applicable (if not author)
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1 Introduction
The Governing Body Quality Report is produced to provide assurance of the quality monitoring and support work being undertaken by GCCG with providers in county.
Formal assurance of the quality of NHS contracted services is by way of the Governance and Quality Committee, minutes of which are received by the Governing Body. This report provides succinct detail on activity undertaken and areas of strong performance or concern. Full details of provider performance are reported to the Quality and Governance Committee
2 Summary Serious Incidents & Never Events
2.1 A ‘Serious Incident’ is defined by the National Patient Safety Agency (NPSA) as an incident that occurred in relation to NHS-funded services and care. These are often referred to as STEIS incidents after the reporting system. The Strategic Executive Information System (STEIS) allows us to break down the numbers being reported into categories.
Each reported incident and subsequent action plan is reviewed by the Quality Lead for that specific provider. This allows for identification of any potential themes or trends and can inform more in-depth discussions at the relevant Clinical Quality Review Group (CQRG). Full details of Serious Incidents, split by category, are provided to Quality and Governance Committee. 11 The tables below give an overview of Serious Incidents (SI) in providers. Narrative information is contained within the appendices for individual organisations.
2.2 Gloucestershire Q3 Q4 Q1 Q2 Q3 Hospitals NHF 19/20 19/20 20/21 20/21 20/21 FT Never Event 2 2 2 1 3 Serious 6 6 2 11 9 Incidents 8 8 4 12 12
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Q3 Q4 Q1 Q2 Q3 Gloucestershire 2019/2 19/20 20/21 20/21 20/21 Health and Care 2.3 0 NHSFT
Never Event 0 0 0 0 0 Serious 11 10 14 6 9 Incidents 9 11 10 14 6
SWAST Q1 Q2 Q3 2.4 20/21 20/21 20/21
Never Event 0 0 0 Serious 2 0 0 Incidents 2 0 0
2.5 We are able to break down GHCNHSFT Serious Incidents in relation to their care setting. For Quarter Three five arose in a ‘Mental Health Care’ setting while the sixth was from a ‘Community’ setting.
2.6 Never Events
The Never Events reported by GHFT relate to a medication incident where Oramorph medication was administered via patient's cannula. The patient has since been discharged and is not receiving ongoing care. The second was in relation to some guide wires left in situ. Sadly 11 this patient has died, but not as a result of this incident. The third was in relation to a wrong scar incision.
3 Engagement and Experience
3.1 Patient Advice and Liaison Service (PALS) The table below gives a breakdown of the types of enquiries the CCG PALS team has responded to up to end of Q3 20/21.
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Type Q3 19/20* Q4 19/20 Q1 20/21 Q2 20/21 Q3 20/21
Advice or 51 96 76 88 112 Information (9 PC) (PC 25) (12 PC) (PC 22) (PC 22) (PC 3 Covid related)
Comment 1 5 6 4 36 (PC 1) (PC 1) (PC 3) (PC 8) Compliment 1 4 2 5 9 (PC 1/GHAC) ( PC 1) (1 PC)
Concern 48 73 73 101 126 (PC 12) (PC 19) (PC 24) (PC 37) (PC 37) (PC 5 Covid related) Complaint 9 3 5 6 0 about GCCG
Complaint 36 17 25 23 39 about (PC 8) (PC 1) (PC 3) (PC 8) provider NHSE 17** 11 ** 6** 9 ** 4** complaint responses copied to GCCG PALS
Gluten Free 0 0 0 0 1
Other 57 17 4 14 31 (PC 16) (PC 2) Total 220 226 197 250 358 contacts (PC 62) (PC 61) (PC 47) (PC 78) 11
3.2 Themes identified from GCCG PALS Contacts Q3 2020/21
PALS have had an extremely busy quarter and have taken a high volume of telephone calls, emails and letters. Many of the telephone calls have been complex and taken time to resolve.
Q3 has seen an increase in MP contacts, 29 in total. This covered commissioning of services, access to health services, accessing test results, Vitamin B12 enquiries, , provision of health care services, cross-border enquiries and primary care, managing benefits (DWP), IFR funding requests, additional CHC funding during Covid.
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The rise in provider complaints (39) came from contacts asking for advice on who/where/how to contact and support available to them. Where necessary information given for POhWER Advocacy service.
8 were GP related (accessing treatment, registering with GP when moved outside catchment area, unavailability of GP appointments, administration services). 22 general advice on how to complain and 9 covering a range of health providers (GHNHSFT, GCHNHSFT, GCC)
30 Contacts were Covid related. advice 4 comments 3 formal complaint (2 GHNHSFT, 1 GCC Covid testing) 11concerns (access to treatment/hospital services/CHC assessments/prescriptions) 1 other (private service offering support for MH during Covid)
PALS have worked closely with the other provider PALS teams, this has enabled sharing of useful information, liaising good outcomes for
patients and helping patients get the best out of services.
3.3 Engagement
3.3.1 The two public consultations; Fit for the Future, developing specialist hospital services in Gloucestershire and A new Community Hospital for the Forest of Dean; concluded on 18 December 2020. Two comprehensive reports have been prepared 11 summarising the consultation activities and responses to the consultations. These can be found at: https://www.onegloucestershire.net/yoursay/fit-for-the-future- developing-specialist-hospital-services-in-gloucestershire/ and https://www.fodhealth.nhs.uk/consultation/
We would like to say a huge thank you to everyone who took part in the extensive programme of consultation – on-line, in person, by post and by phone.
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3.3.2 Next Steps: Completing the communication, engagement and consultation for the Fit for the Future programme Citizens’ Jury
A second Jury, independently facilitated by Citizens Juries CIC, will be held in January 2021to consider the feedback from this consultation. 18 independently recruited jurors (not the same jurors who participated in Jury #1), representative of local communities from a broad range of demographics, will receive evidence from a range of witnesses, record their observations and make their recommendations to decision makers of the NHS organisations involved. This will include key feedback from the consultation process, which will be taken into account when making a final decision on the future configuration of the five specialty acute hospital services. The Citizens’ Jury will be hosted online; audio recordings of the plenary sessions will be available on request from Citizens Juries CIC, witness presentation recordings and slides will be available on the One Gloucestershire website https://www.onegloucestershire.net/yoursay/fit-for-the-future- developing-specialisthospital-services-in-gloucestershire/ . Details will be publicised nearer the time.
3.3.3 Elective Lower Gastrointestinal (GI) (colorectal) surgery – no preferred option proposed in the consultation
The Fit for the Future consultation did not propose a preferred option for Elective Lower Gastrointestinal (GI) surgery; two options were described. The next step is to select one of the two options for this service; to co-locate at either CGH or GRH to take forward for a decision. This will be carried out at the beginning of February 2021 and will be a two stage process. Firstly an appraisal by the Trust 11 Leadership Team of Gloucestershire Hospitals NHS Foundation Trust using the feedback from consultation to obtain a recommendation, with the option chosen by the Trust Board and then a final decision made by the NHS Gloucestershire Clinical Commissioning Group Governing Body in March 2021 (see Decision below). The following information will be reviewed: Feedback from the Public Consultation Citizen’s Jury #2 output Presentations on the two options Pre-Consultation Business Case and attachments Financial Information Beds and resource requirements
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Workforce plans including rotas
3.3.4 Consultation review period
There will then be a consultation review period, where Gloucestershire Hospitals NHS Foundation Trust and NHS Gloucestershire Clinical Commissioning Group will carefully consider all of the feedback.
3.3.5 Decision
A final decision will be made about the Fit for the Future proposals at the CCG Governing Body meeting on 11 March 2021. This will be live streamed on the internet.
3.3.6 Process of implementation
If the proposals set out in this consultation are supported by the Governing Body of the Clinical Commissioning Group; then the Emergency General Surgery, Gastroenterology and Trauma & Orthopaedics inpatient services changes will be made permanent. The timescale for other changes will be determined by a number of factors such as estates, staff recruitment and training. The F Programme structure will remain in place with programme and project managers working with clinical staff within the specialties to develop and then deliver detailed implementation plans. Plans to involve local people in the implementation and evaluation process are being developed.
3.3.7 Next steps for new community hospital for the Forest of Dean Consultation review period 11 There will be a consultation review period, where NHS Gloucestershire CCG and GHC will carefully consider all of the feedback received at their Governing Body and Board meetings in January and March 2021 respectively.
3.3.8 Decision
The feedback will be used to inform the CCG in commissioning future hospital services in the Forest of Dean, as set out in this Consultation. If the proposals are supported by the CCG Governing Body i.e. the services that will be provided will be confirmed within a commissioning specification, GHC will finalise a formal business case setting out the benefits, the design specification and financial plan for the building and
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ongoing operation of the new hospital. The final business case will need approval from the Board of GHC. It is anticipated that this approval will be considered at the Trust’s board meeting in March 2021.
3.3.9 Process of implementation
If the consultation proposal is supported by the Boards then the business case will be progressed with GHC needing to seek full planning permission before construction can begin. Services will remain at The Dilke Memorial Hospital and Lydney and District Hospital until the new hospital is opened.
3.4 SURVEYS – created by the Engagement Team in Q3
End of Life Collaborative Survey – Closed Sept 2020 Online Consultations in primary Closed Care Gloucestershire Primary Care – Closed Training Hub – Mid Career Covid 19 NHS Test and Trace Open (no responses) Transfer of Care Bureau feedback Open ( last response 28 Sept survey 2020 2020) Fit for the Future – A new hospital Closed for the FOD Supporting Care Homes – Open (last response 18 Oct Improving our local response to 2020) future pandemics Fit for the Future – What matters Closed 11 to you? Rehabilitation Questionnaire 2020 Closed Monthly GDPR survey Open (Current) Fit for the Future (Easy Read) Closed A new Hospital for FOD (Easy Closed Read) Care Home pre event - 2020 Closed Video Consultations with your GP Closed Evaluation of Ardens / Qmasters Closed Care Home Feedback Event 2020 Closed Safeguarding Children GP Forum Open (Current) Safeguarding Adults GP Forum Open (Current)
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Social Prescriber Link Worker Closed Survey Sanger House Awards 2020 Closed Children’s Clinical Programme Open (Current) Group Refresh Care Homes Staff Survey 2021 Not yet opened Blood Pressure Testing Data Open (Current) Collection Information Bus Evaluation form Open (Current) Information day Summary form Open (Current) NHS Referral Assessment Service Open (RAS) My COPD – Baseline Open My COPD – Pilot Evaluation Open Phlebotomy Services Open North Cotswold Community Open Matron Service
4.1 Methicillin-Resistant Staphylococcus Aureus (MRSA) Bacteremia
Two cases of MRSA in a blood culture have been reported (September 2020 and November 2020), which are the only Gloucestershire patients diagnosed with MRSA Bacteraemia for 2020 to date.
Full Post Infection Reviews were undertaken; both cases were identified as community onset community associated. 11
4.2 Clostridium difficile Infections (CDI)
To date NHSI has not set a threshold for 2020/21 therefore we are using last year’s threshold of 194 as a guide.
Since 1 April 2020 cases have been reported as shown in the table below.
To be lower than the previous threshold target we need to have 16 or less cases per month. The average per month for the first 8 months of 2020 is 13.9 cases (an increase of 0.5 on last month’s figures).
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CASES OF CLOSTRIDIUM DIFFICLE IN GLOUCESTERSHIRE 1 APRIL 2020 – 22nd December 2020 Category Apr May Jun Jul Aug Sep Oct Nov Dec Total Hospital Onset – Healthcare 1 2 1 2 6 1 2 2 19 Associated Community Onset – 1 2 1 4 7 3 6 2 1 27 Healthcare Associated Community Onset – 3 1 3 2 2 2 3 2 18 Indeterminate Association Community Onset – 4 7 9 2 4 1 10 6 3 46 Community Associated Missing Info 0 0 0 0 0 0 0 0 0 Unknown 1 0 0 0 0 0 0 0 1 Total number of 11 12 15 10 19 7 21 12 4 109 cases
Hospital Onset An Assurance Panel chaired by the CCG has been reinstated from October 20 meeting monthly to review CDI cases reported as hospital onset. This monthly panel was suspended during the “first wave” of the Covid-19 situation. A contingency plan has been put in place over winter to maintain the assurance process.
Over the period August – October 2020 there have been three outbreaks on three different GHNHSFT hospital wards. Under the leadership of senior nurse managers and the Infection Prevention & Control Team action plans are in place. Key actions such as improving ward cleaning, cleaning of equipment, steps to use antibiotics 11 appropriately, recruiting permanent nursing staff into vacancies and increasing participation from medical colleagues. There has been no meeting since October, but the next one is scheduled for 19th Jan 2021
Gram Negative Bloodstream Infections (GNBIs) Escherichia coli (E.coli) Infections
1 April 2020 – 30 November 2020. 4.3 During this period the total number of cases reported up to the 30th November 2020 is 137 cases. During the same period last year (01/4/19 – 30/11/2019) there were 176 cases. Therefore there is a downward trend compared to previous year to date.
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At the end of November 2020 GHT reported 40 cases with a healthcare association.
A countywide UTI reduction plan is in place and reviewed quarterly. Under GHT there is an additional plan addressing other causes of Gram Negative Blood Stream Infections.
Seasonal Flu
Vaccinations continue but the main focus now is Coronavirus vaccinations. The uptake of seasonal flu vaccinations has been very 4.4 encouraging with the uptake exceeding that of previous years and for the over 65years cohort is around 80%, exceeding the national target of 75%.
The circulating levels of flu infections in the South West remain low.
Covid Vaccinations
The Covid Vaccination programme in the county is progressing extremely well. There are two key focuses, the over 80s and care 4.5 home residents and health and care staff. The staff are predominantly being vaccinated at the vaccination centre at Gloucester Royal Hospital and the residents are receiving their vaccinations at the PCN vaccination hubs or in the care homes. With the introduction of the Astra-Zeneca vaccine the vaccination of housebound patients has now commenced. The uptake of the vaccine in both groups has been very high and the aim is to complete these groups by the middle of February. 11 5 Provider Updates
5.1 Gloucestershire Hospitals NHS Foundation Trust
5.1.1 At the time of writing this report the Trust is in a very challenged position in the second wave COVID-19 pandemic. The number of Covid positive inpatients means the Department of Critical Care is once again coming under pressure with high acuity Covid positive patients, some requiring organ support and the Trust are currently assisting other NHS Trusts in London and the South East daily with mutual aid transfer of ventilated patients. The Trust are currently admitting an average of 20 COVID positive patients per day and this is expected to rise to 30 patients a day in the next couple of weeks.
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The number of patients on the medically stable list had increased following the Christmas holidays which creates challenges for patient flow. System wide support for discharge solutions remains ongoing with the number of patients on the medically fit for discharge list reducing and a significant number of complex discharges have been achieved..
During November and December 2020 the Trust has experienced outbreaks resulting in COVID-19 exposures and nosocomial infections. The Countywide IPC Bronze Cell has commissioned the Patient Safety Team to conduct aa cluster SI investigation in to all of these cases.
The Infection Prevention Control Team at the Trust has been working extremely hard to support PPE compliance, in particular in relation to eye protection and compliance with surgical masks. They are also reviewing the learning from staff outbreaks to help improve social distancing in rest areas and meeting rooms. The Trust has a planned CQC inspection of their infection, prevention and control th arrangements the week commencing 18 January.
5.1.2 Performance: Emergency Care
The Emergency Departments remains under significant pressure due to increased admissions, Covid and poor flow throughout the Hospitals. The latest 4 hour performance stands at 74.2% the ED at GRH. As a result of bed closures due to infection and social distancing to control the spread of infection there has been a significant increase in the times that patients are waiting for beds resulting in multiple breaches. 11 However additional ward areas have been opened up across both sites to match the demand .Green patient pathways (non covid) continue to see a higher acuity patient and Red (covid) pathways make for very challenging patient flow
5.1.3 Performance : Planned
Elective P3 and P4 patients have been widely cancelled to support Cancer treatments and maintain essential elective services. The Trust are doing very little operating beyond that of the Cancer surgery at present. Outpatient staff have been redeployed to assist along with the release of Surgical Consultants.
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5.2 Gloucestershire Health & Care NHS Foundation Trust
5.2.1 The Dilke Hospital Minor Injury Unit remains closed as part of the COVID 19 response. The Vale Hospital’s MIiU closed on the 14th December to allow for the site to be used as a PCN mass vaccination site.
Due to increasing pressure across the healthcare system, Tewkesbury MIIU has temporarily closed from Sunday 10th January with clinicians re-deployed to support urgent and emergency calls for care and treatment and help reduce pressure on the ED at GHNHSFT.
All other MIIU units remain open 8am-8pm. Telephone triage has now commenced and is in place during core hours with GHCNHSFT reporting that this is working effectively.
All standard and scheduled quality monitoring processes, including measures requiring audit, validation or specific narrative feedback have recommenced. Reported serious incidents during Covid-19 are still within historical norms and weekly monitoring meetings continue to take place between the patient safety team and the CCG.
GHCNHSFT reports that the number of formal complaints increased significantly in November with a subsequent decrease in performance regarding ability to acknowledge these within 3 working days. The number of concerns reported decreased. A review of historical rates by GHC has found that an escalation in the numbers of complaints 11 received is usual at this time of year and this month’s figures are consistent with this pattern.
5.2.2 Performance/Planned Care
The high demand for community hospital beds continues in response to multi-faceted delays across the system discharge pathways. System partners are regularly reviewing options to target existing resources which include the re-allocation of system therapists to the Home First discharge model jointly delivered by the Trust.
The IAPT (Improving Access to Psychological Therapies Team) recovery rate indicator continues to exceed the required threshold.
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This has been maintained for the past 6 months.
The Early Intervention in Psychosis (EIP) service has met the target threshold and achieved 100% for November 2020.
5.3 Care Homes
The CCG and County Council have continued to hold the Care Home quality review meetings throughout Covid19 recognising that the local authority is the lead commissioner for Care Homes. The frequency of the meetings has been increased during the Covid pandemic to reflect the level of concern regarding Care Homes during this time, particularly in relation to the use of PPE, swabbing and the management of IPC. The CCG have worked with the Local Authority to develop a risk stratification process in order to prioritise support based upon the needs of the homes and their residents. Support includes face to face visits, education of staff, and practical support in relation to IPC- particularly in the cohorting of residents to prevent further spread.
The Public Health service at GCC have funded for 18 months a team of specialist IPC nurses to advise and support care homes. The senior nurse started in post at the beginning of December and two further nurses will join the team in February. Support is also being provided to this team from the GHFT and GHCFT IPC teams as required.
Where there are concerns regarding a home the CCG have escalated these concerns to the regulator (CQC) or the commissioner (GCC) and played an active role within provider led meetings chaired by the local authority head of safeguarding. 11 6 Quality Team Activity
6.1 Safeguarding
6.1.1 Gloucestershire Safeguarding Children Partnership (GSCP)
The October meeting of the Gloucestershire Safeguarding Executive moved to refine the membership, structure and roles of the Partnership. There is a change to the name to reflect a joined up approach. The CCG Executive Nurse is Chair of GSCP.
6.1.2 Statutory Reviews
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Child Safeguarding Practice Reviews / Serious Case Reviews: publication dates amended as of 13/01/2021
Review Commenced Theme Publication expected CSPR (WT-2018) August 2020 Rapid Reviews x3 End January 2021 Child Exploitation CSPR (WT-2018) November 2020 Child in Care May /June 2021 SCR (WT-2015) May 2019 Child Sexual Abuse and Published: ‘Lauren’ Neglect Partnership website December 2020 SCR / DHR May 2018 Domestic Homicide – mother SCR completed– combined (WT- and daughter publication pending 2015 and Home DHR Home Office Office) scrutiny.
Links to the published reports: https://www.gscb.org.uk/i-work-with- children-young-people-and-parents/serious-case-reviews-and-learning- from-reviews-and-audits/serious-case-reviews/
Two Rapid Reviews (Children Social Care Serious Incident Notification) took place in November 2020, one proceeding to LSCPR (Child in Care). 6.1.3 Adults Safeguarding Board: GSAB Board (virtual) meetings were resumed from August. GSAB Chair has remained a member of the Covid19 ICC Bronze Group and
the ICS Independent Sector Scrutiny Review meeting. 6.1.4 11 Safeguarding Adult Reviews (SAR): publication dates amended as of 13/01/2021.
Review Commenced Referral / Publication Theme expected SAR ‘Laura’ 2018 Death out of county – Published to WSAB Warrington SAB Review website Dec 2020 SAR - NC Oct 2019 LEDER referral May 2021 Thematic non-stat March 2020 Nelson Trust / ACEs & wider May 2021 – TBC Review – SWOP vulnerability SAR – PH Nov 2020 Districts / Homelessness TBC – Exp June 2020 Thematic audit – Sept 2020 GHTNHSFT / Alcohol related Learning event: Feb SAR subgroup deaths 2021
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6.1.5 Domestic Homicide Reviews: publication dates amended as of 13/01/2021
DHR Commenced Narrative / key info Publication expected KD (Cheltenham) June 2019 Domestic Abuse Related Death Draft report in Review’. progress. JL (Stroud) June 2020 Suicide Case that fits Statutory TBC definition for DHR SW (Stroud) July 2020 Suicide Case that fits Statutory TBC definition for DHR SD (Gloucester) Sept 2020 Suicide Case that fits Statutory TBC definition for DHR JD Early 2018 Report completed – now with With HO, Pending Home Office return SCR / DHR May 2018 Domestic Homicide – mother DHR Home Office combined (WT- and daughter scrutiny. 2015 and Home Joint SCR / DHR Office) Report still pending final draft.
‘Stranding Together’ organisation are undertaking the 3 DHRs that are identified separately as suicide cases that fit the statutory definition for Domestic Homicide Review. This should support combined learning outcomes for the county. The DHR process is undoubtedly lengthy, but work to address learning and practice development through the strategic action plan from the early stage of Reviews is led by the
County Domestic Abuse and Sexual Violence (DASV) Strategic
Coordinator (Glos Constabulary). CCG Safeguarding is fully involved and utilise the Safeguarding Strategic Health Groups (adult and children) to facilitate this work. 11
6.2 Medicines Optimisation
6.2.1 Prescribing Expenditure
The most recent prescribing figures available for October 2020 indicate a slight reduction in prescribed item numbers of -0.4%, but a cost growth of 6.5% (+£3.4m).. The main drivers for the prescribing costs in general remain as the previous report, namely DOACs, Respiratory, Appliances and Diabetes. Sertraline, a medicine used for conditions such as depression was formerly an inexpensive medication has had a large impact as a result of category M changes. At risk patients classed as receiving polypharmacy are now below the target level of ‘<18%’
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(17.9%), which will help to reduce medication based adverse events leading to hospitalisation. The county’s antibacterial usage is also considerably lower than the target level of 0.965, at 0.787 (these numbers reflect usage of antimicrobials across the population, lower being considered better).
6.2.2 Our Specialist Appliances Nurse, who recently commenced with the team to optimise the use of appliances, has been largely redeployed to the Covid vaccine programme, which will reduce the possible savings in year. Indeed, the whole medicines optimisation team has been supporting the vaccine programme as a priority, and clearly there will be an impact on standard medicines optimisation targets and activities.
6.2.3 Workforce Development
Joint working continues to develop a Gloucestershire wide Integrated Pharmacy and Medicines Optimisation (IPMO) approach, working across primary and secondary care stakeholders to develop a sustainable approach to generating and maintaining a pharmacy workforce across all sectors. Two new pharmacy technician trainees have recently been appointed to participate in the exciting development across the pharmacy workforce sectors.
The vaccine programme has boosted numbers of qualified vaccinators, and many of the wider medicines optimisation field team have undertaken the training and assessments to be able to vaccinate. Where vaccinator training has not been undertaken, those staff are supporting the vaccine programme in any way possible and making effective use of their inherent skills. 11 6.3 Prescription Order Line (POL)
The situation remains similar to the last report, with social distancing remaining throughout the Prescription Ordering Line (POL) area, and wider throughout Sanger House, and the POL continue to answer an increased number of patient calls. The POL team are continuing to successfully handle an average of 700 telephone calls daily throughout September and October, with the daily range from 900 to 500 depending on the day of the week. The POL team no longer have the support of our pharmacy technicians as they have been largely redeployed to support the vaccine programme. The POL team are working hard to ensure the service is maintained as best as possible.
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6.4 Primary Care Education
The focus on training in Primary Care since last month has been on preparing staff for the COVID-19 community vaccination delivery programme across 10 sites in the Primary Care Networks. In addition to the General Practice Nurses and Health Care Assistants already trained in immunisations and vaccinations, the Matron for Clinical Learning and Development is delivering Intramuscular injection training and ensuring that the National training guidance is available to GCCG staff and volunteers who wish to help vaccinate in Gloucestershire.
The Parachute Nursing Services managed by GDoC and Practice Nurse Coordinators working with the Matron for Clinical Learning and Development in the CCG are currently supporting the COVID-19 vaccination programme. Higher educational courses are being run as normal though not as face to face and all Advanced & Community Workforce development and Non-Medical Prescribing (NMP) courses are fully booked until April 2021. Four Trainee Nursing Associates being their 2 year course in February 2021.
6.5 Gloucestershire ICS Quality Surveillance Group (QSG)
The second meeting of the ICS Quality Surveillance Group took place th on 18 November. As well as updates from the two local Trusts the group also had a presentation on the impact of Covid on people with a learning disability and what could be done to improve their outcomes. There were also updates from CQC and HEE at the meeting. It was 11 th agreed that the next meeting which is to take place on 20 January, would have a focus on Learning Disability Services. A programme of work for the forthcoming year is also to be agreed at this next meeting.
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Agenda Item 12 Governing Body
Meeting Date 28 January 2021
Report Title Forest of Dean Response to Consultation
Executive Summary This report is intended to support the Governing Body of NHS Gloucestershire Clinical Commissioning Group (GCCG) to respond to the outcome of the consultation on the services model for the new Forest of Dean Hospital.
This consultation was focussed on the service proposals specific to the planned building of a single new community hospital for the district, which following previous phases of engagement and consultation, and subsequent decisions by the CCG Governing Body and Board of Gloucestershire Health and Care Trust (GHC), is planned to be built in Cinderford.
Key Issues
Risk Issues: Risks and potential risks are reported to the CCG and the ICS for the purpose of risk monitoring Original Risk (CxL) and assurance. Residual Risk (CxL) Management of N/A 12 Conflicts of Interest Financial Impact N/A
Legal Issues N/A (including NHS Constitution) Impact on Health The report supports the effort to reduce health Inequalities inequalities Impact on Equality The report positively impacts on improving
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and Diversity equality and diversity Impact on N/A Sustainable Development Patient and Public The report is centred on public engagement. Involvement Recommendation Governing Body/Board members are asked to approve the report.
Author Ellen Rule: Director of Transformation and Service Redesign and ICS Programme Director
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Fit for the Future: A new hospital for the Forest of Dean Consultation
Governing Body Response to the outcome of Public Consultation
Document Control
Author: Ellen Rule, Director of Transformation and Service Redesign GCCG and ICS Programme Director
Status: Version 1
Version Date Author/ Comments Reviewer 0.1 18/01/2021 Ellen Rule V 0.1 first draft of document developed 0.2 20/01/2021 Ellen Rule / V0.2 second draft incorporating feedback from Becky Parish Becky Parish 0.3 20/01/2021 Ellen Rule / V0.3 third draft incorporating feedback from Mary Hutton Mary Hutton and Caroline Smith 1 20/01/2021 Ellen Rule Check through and PDF to issue to Governing Body
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Contents Fit for the Future: A new hospital for the Forest of Dean Consultation ...... 1 1. Purpose of the Document ...... 4 2. Assurance and Oversight ...... 5 3. Service Models and Response to Consultation Feedback ...... 7 3.1 Inpatient Bed Numbers ...... 7 3.1.1 Feedback from the Consultation relating to Inpatient Care ...... 10 3.1.2 Proposed Response to Feedback relating to Inpatient Care ...... 13 3.2 Urgent Care Provision ...... 14 3.2.1 Feedback from the Consultation relating to Urgent Care ...... 16 3.2.2 Proposed response to Feedback relating to Urgent Care ...... 18 3.3 Ambulatory Care (Diagnostics and Outpatients) ...... 20 3.3.1 Consultation feedback on Diagnostic services ...... 21 3.3.2 Outpatient services ...... 23 3.3.3 Proposed response to Feedback relating to Outpatients and Diagnostics ...... 24 3.4 Travel and Access ...... 25 4. Next Steps ...... 27 Annex 1: Output of consultation Report ...... 28 1. Executive Summary ...... 28 1.2 Consultation key facts ...... 29 1.3 Summary of feedback ...... 29 1.4 Making the best use the information provided in this Report ...... 30 1.5 Appendices ...... 31 2. Introduction ...... 32 2.1 A new hospital for the Forest of Dean ...... 32 2.2 Public and staff consultation programme ...... 32 12.1 2.3 Next Steps: What happens next? ...... 33 3. Our approach to communications and consultation ...... 35 3.1 Working with others ...... 35 3.2 Covid 19: Socially distanced consultation ...... 35 3.3 Developing understanding and supporting the consultation ...... 36 3.4 Staff communication and engagement...... 37 3.5 Elected Representatives ...... 37 3.6 Other community stakeholders and the public ...... 38
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3.7 Consultation events activity timeline ...... 41 4. Equality and Engagement Impact Assessment (EEIA) ...... 42 4.1 Consulting people with protected characteristics and others identified in the Equality and Engagement Impact Assessment ...... 43 5. A new hospital for the Forest of Dean: Survey Responses ...... 46 5.1 Respondents to the survey ...... 46 5.2 Survey Feedback ...... 55 5.3 Easy Read survey ...... 66 6. Other feedback received ...... 68 7. Questions and Answers...... 69 8. Evaluation and next steps ...... 73 9. Copies of this report...... 75
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1. Purpose of the Document This paper is intended to support the Governing Body of NHS Gloucestershire Clinical Commissioning Group (GCCG) to respond to the outcome of the consultation on the services model for the new Forest of Dean Hospital. This consultation was focussed on the service proposals specific to the planned building of a single new community hospital for the district, which following previous phases of engagement and consultation, and subsequent decisions by the CCG Governing Body and Board of Gloucestershire Health and Care Trust (GHC), is planned to be built in Cinderford. This paper should be read in conjunction with the output of consultation report and the various appendices of supporting information. The output of consultation report is attached as an annex to this report, the appendices to the consultation report can be found online at https://www.fodhealth.nhs.uk/consultation/. The service proposals consulted on are consistent with the aims and objectives of the Gloucestershire Integrated Care system and are planned to meet the needs of the population now and into the future within available resources. The business case to build a new community hospital is primarily concerned with ensuring the ‘right’ infrastructure can be developed with sufficient flexibility to allow for the continuous evolution of service delivery models in the NHS. The Gloucestershire Integrated Care System is confident that the proposals set out in this paper will ensure that the Forest of Dean gets a bright, modern facility that is flexible and forward looking – one that is Fit for the Future of our local NHS. Various phases of engagement and consultation with local communities and clinicians have been completed across the locality over a number of years. Our last period of engagement highlighted some key issues that were of particular interest to the local population, and these have been taken account of in the recent consultation: The key issues of interest to the local community are: Proposed inpatient capacity in the new hospital Urgent Care provision for the district, and in particular for residents of the south of the forest now that we have confirmed that the new hospital will be based in Cinderford End of Life care provision Travel and Access The consultation set out proposals for the services to be included in the new hospital. These are: Impatient Care Urgent Care 12.1 Diagnostics Care Outpatients Care This updated paper will describe the consultation feedback received for each area and conclude our firm commissioning intentions for each to enable the programme to develop the hospital to proceed to full business case stage.
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2. Assurance and Oversight All programmes that involve service change need to fulfil the assurance requirements that apply to all significant service changes. These can be found in the national guidance document from NHS England, Planning, Assuring and Delivering Service Change: https://www.england.nhs.uk/wp-content/uploads/2018/03/planning-assuring-delivering- service-change-v6-1.pdf. In summary the requirements are to: Meet the Governments’ four tests for service change, which are: o Strong public and patient engagement o Consistency with current and prospective need for patient choice o Clear, clinical evidence base o Support for proposals from clinical commissioners NHS England’s test for proposed bed closures (where appropriate) The NHS England bed test was introduced from the 1 April 2017. This requires that in any proposal including plans to significantly reduce hospital bed numbers NHS England will expect commissioners to be able to evidence that they can meet one of the following three conditions: Demonstrate that sufficient alternative provision, such as increased GP or community services, is being put in place alongside or ahead of bed closures, and that the new workforce will be there to deliver it; and/or Show that specific new treatments or therapies, such as new anti-coagulation drugs used to treat strokes, will reduce specific categories of admissions; or Where a hospital has been using beds less efficiently than the national average, that it has a credible plan to improve performance without affecting patient care (for example in line with the Getting it Right First Time programme). Due to the extensive timeline associated with the project, the proposals for the Forest of Dean have been considered by NHS England/Improvement (NHSE/I) over a two stage process, initially in 2017 and then more recently on the 1st October 2020. The 2017 assurance process confirmed that tests 1-4 were fully met at that stage; therefore the final stage of assurance was to ensure that NHSE/I were satisfied regarding the fifth test – the NHS bed test. A summary of our response to the bed test requirements is set out in the following table: 12.1
Bed Test Requirement Evidence Demonstrate that sufficient Significant alternative provision in both beds and alternative provision, such as ‘bed alternatives’ has been provided: This includes: increased GP or community Complex Care at home service services, is being put in place Rapid Response Service alongside or ahead of bed closures, End of life hospice care arrangement and that the new workforce will be Stroke rehabilitation at the Vale there to deliver it; and/or Rehab beds in Gloucester purchased as part of Enhanced Independence Offer (EIO)
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Show that specific new treatments or Not applicable to this case, although it should be therapies, such as new anti- noted that our alternative provision for stroke rehab coagulation drugs used to treat at the Vale and the new end of life care model ‘spot strokes, will reduce specific purchase’ arrangement will reduce admissions to categories of admissions; or the Forest hospitals for both of these categories Where a hospital has been using Our developing new model of care for rehabilitation beds less efficiently than the national will improve length of stay in the community average, that it has a credible plan to hospitals and improve efficiency. This has not been improve performance without factored into our model and therefore we believe affecting patient care (for example in this provides a ‘buffer’ regarding the number of line with the Getting it Right First beds proposed. Our planning proposals have Time programme). assumed that we will no longer have ‘super stranded’ patients with a length of stay over 50 days as this does not represent a good quality experience or care outcome for our patients.
Statement of Assurance:
Test Panel finding Test 1 - Strong Public & Patient Engagement / Fully Assured (2017 and 2020) Stakeholder Engagement Test 2 - Consistency with current & prospective need for Fully Assured (2017) Patient Choice Test 3 - Clear Clinical Evidence Base Fully Assured (2017) Test 4 - Support from Clinical Commissioners Fully Assured (2017) Test 5 - NHS Beds Test Fully Assured (2020) Financial Assurance Fully Assured (2020) Implementation Plan Fully Assured (2020)
Key Points
The updated proposals for Inpatient Care, Urgent Care, Diagnostics and Outpatients have been developed through extensive feedback and engagement with local communities and clinicians across the locality over a number of years 12.1 The service proposals consulted on are consistent with the aims and objectives of the Gloucestershire Integrated Care System The proposals are robust and we, and NHS England, are satisfied that all five tests were met to enable the proposals to move to consultation. The key issues of interest to the local community in the response to the consultation are proposed inpatient capacity, urgent care provision for the district – in particular the South of the Forest, End of Life care provision and Travel and Access
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3. Service Models and Response to Consultation Feedback The consultation set out a proposal to include 24 beds in the new hospital in line with the modelling completed and the evidence set out and assured by NHSEI for the 5th or ‘beds’ test. The rationale and approach for how we reached this number is set out in summary below for information:
3.1 Inpatient Bed Numbers To support our bed planning approach the CCG and the former GCS jointly commissioned 33N, an external bed modelling consultancy firm to provide an independent review of the bed capacity required for the Forest of Dean. Acknowledging that this work was undertaken in 2018/19 the assumptions contained were updated and reviewed during 2020 and were confirmed as remaining valid with no significant changes to activity trends and demographics prior to the final proposals being shared in the consultation. Analysis of GCS community hospital activity data was undertaken by 33N with the specific purpose of: Developing a view of how community hospitals function on a county level; Developing an understanding of the bed requirements for the Forest of Dean; Enabling “what if” modelling around changes in bed base, length of stay (LoS) and efficiency at hospital, county and locality level; Enabling bed modelling based on the breakdown of acuity, dependency and complexity of patients/ The existing model of care within all of our Community Hospitals is for sub-acute, general rehabilitation and to support those who may have complex discharge needs. This is consistent with the model of care from the existing beds at the Dilke or Lydney Hospital. Predominately these beds are used for patients stepping down from an episode of acute hospital care and in need of a period of intense rehabilitation to maximise their independence and outcomes. Additionally, the units will (to a significantly lesser degree) admit people directly from the community, helping to prevent an acute hospital admission. The new hospital will continue to support this model of care. The unit will (continue to) be nurse led, with strong multi-disciplinary support from GP medical input, therapists and social workers. This multi-disciplinary input is key to assessing and planning for discharge from the point of admission. The number of residents from the Forest of Dean who have used a community hospital bed in any locality has fallen over the last 5 years. This is consistent with the pattern across other 12.1 localities in Gloucestershire, and is in line with the One Gloucestershire system direction for people to receive care at home where this is appropriate. Our proposal for the new hospital is that it should provide a bed capacity that aligns to the needs of the local population of the Forest of Dean. Our modelling has confirmed that the new hospital should provide 24 beds which is a reduction from the current bed base across both existing hospital sites ( 47 available beds) however, it should be noted that since March and throughout the COVID pandemic these two sites have been operating at a reduced capacity of 30 beds in total. The other important point to note (and key to assurance received through the bed test) is that our county will not see an overall reduction in beds, instead this proposal is an
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intentional rebalancing of beds both geographically (from the Forest district to other areas of the county, predominantly Gloucester city to reflect actual patterns of use) and into the independent sector via brokerage which has significant capacity available to be flexibly purchased to meet demand, ensuring better value for the Gloucestershire £. Further details of some of our bed modelling key figures are as follows: a) At any given time, approximately half of the current beds in the Forest of Dean hospitals are occupied by people who are travelling from other localities in our county (most typically Gloucester). This can be seen in the table below.
Year / Total Resident FoD Non Resident FoD Residency not known
2017/18 56.32% 39.80% 3.88%
2018/19 54.89% 42.11% 3.00%
2019/20 53.95% 42.43% 3.62%
Grand Total 55.04% 41.47% 3.49%
It is worthy of note, that whilst we have been operating at a total of 30 beds across both sites since March 2020, the capacity and flow of patients has not been significantly impacted. The flexible model of alternative community provision has enabled the capacity to be flexed appropriately and this is further supported by additional beds that have been purchased in the Gloucester locality to provide care closer to home for these patients. At the present time, our community is purchasing approximately 230 additional beds across our county to support winter delivery. This reflects the new model of flexible purchases to meet needs close to people’s own homes where possible, and a move away from fixed NHS beds capacity that is not located where people live (in the case of the predominately Gloucester based residents who have historically used the beds in the Forest hospitals). Our current thinking has recognised the challenges that COVID has presented across the existing hospitals estate in the Forest of Dean with regards to infection, prevention and control - and our proposals are continuing to evolve. We are considering a proposal that aims to build the new hospital with 24 single self-contained rooms with en-suite bathrooms, thus ensuring that we can manage care as safely as possible with regards to managing infection prevention and control, and maximising bed availability and capacity. 12.1 b) It is proposed that the new hospital will operate a 7 day therapy model. This has been shown to improve patient outcomes and reduce length of stay through more intensive, multi-disciplinary team support. Based on both CCG and GHC reviews, in Gloucestershire 74% of 2681 admissions to community hospitals (all patients across all community hospital sites, 17/18 data) for rehabilitation require physiotherapy as the primary need. This 74% of patients would benefit from improved access to physiotherapy of up to 6 contacts a week which has the potential to reduce Length of Stay (LoS) by 2 days. A 2 day reduction in LOS could equate to approximately 5 beds being saved across the system. This saving has not been factored into our bed modelling and is therefore part of our ‘buffer’ in planning terms. A 7 day
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therapy model has been used in the Forest hospitals since March 2020 to support the current bed reduction in place due to COVID-19. Aside from the productivity impact, there is a significant benefit for patients from the 7-day therapy model who can get home more quickly and face less risk of ‘decompensating’ (loss of capability and independence) due to avoidance of excessive time spent in a hospital bed. c) Community based services are also supported by a range of assessment unit beds for reablement, rehabilitation (including acquired brain injury), non-weight bearing and Discharge to Assess for Continuing Healthcare and Adult Social Care assessments and therapeutic input. At the time of putting together the proposals for consultation the system was purchasing 136 beds in various locations across the county, but predominately in Gloucester City and Cheltenham. We described how as the bed base in the Forest community hospitals reduces, then we have the ability to increase the capacity through our brokerage services and purchase additional bed based care close to people’s place of residence should this be required. We set out that we are already implementing this model to support winter 2020/21, and as set out above we are now – mid winter 2020/21 – purchasing approximately 230 beds flexibly to support our current delivery model. There is no feasible way that NHS capacity could flex up and down to meet demands to this scale and so we believe that this further supports the validity of our model, and that bed based care can be successfully purchased as required to support demand – as it arises.
d) Our vision for our county is that we expect to have less reliance on inpatient beds, including community beds over time, as we have invested extensively in community- based alternatives such as Rapid Response (a service providing care in people’s own homes and minimising delayed transfers of care), Complex Care at Home and the use of Virtual Wards as currently demonstrated by our COVID virtual ward operating across Gloucestershire since November 2020. Our community teams are now operating in a relatively stable state and as can be seen in the two tables below (which demonstrate the data for Complex Care at Home but are consistent in terms of the pattern for other community based alternatives) there has been a year on year growth in referrals pattern and contacts since the service commenced in 2018/19.
12.1
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Referrals
201819 201920
400 350 300 250 200 150 100 50 0 Forest of Dean Gloucester Cheltenham Other Not recorded District District (B) District (B) Complex Care At Home
Contacts
4500 201819 201920 4000
3500
3000
2500
2000
1500
1000
500
0 Forest of Dean Gloucester Cheltenham Other Not recorded District District (B) District (B) Complex Care At Home
3.1.1 Feedback from the Consultation relating to Inpatient Care 12.1 As set out in the introduction we described each of the services to be offered in the new hospital. We described that we think that the range of services proposed in this Consultation will meet the needs of local people. We asked people to tell us whether they agreed with this statement. The summary of the findings are set out below (the full detail is available in the Annex and online resources referenced in this paper) :
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Feedback relating to our proposals Inpatient Care:
Response Response 1. Inpatient care: Percent Total
1 Strongly agree 21.9% 105
2 Agree 21.9% 105
3 Disagree 19.8% 95
4 Strongly disagree 32.6% 156
5 No opinion 3.8% 18
answered 479
Closer analysis of the breakdown of this feedback relating to inpatient care shows a strong geographical partiality. Now the location of the hospital has been specified (not known for the previous consultation) it can be seen that for residents located in the Centre or North of the district (better for access to Cinderford) then those who supported the proposals exceeded the number of those who did not support. For respondents in the South of the district (worse for Cinderford) then there was an overall negative response to the inpatient proposals: Breakdown of responses by area of the Forest in which the respondent lives:
Central (123 North (7 South (190 responses) responses) responses)
Strongly agree 33.3% 42.9% 10.0%
Agree 24.4% 42.9 % 18.9%
Disagree 16.3% 0.0% 24.2% 12.1
Strongly disagree 21.2% 14.3% 43.7%
No opinion 4.9% 0.0% 3.2%
Analysis of other demographics, e.g. disability, age, ethnicity, health care professionals did not show any notable variation in responses between those who shared a certain characteristic and those who did not.
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Qualitative feedback noted that those who agreed with the proposals for inpatient care thought the new hospital would reduce the need for travelling out of the Forest of Dean, but recognised the need to provide high quality care in the community. A local hospital which we can get access to inpatient and outpatient services will be good and the travelling will be less than having to go out to Gloucester or Cheltenham Keeping the number of beds to 24 in the light of a growing and aging populations will require excellent community care and home based end of life care. The analysis undertaken seems to meet the population needs of people living in the area As a staff nurse who currently works at the dilke the resources we are having to work with, or lack of inhibits our ability to care for our inpatients to the standard at which everyone should expect from a modern NHS.
Feedback from those who disagreed with the proposals asked for consideration of an increase in the local population and questioned whether the 24 beds provided sufficient capacity to support the needs of people in the Forest of Dean. There were comments about a lack of capacity across the county and the need for end of life care to be provided. The number of beds proposed is inadequate. Although based on the current number of inpatients at both Lydney and The Dilke, it fails to account for an aging population and an increase in population in the area. There are numerous patients from the forest area in hospitals outside the area atm, with all these new houses being built throughout the forest there is no way 24 beds will cover the 'locals' needs. Need to be able to provide end of life care in a hospital - not all patients wish to die at home and no hospice inpatient facility in forest Concerned about reduction in beds. Beds currently occupied by many Glos and Chelt patients as they do not have a community hospital. This will not change. I feel that consideration should be given to reviewing the bed provision, if there is insufficient capacity achieved elsewhere in the county forest residents could find the reduced number of beds unavailable to them if otherwise occupied. Single rooms 12.1 There was a mixed response to the proposals for the provision of single en-suite rooms, with some concerns that patients may feel isolated. Single en-suite rooms probably best Better facilities in the single rooms would be more beneficial Will there be communal spaces and or dinning area to support people to interact when appropriate? My main concern is that although single rooms are wonderful they are isolating and make observation difficult. I think individual rooms whilst helpful to a degree with infection control do not overall aid care or recovery.
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3.1.2 Proposed Response to Feedback relating to Inpatient Care There has been a significant complexity in describing a position where at a county level we have no planned reduction in beds, but at the district level we do plan to reduce NHS bedded care, to rebalance against the wider county level needs in our system (most notably, our aim for residents in all parts of the county to have their bedded care provided closer to home). It is clear and completely understandable that on observing the loss in NHS ‘owned’ bedded care for their locality the feedback is somewhat negative. That said, the strong geographical partiality within the dataset shows that people have responded to the service offer at a level that is very local (sub district) level to their home. Those, for whom the new hospital will be most local, support the proposed provision. Those in the South of the Forest, do not. These results suggest that the impact of travel distance to the new Forest of Dean Hospital is impacting on responses to the consultation question about inpatient service provision to a greater extent than the (somewhat complex) detail on modelling and projected bedded and community based capacity. That said, the qualitative feedback did indicate that people appreciated the links between community and bedded care, the need for newer facilitates to support excellent care, and the impact of population growth which was flagged a number of times (population growth has been taken into account in our modelling work). End of life care was raised again by some respondents (flagged in previous engagement) and more work is clearly required to ensure that clinical leaders working in the district can support the countywide End of Life care model being developed. It is not proposed that the Forest should develop an independent model of End of Life care based on capacity being developed for this care in an inpatient community hospital setting. With regards to the proposal for single rooms, some people felt that this could be isolating for patients with others feeling that this represented higher quality of care. Communal areas are planned for the facility, with shared spaces to enable those who can safely socialise with others to do so during the day. The recent experience of COVID has demonstrated that facilities with single rooms were able to keep operating safely throughout the pandemic, providing further evidence for this being a resilient model of inpatient care for community hospitals into the future. 12.1 Planning for inpatient capacity in the hospital has been complex and based on detailed modelling that takes account of needs, available resources, and the developing pattern of services. The backdrop to modelling bed numbers is made more complex due to trying to complete a ‘point in time’ assessment against a dynamically developing sector. Just in the last five years alone we have seen in Gloucestershire a radical development of community services such as Rapid Response and Complex Care at Home, a new End of Life model of care, increasing use of Home First, and the new Enhanced Independence Offer EIO supporting hospital discharges).
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Whilst it is acknowledged that the feedback about the inpatient care proposal has not been wholly positive, the recommendation is that at this stage and based on all of the above we proceed with the commissioning intention to commission 24 beds in predominately single rooms for the new Forest Community Hospital. Key Points
Approximately 50% of the current bed base in the existing Forest of Dean hospitals are utilised by people who do not live within the Forest. In the future we will commission care for these patients closer to home through the ‘spot purchasing of beds’ across our county. A robust and resilient community based set of alternative services such as Rapid Response and Complex Care at Home are now in place Additional community bed based capacity is available with currently 230 beds being purchased in our system, predominately in Gloucester City and Cheltenham. We are confident that we have the ability to increase this capacity through our brokerage services if additional capacity is required once the bed based provision in the Forest is reduced A 7 day therapy model will support a reduction in length of stay which will increase the efficient utilisation of hospital based care and improve patient outcomes, helping them to get home more quickly to their families People in the centre and north of the district with better access to the new hospital supported the proposals for inpatient care, people who lived in the south of the district did not, indicating that travel and access remain a primary concern We propose to proceed with the commissioning intention to commission 24 beds in predominantly single rooms for the new Forest Community Hospital
3.2 Urgent Care Provision As part of the ongoing development of the Fit for the Future programme it has been established that there are clear drivers for change for community urgent care services. These have been developed from extensive public and stakeholder engagement and can be summarised as follows; 12.1 Reduce confusion – the public have clearly stated that they find the current model of delivery confusing, with different entry points and opening hours Accessibility - the recognition that a community urgent care service should be offered in every locality Sustainability - proposed changes must minimise the impact on the main Emergency Departments at both Gloucester and Cheltenham Hospitals. An extensive piece of work was undertaken to review the model of provision of urgent care in the community across the whole of the county, but particularly focused on the Minor Injury and Illness units provided in the seven existing community
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hospitals. Recommendations have been accepted by the ICS Board in early 2020, including that the national Urgent Treatment Centre model would not be implemented across Gloucestershire. Countywide context for Minor Injuries and Illness services (MIIU) Illness is core to the business of primary care and we expect that over time all urgent care services in the county will focus on injuries, with illness being predominately managed in primary care. Urgent Care services will increasingly be pre booked (‘talk before you walk’) which will support the redirection of illness to primary care. Forest of Dean Minor Injuries and Illness services context: Our proposal for the new community hospital is that there will be an urgent care service that is operating 7 days per week to replace the existing two centres at Lydney and Dilke hospitals. The new hospital service will be open from 8am to 8pm, seven days a week. Opening hours of the existing units have changed due to the recent pandemic, with Lydney Urgent Care Centre now open from 8am to 8pm and Dilke Urgent Care Centre remaining closed temporarily (since March 2020). Before the changes that were made to respond to the pandemic, on average 26 people per day attended the service at the Dilke with a similar number attending the service at Lydney. The majority of people attend between 8am and 8pm, with only an average of 1 person per hour presenting between 8pm – 11pm. Activity analysis across the system demonstrates a typical split of injury to illness is that 62% of the activity is injury and the remaining 48% is illness. Based on 2018 / 2019 data, the baseline figures for the Forest of Dean suggest that that year the Forest units saw 10,766 minor injury attendances and 6,598 minor illness attendances. This baseline has been used given that more recent activity has been significantly depressed due to the impact of COVID-19. The service would be supported by a range of diagnostic services including x-ray which would be open 7 days a week. It should be noted that approximately 5-6% of people who present to the urgent care services require an x-ray. The bulk of x-ray usage in the Forest hospitals currently is by people who are referred by their GP, or who are attending the outpatient department and require supporting diagnostic investigations. 12.1 We plan to provide a Minor Injuries urgent care service in the new Forest Hospital to provide services to the whole locality. Following the recommendation of the citizens jury to position the new hospital in Cinderford, we received engagement feedback expressing concerns about access to urgent care provision for the district (these concerns are related to travel and access), in particular with regards to provision for Lydney and the surrounding area in the south of the Forest of Dean (and the distance from these areas to Cinderford). We fully acknowledge the concerns raised during our last phase of engagement around the availability of urgent care in the southern areas of the Forest and the challenge for residents in terms of distance and accessibility to the new hospital in
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Cinderford. Therefore, we will convene a working group including local stakeholders to explore if it might be possible for us to develop other options for the provision of additional urgent care services in the Lydney area. Just under 100 local people have expressed an interest through the consultation survey in participating in this process. We will work with the local community and healthcare partners to identify any potential solutions, which will then need to be tested to ensure they provide high quality, deliverable services into the future.
3.2.1 Feedback from the Consultation relating to Urgent Care As set out in the introduction we described each of the services to be offered in the new hospital. The consultation materials proposed that the new Forest hospital would include an Urgent Care offer, and asked for interest in working with us through a ‘deliberative exercise’ to consider if there would be scope to develop an urgent care offer for the south of the Forest. A summary of feedback we have received is set out on the next page. The comments indicate that people were strongly influenced by the location of the new hospital (being in Cinderford) when they considered whether they supported the proposal to include urgent care services within the new community hospital.
Response Response 2. Urgent care: Percent Total
1 Strongly agree 23.4% 112
2 Agree 19.2% 92
3 Disagree 20.3% 97
4 Strongly disagree 34.3% 164
5 No opinion 2.7% 13 12.1 answered 478
To explore this further, we again undertook to look in more detail at the responses by sub area of the Forest of Dean. It can clearly be observed that the strength of support is dependent upon the individual respondent’s or groups of respondents’ geographical partiality. Respondents from the south of the district are much less supportive of the proposed services for urgent care, compared with those in the central and northern parts of the Forest of Dean.
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Central (122 North (7 South (191 responses) responses) responses)
Strongly agree 35.2% 28.6% 11.5%
Agree 27.0% 57.1 % 14.7%
Disagree 18.0% 0.0% 20.9%
Strongly disagree 18.0% 14.3% 50.8%
No opinion 1.6% 0.0% 2.1%
Analysis of other demographics, e.g. disability, age, ethnicity, health care professionals did not show any notable variation in responses between those who shared a certain characteristic and those who did not. A review of the qualitative comments in response to this question further corroborated that view that the responses were focussed to a large degree on issues of location of the services, rather than whether the hospital itself should contain a minor injuries service. The opening hours of the unit were also raised as a point of concern. Urgent care - locating all MIIU services in one area, namely Cinderford, severely disadvantages people who live in the south of the Forest. Access to local GPs is becoming increasingly difficult and being able to call in at a local 'urgent care centre for reassurance is most important. Easy access to urgent care services for Lydney and surrounding areas will be key. With hours being 8 am to 8 pm it means for urgent care (A&E) you will have to go to Glos which can cause delay to treatment. The distance to travel to the new hospital from Lydney and its surrounding villages is too great for "Urgent" care 12.1 The urgent care should be open for longer hours. Our child had an accident that required treatment this happened late into an evening but luckily the Dilke was open past 10pm Concerned at the lack of emergency cover in the forest between 8.00 pm and 8.00 am
Urgent care support for the south of the Forest of Dean During earlier engagement about the new hospital, as noted earlier in this paper, concerns were raised about people accessing a single urge care facility located in
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Cinderford. A commitment to undertake a further review of urgent care services in the south of the Forest has therefore been made and, through this Consultation, people were offered the opportunity to be involved in this work. Just under 100 people have expressed an interest in participating in further discussions. People’s suggestions for how urgent care could be made more accessible for those living in the south of the Forest included an additional facility; working with local GP services; and improved transport links. Feedback received will be used to inform the planned review.
3.2.2 Proposed response to Feedback relating to Urgent Care As noted in the review of the feedback, the responses strongly reflected the views of local residents on the location of the new community hospital and this has impacted heavily on the feedback received regarding the services offered from a locality perspective. The issue of concerns regarding access from the South of the Forest is well known to the CCG from previous engagement, and we heard this clearly again in the consultation. The next steps are therefore proposed as follows: To confirm, plan and convene the deliberative process to establish if an urgent care offer is viable in the South of Forest (subject to reasonable tests of this being affordable / deliverable) To complete an impact assessment to establish if the potential development of an urgent care offer for the South of the Forest will impact to a material degree on the emerging business case for the Forest community hospital, or whether these two pieces of work could now be reasonably ‘decoupled’ to allow each to proceed to an independent timeline Given that it was known from existing feedback from our previous engagement that there was a high level of interest in an offer for the South of the Forest, an impact assessment had been developed in advance to inform this response: A high level summary of this is set out below. The impact assessment considers the following service planning issues on the likely activity expected to flow through a future unit at the community hospital: The potential move of minor illness to primary care 12.1 The potential development of a minor injury offer for the South Forest
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Impact assessment for South of the Forest Urgent Care Offer
Emergent Service Planning Options
Baseline – Minor Based on historic use total MIIU activity for the district is Injury and Illness 10,766 minor injuries and 6,598 minor illness attendances service as per now, (2018/19 baseline, 8am to 8pm). Option 1 assumes we will delivered from need to see Injuries and Illness & we do not redirect illness community hospital to primary care for all of the Forest Option 1: We can plan a hospital urgent care unit with Locality enough space and staff to take the total activity of 17,364 attendances per annum / 8 til 8 7 days per week GP services take In the future people will book to attend urgent care services minor illness using NHS 111 (talk before you walk) this will mean we can redirect people who need minor illness care to GP services. Option 2 assumes the hospital will be a minor injuries only urgent care unit and will therefore see around 10,766 people per year through the site Option 2: We can plan a hospital urgent care unit with enough space and staff to take the injuries only activity of 10,766 attendances Minor Injuries Care District injuries activity is around 10,766 people per year. delivered in a new Option 3 assumes we can purchase an injury service from facility from Lydney primary care in Lydney. The hospital service will be open 7 days per week, a Lydney service is likely to be open 5 days a week and won’t have Xray. Assuming 10% need Xray, and based on 5 days per week Lydney service could see approx. 3,460 patients per annum. Option 3: We can purchase a Lydney injuries service for 3,460 patients per annum and plan that the hospital unit takes the remaining injuries only activity, 7,306 attendances
These options have been tested with our provider colleagues at GHC and the conclusion is that the activity differences between Option 1, 2 and 3 will NOT make a material difference to the spatial requirements for a minor injuries unit in a community hospital. The business case for the new community hospital at this stage needs to confirm the capital costs, and set out the outline revenue costs. Our 12.1 workings indicate that in capital terms there will be no impact between the different options set out above. From a revenue perspective, there may be a small impact - most significantly between options 1 & 2, with a minimal / if any difference between 2& 3. With up to three years still to go prior to the new hospital opening, we will need to continue to be able to make adjustments to the staffing model (which will drive the revenue costs) between now and the opening date to ensure the proposals continue to be reflective of activity levels in the district. The proposal is therefore that the decision can be made now to allow the business case for the new hospital to proceed, with an urgent care service included, while the
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work on whether an offer for the South of the Forest is viable continues concurrently. The financial impact of developing an additional offer for the South of the Forest is expected to be wholly a revenue consideration rather than capital.. Key Points
It has been a commitment since the inception of the Forest Community Hospital programme that the new hospital will contain an urgent care unit The unit will operate 7 days per week, 8am – 8pm Diagnostic support is proposed to be available 7 days per week Concerns have been raised (and acknowledged) regarding access to urgent care in the South of the Forest and we will convene a working group to include local stakeholders to identify if a South Forest solution can be found. Options analysis indicates that the capital business case for the new hospital is not dependent on any decision on a South Forest offer, therefore the work on the capital business case can proceed alongside the work to consider if a South Forest offer is viable.
3.3 Ambulatory Care (Diagnostics and Outpatients) A range of other services will be contained within in the new hospital development alongside inpatient care and urgent care. The feedback we received in the previous engagement events regarding the range of ambulatory care proposals was positive and we will continue to refine and update the proposals to take account of new ways of working and modern technologies. The range of services is intended to include: Endoscopy - this remains an area of growth across the county with the changes in demand being driven by the expansion of the age range for the bowel screening programme and the demography of the population. Overall, the county has a shortfall in capacity for endoscopy procedures and therefore the provision of a unit in the Forest of Dean will ensure a locally available service and reduce the pressure on services within the main hospital units. This remains consistent 12.1 with our planning assumptions in 2017. Outpatients – the need to have a range of local and accessible outpatient services in the community hospitals was an important element from the engagement exercises and the new hospital will continue to ensure that people are able to access consultant led outpatient services provided by both Gloucester Hospitals NHS FT and Gloucestershire Health & Care NHS FT in a convenient manner. The impact of Covid-19 has meant a change in the way services are currently delivered, including outpatient appointments and therapies. Looking beyond this our
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intention is to continue to deliver services as close to home as possible and acknowledge that this may now include a greater use of technology and virtual appointments either by telephone or video where appropriate to do so. We recognise that models of health care and the ways in which we deliver services will always continue to evolve. Therefore, the new hospital design will focus on flexible multi-use space that incorporates a range of consulting, treatment and group rooms as well as space for video consultations. The range of diagnostics services proposed will ensure a local and accessible service to investigations such as ultrasound and plain film radiology which the GP will be able to refer people directly to along with blood tests for patients who are attending outpatients or the urgent care unit.
3.3.1 Consultation feedback on Diagnostic services People were asked whether the diagnostic services proposed in this Consultation would meet the needs of local people. The feedback on diagnostics is as follows:
Response Response 3. Diagnostic services: Percent Total
1 Strongly agree 24.1% 115
2 Agree 31.4% 150
3 Disagree 15.1% 72
4 Strongly disagree 24.5% 117
5 No opinion 4.8% 23
answered 477 12.1 Although the response this time is more positive than negative, the same pattern of geographic partiality is observed. Respondents from the south of the district are less supportive of the proposed diagnostic services, compared with those in the central and northern parts of the Forest of Dean.
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Central (123 North (7 South (190 responses) responses) responses)
Strongly agree 39.0% 42.9% 11.1%
Agree 36.6% 42.9 % 28.9%
Disagree 8.1% 0.0% 19.5%
Strongly disagree 13.8% 14.3% 35.3%
No opinion 2.4% 0.0% 5.3%
Analysis of other demographics, e.g. disability, age, ethnicity, health care professionals did not show any notable variation in responses between those who shared a certain characteristic and those who did not. Qualitative feedback noted support for the proposals which would result in a reduced need to travel outside the Forest of Dean, but also reflected on the overall difficulty in accessing services for those living in the south of the Forest. Good that diagnostic services will be there, so that people in the forest don’t have to travel to Gloucester or Bristol. More diagnostics and minor surgical procedures would be welcome to save the trips to Gloucester or Cheltenham. I welcome the additional diagnostic services over the weekend, but you need to ensure that staff are sufficiently competent to provide the right level of care I like the sound of more diagnostic and outpatient services Lydney hospital is super important for people like me, I can’ drive and I have 4 children. The buses to anywhere are practically impossible and I can’t afford a taxi to Cinderford or Gloucester for a hospital visit. It would be detrimental to the health of myself and my children. Diagnostic services in one place should not preclude x ray in Lydney which needs ready access and already has a state of the art facility funded by local people. 12.1
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3.3.2 Outpatient services People were also asked for their views on the outpatient proposals. A summary of the feedback is set out below:
Response Response 4. Outpatient services: Percent Total
1 Strongly agree 25.9% 124
2 Agree 28.5% 136
3 Disagree 15.1% 72
4 Strongly disagree 26.4% 126
5 No opinion 4.2% 20
answered 478
Again, the theme continues that the strength of support is dependent upon the individual respondent’s or groups of respondents’ geographical partiality. Respondents from the south of the district are much less supportive of the proposed outpatient services, compared with those in the central and northern parts of the Forest of Dean.
Central (123 North (7 South (190 responses) responses) responses)
Strongly agree 38.2% 42.9% 12.6% 12.1 Agree 35.8% 42.9 % 24.7%
Disagree 9.8% 0.0% 20.0%
Strongly disagree 13.0% 14.3% 39.5%
No opinion 3.3% 0.0% 3.2%
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Analysis of other demographics, e.g. disability, age, ethnicity, health care professionals did not show any notable variation in responses between those who shared a certain characteristic and those who did not. Qualitative feedback noted support for the proposals which would result in a reduced need to travel outside the Forest of Dean, but also reflected on the overall difficulty in accessing services for those living in the south of the Forest. I think it would be great to also consider outpatient services with the availability to connect with consultants digitally/ remotely rather than driving to Gloucester /Cheltenham. Ortho and Neuro and Respiratory O/P appointments would be REALLY useful if the hospital was to have an effective REHAB role. We need as many outpatient clinics as possible because getting to Gloucester/Cheltenham by car is bad enough, (time, traffic, parking) but without a car can mean several buses and a whole day taken. I question the statement on page 21 about the range of outpatient clinics provided by Gloucester hospital. Recently I have had to visit orthopaedics several times for follow up consultations. I was told neither of these clinics were available at the Dilke or Lydney. This once in a life time opportunity to get it right – don’t combine services assuming they will work it out. Space is a necessity when providing rehabilitation for complex people with multiple disabilities. Having all community services within the hospital space will enhance the holistic management of patients and the patients journey. That is why investing in multidisciplinary teams is the gold standard approach.
3.3.3 Proposed response to Feedback relating to Outpatients and Diagnostics As noted in the review of the feedback, the responses continued to reflect the views of local residents on the location of the new community hospital and this has impacted on the feedback received regarding the services offered from a locality perspective. That said, the balance of feedback is that the proposals for outpatients and diagnostics are broadly supported by the feedback received with caveats about where possible maximising the potential for all residents in the district to be able to 12.1 access outpatient and diagnostic care as close to home as possible. The proposed response therefore is to proceed with the proposed approach to outpatients and diagnostics in the new community hospital. Key Points
The proposal will include a dedicated endoscopy unit to meet the needs of the local population. This will be a new offer in the new hospital compared to the existing facilities (which do not have suitable estate to offer this service)
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A range of outpatient services will be provided similar to that within the existing two hospitals. The facility will be designed to take account of new ways of working and increased use of video consultation and technology. Diagnostic provision will include plain film and ultrasound and blood tests for patients attending the outpatient department and urgent care unit.
3.4 Travel and Access Although there were not any specific questions relating to travel and access in this consultation, it can clearly be seen throughout the responses that the location of services and issues of access are a principle concern of local residents. Travel and access has in fact been a consistent theme in all stages of the engagement processes. Detailed analysis has been completed to consider the travel implications associated with the change in service delivery. We have analysed the rates of car ownership and public transport services in the district. Over 80% of the people who responded during a public engagement event indicated that they have their own motorised transport with 10% generally relying on public transport as their main mode of transport. Since the travel analysis was completed the decision has been made to locate the new facility in Cinderford and a site has now been acquired by Gloucestershire Health & Care NHSFT. This phase of the consultation is not concerned with the decision regarding the location of the hospital, this decision has already been made and the site already purchased for development. For information however the figure below shows the locations that can access Cinderford within a 30-minute travel time by car. This shows that the two main urban areas of Lydney and Coleford are within this parameter. Sedbury is the area facing the longest drive to Cinderford in the locality, but analysis indicates that residents from this area also access services in North Bristol (which is a shorter drive and no longer subject to Severn bridge tolls). A new community hospital is also planned by the Anuerin Bevan Health Board in South Wales which may also enhance choices for local people in terms of access. In relation to public transport a 90-minute journey time was considered to arrive at 12.1 Cinderford by either 8.30am or 1.30pm and then associated departure times. This showed that with the new hospital based in Cinderford, people from Lydney could achieve 3 out of the 4 timeframes but were unable to achieve the 1.30pm arrival time in 90 minutes. Again, Sedbury was the most affected locality with only 3 out of the 4 scenarios being possible. In the past we have successfully worked with local councils to ensure that bus routes are adjusted to provide better access to NHS facilities and we would seek to do the same for any new hospital located in the Forest of Dean. Additionally, there is a strong provision of community transport available across the Forest of Dean and we would continue to work with these providers to ensure a robust offer and particularly look to improve the impact for those residents most affected.
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Local Travel Analysis:
Key Points
We acknowledge that travel and access remains a concern in terms of access to services across the Forest of Dean Travel analysis has been conducted considering the new hospital location in Cinderford. The area of the Forest impacted most significantly is the Sedbury population. Public transport is generally poor in the district. We will continue to work with the Local Authority to improve access to the new hospital via bus routes and bus stops being positioned either within or at the entrance to the site. 12.1
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4. Next Steps The Governing Body needs to consider the recommendations that are set out in this paper, which are summarised for ease of reference below. Confirmation of these will constitute a firming of the commissioning intentions for the new community hospital, which will enable the work on the capital business case to proceed towards the intended March deadline for completion. The recommendations are as follows: Inpatient Beds: Whilst it is acknowledged that the feedback has not been wholly positive, the recommendation is that based on all of the issues set out and explored in this paper, the Governing Body should proceed with the commissioning intention as it stands – i.e. to confirm our intention to commission 24 beds in predominately single rooms for the new Forest Community Hospital Urgent Care: To confirm our intention to include a Minor Injuries Unit in the new hospital in line with our previous commitment, to enable the work on the capital business case for the new hospital to proceed. Urgent Care: To confirm that the work to develop an offer for the South of the Forest and test whether it is viable can continue concurrently (and not as a dependency to the hospital business case) given that analysis confirms the financial impact of developing an additional offer for the South of the Forest is likely to be wholly a revenue consideration and will not impact to a material degree on the capital scheme for the hospital Ambulatory Care (Diagnostics and Outpatients: To confirm that we will continue to confirm our commissioning intentions for ambulatory care services as set out in the consultation proposals, noting that these have been broadly supported in the consultation. Where possible, ongoing development of proposals should seek to maximise the potential for all residents in the district to be able to access outpatient and diagnostic care as close to home as possible. Travel and Access: Although this was not a specific question in the consultation it is clear that issues relating to travel and access remain central to respondents views on the services proposed. A strong geographical partiality was observed in every area of the consultation, with responses becoming more negative the further respondent’s homes were located from the site of the proposed new 12.1 community hospital. Ongoing work to support transport and travel in the district, and work to consider opportunities further developments of out of hospital care (such as virtual outpatients) are therefore key to how we need to work to support ongoing service improvement for local residents in the Forest of Dean. Next steps: To confirm our commissioning intentions as set out in these recommendations, if agreed, to GHC to enable their work to proceed on the capital business case. The timeline agreed is that GHC will aim to complete the Full Business Case (FBC) by the end of March 2021.
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Annex 1: Output of consultation Report
1. Executive Summary The A new hospital for the Forest of Dean Output of Consultation Report is intended to be used as a practical resource for NHS Gloucestershire Clinical Commissioning Group (CCG) and Gloucestershire Health and Care NHS Foundation Trust (GHC); to provide them with information about how the public, community partners and staff feel about the range of services proposed for the new hospital, in order to inform their decision making in 2021.
The new hospital in the Forest of Dean is part of the wider ambitions of One Gloucestershire; a partnership between the county’s NHS and care organisations to help keep people healthy, support active communities and ensure high quality, joined up care when needed. The NHS partners of One Gloucestershire are: NHS Gloucestershire Clinical Commissioning Group (CCG) Primary care (GP) providers Gloucestershire Health and Care NHS Foundation Trust Gloucestershire Hospitals NHS Foundation Trust South Western Ambulance Services NHS Foundation Trust
This Report will be shared widely across the local health and care community and is available to all on the Forest of Dean health website www.fodhealth.nhs.uk and on the new online participation platform Get Involved in Gloucestershire https://getinvolved.glos.nhs.net
We would like to thank everyone who has taken the time to share their views and ideas.
‘Consultation: The dynamic process of dialogue between individuals or groups, based upon a genuine exchange of views and, with the objective of influencing decisions, policies or programmes of action’. The Consultation Institute (2004)1
The Governing Body of NHS Glos CCG and Board of GHC are invited to consider the feedback from the Consultation and indicate how it has influenced their decision making. Full details of 12.1 the next steps for the development of the new hospital can be found in Section 2.3.
This Report has been prepared by the One Gloucestershire Communications and Engagement Group. This report is produced in both print and on-line (searchable PDF) formats. For details of how to obtain copies in other formats please turn to the back cover of this Report.
1 The Consultation Institute: https://www.consultationinstitute.org/beware-wholly-inadequate-definition- consultation/#:~:text=Since%202004%2C%20the%20Institute%20has,policies%20or%20programmes%20of%20a ction 28
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1.2 Consultation key facts 3,400 Consultation booklets distributed, 495 requests for information following door- to-door leaflet distribution. 20 consultation events. More than 250 socially distanced contacts with members of the public & community partners and over 100 with staff. 10 Facebook posts with a reach of over 56,000 and 200 ‘engagements’. 8 tweets generated over 7,000 impressions and 100 ‘engagements’. 554 consultation surveys completed, plus additional written responses.
1.3 Summary of feedback The summary of feedback uses the following sources of consultation feedback: Analysis of 554 completed surveys Themes from other forms of responses including: correspondence (including formal responses), events, social media and responses to an alternative survey developed by a local campaign organisation Themes from face-to-face Information Bus Tour visits Themes from targeted consultation activities, taking account of groups identified through the Equality Impact Assessment Detailed feedback from all of these consultation activities can be found in Section 5.2
Based on quantitative analysis the feedback to the consultation is less supportive of the proposals for inpatient care and urgent care and more supportive of the proposals for diagnostic and outpatient services. The strength of support across all services is dependent upon the individual respondent’s or groups of respondents’ geographical partiality. Respondents from the south of the district are less supportive of the proposed services for the new hospital than those in the central and northern parts of the Forest of Dean.
Qualitative feedback notes the benefit of providing services from an improved facility in the Forest of Dean, rather than having to travel to Gloucester or Cheltenham. Concern is voiced about access to the new hospital from Lydney and the south of the Forest, and the ability to 12.1 provide services from a single site, whilst the population in the Forest of Dean is continuing to increase. Many of the comments made focussed on issues outside of the Consultation; the decision to provide one new hospital which would result in the closure of the existing hospitals; and the agreed location for the new hospital.
In terms of the reach of the consultation, demographic information is known about those survey respondents who chose to provide ‘About You’ information in their survey responses; approximately 27% of respondents did not complete the ‘About You’ information.
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Targeted activities aimed to extend the reach of the Consultation and collect data on all protected groups, as recommended in earlier Equality Impact Assessments. Analysis of the survey responses shows there is a broad representation of most groups. Further analysis of responses by various demographics, e.g. age, gender, health and care professionals, does not show any significant variation when compared with the overall themes.
During the consultation participants also took the opportunity to access information, ask questions and comment on the national and local response to the coronavirus pandemic. Many people expressed their gratitude to NHS and care staff and recognised Gloucestershire’s diverse communities’ mutual acts of support for colleagues, friends, families and neighbours.
A detailed summary of feedback received can be found in Section 5.2. All feedback received can be found in the Appendices to this Report.
1.4 Making the best use the information provided in this Report There are elements of feedback which will be relevant and of interest to all readers; these can be easily found in the main body of the report. The theming of the qualitative feedback presented in this report has been undertaken by members of the One Gloucestershire Communications and Engagement Group.
All feedback relating to the specific services can be found in a series of online Appendices. These Appendices include all comments collected including copies of individual submissions received in addition to the FFTF survey responses.
Some respondents may have answered the formal consultation survey as well as giving feedback in other ways, such as sending a letter, participating in a discussion event. All feedback received has been read and summarised and had been coded into themes such as: ‘access’, ‘capacity’ and ‘quality’. Please note that individuals comments may cover more than 12.1 one theme.
We acknowledge that such an exercise includes a subjective element and we recognise that others may have chosen to place items of feedback under alternative themes. To provide assurance, all qualitative written feedback from both survey respondents, comments and individual correspondence received and collated by representatives of One Gloucestershire partners during the consultation period is included within this report and/or the online Appendices.
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1.5 Appendices All appendices are available at: www.fodhealth.nhs.uk Appendix 1: Survey analysis i) Full survey ii) Easy Read iii) Responses by geography: Central, North, South iv) Response by other demographics: age, gender, disability, staff, members of the public & community partners, carer Appendix 2: Other feedback/correspondence: i) public responses; ii) responses from elected representatives and political parties iii) Primary Care Network iv) Forest of Dean District Council
Appendix 3: Equality and Engagement Impact Assessment
12.1
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2. Introduction
2.1 A new hospital for the Forest of Dean Following a period of Consultation in 2017, the Board of Gloucestershire Care Services NHS Trust (now Gloucestershire Health and Care NHS Foundation Trust; GHC) and the Governing Body of NHS Gloucestershire Clinical Commissioning Group (CCG) approved the option to build a new community hospital in the Forest of Dean. This new hospital will replace The Dilke Memorial Hospital and Lydney and District Hospital.
A Citizens’ Jury, made up of local people, met over four days in August 2018. Having reviewed extensive information, they recommended that the new hospital should be located in Cinderford. This recommendation was formally approved by the CCG and GHC.
Further engagement with local people and staff during 2019 has informed the services for the new hospital as proposed through this Consultation. The site for the new hospital was announced in December 2019 as the Collingwood Skatepark and Lower High Street Playing Field in Steam Mills Road, Cinderford.
2.2 Public and staff consultation programme What the Consultation is about The public and staff consultation programme started on 22 October 2020 and ran until 17 December 2020. The purpose of the consultation is to seek views on the range of services provided at the new hospital for the Forest of Dean: Inpatient care Urgent care Diagnostic services Outpatient services All feedback received is collated into this comprehensive Output of Consultation Report and online appendices and will be used to inform the decisions about the future of local NHS 12.1 services.
During the last phase of engagement, concerns were raised around the availability of urgent care in the southern areas of the Forest and the challenge for residents in terms of distance and accessibility to the new hospital in Cinderford. Alongside this Consultation, there is a public commitment to explore if it might be possible to develop other options for the provision of additional urgent care services in the Lydney area. Comments regarding this are also included in the Output of Consultation Report.
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What the Consultation is not about This Consultation is not about the decision to move to a single community hospital for the Forest of Dean. Nor is it a consultation on the location of the new hospital, which was approved following a recommendation by a Citizens’ Jury in August 2018. However, people completing the survey have taken the opportunity to comment on both of these decisions and this is noted in the Sections 5.2 and 5.3 of this Report
Consultation process There have been a number of innovative ways the NHS has involved local people and staff over the past few months from online events, to a ‘socially distanced’ Information Bus Tour to a door-to-door mail-drop to all households in Gloucestershire. Full details of the consultation process can be found in Section 3.
This Consultation is the latest element of the review of health and care services in the Forest of Dean2, which began in September 2015.
2.3 Next Steps: What happens next? Consultation review period There will be a consultation review period, where NHS Gloucestershire CCG and GHC will carefully consider all of the feedback received at their Governing Body and Board meetings in January and March 2021 respectively.
Decision The feedback will be used to inform the CCG in commissioning future hospital services in the Forest of Dean, as set out in this Consultation. If the proposals are supported by the CCG Governing Body i.e. the services that will be provided will be confirmed within a commissioning specification, GHC will finalise a formal business case setting out the benefits, the design specification and financial plan for the building and ongoing operation of the new hospital. 12.1 The final business case will need approval from the Board of GHC. It is anticipated that this approval will be considered at the Trust’s board meeting in March 2021.
Process of implementation Following approval of the business case, GHC will need to seek full planning permission before construction can begin. Services will remain at The Dilke Memorial Hospital and Lydney and District Hospital until the new hospital is opened.
2 Previous engagement: https://www.fodhealth.nhs.uk/consultation/ 33
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Providing feedback to you on the consultation and decisions The feedback from the consultation and the final decisions made by the CCG Governing Body and Board of GHC will be published at: https://www.fodhealth.nhs.uk/consultation/ and shared on the online participation platform Get Involved in Gloucestershire https://getinvolved.glos.nhs.uk
12.1
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3. Our approach to communications and consultation
3.1 Working with others Planning and delivery of the consultation has been supported by many external groups: Forest of Dean Locality Reference Group: helped refine our plans for Consultation and raise awareness of the Consultation with their local networks. The Consultation Institute: The Consultation Institute provides advice and guidance in relation to all aspects of consultation planning and activity. Gloucestershire Health and Care NHS Foundation Trust (GHC) : Assisted with the development of Easy Read materials. Healthwatch Gloucestershire (HWG): HWG Readers Panel reviewed an early draft of the full consultation booklet and made suggestions for changes, which were incorporated into the final version. Community Connectors3: This forum allowed us to share information at their online meeting during November to promote the Consultation. District/Town Council and Retail partners: Supported the ‘socially distanced’ visits of the Information Bus (outside of Lockdown 2) to locations with maximum footfall across the Forest of Dean. Others: Many other groups and individuals have helped to raise awareness of the consultation.
Thank you to everyone who has supported this consultation.
3.2 Covid 19: Socially distanced consultation In order to maximise opportunities to raise awareness of the consultation and opportunities to get involved the following methods were used:
Door to Door mailer
The NHS commissioned the Royal Mail to deliver a mailer to all households in Gloucestershire. 12.1 The mailer gave brief information about the Forest of Dean Community Hospital consultation and the Fit For the Future consultation, which has been running concurrently. The mailer included a freepost reply slip to request information in a range of formats, or ask for a telephone call.
833 mailers were returned in total (before the Consultation closed) 1,743 requests for information (1,286 items posted)
3 Community Connectors: Facilitated by Forest Voluntary Action Forum, this group of community partners was established as a response to the current pandemic. 35
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FoD CH (495) Full booklet 308 (239 sent by post) Easy Read 187 (145 sent by post) FFTF (1248) Long 226 (162 sent by post) Short 587 (415 sent by post) Easy Read 256 (193 sent by post) Pre-Consultation Business Case 180 (132 sent by post) 116 requests for telephone call backs FOD CH (33) FFTF (83)
In addition, households in Springfield Drive, Cinderford, (which neighbours the site for the new hospital) received a letter from Gloucestershire Health and Care NHS Foundation Trust, updating them on the consultation.
3.3 Developing understanding and supporting the consultation This section describes the wide ranging approach taken to promote the Consultation and the range of involvement opportunities. In summary:
Media releases and stakeholder briefings
This included: launch materials – media release and stakeholder briefing media statements reinforcing key messages and involvement opportunities materials sent by post to 334 GHC Foundation Trust Members living in the Forest of Dean and emailed to all 6095 Members across the county.
Hardcopy engagement booklets 12.1 3,400 booklets were widely distributed to a range of public places including community pharmacies, GP surgeries, hospitals and libraries. The booklets included the survey and information detailing the ways people could get involved.
‘Consultation’ area on the FODhealth website and Get Involved in Gloucestershire online participation platform
All consultation materials can be found at: https://www.fodhealth.nhs.uk/
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Get Involved in Gloucestershire is an online participation space where anyone can share views, experiences and ideas about local health and care services. Information about the consultation including activities can be found at https://getinvolved.glos.nhs.uk/fit-for-the- future11
Social media
Social media was used to support the consultation and planned activity covered topics such as promotion of how people could get involved, Information Bus Tour and Cuppa and Chat events and promotion of the booklet and survey.
Facebook During the engagement there were 7 Facebook posts (non-paid for activity), with a total reach of 30,077. There were 177 ‘engagements’ with these posts (i.e. actions such as comments, likes or shares) of which 72 were shares. There were also three paid-for adverts that linked to the Consultation section on the FOD health website. They achieved a reach of 26,280 with 23 shares.
Twitter During the Consultation period there were 8 tweets, with a total of 7,198 impressions. There were 109 ‘engagements’ with these tweets (i.e. actions such as link clicks, retweets, likes, or comments) of which 17 were retweets and 55 were clicks through to the FOD health website.
3.4 Staff communication and engagement Gloucestershire Health and Care NHS Foundation Trust Information regarding the Consultation was shared with all Trust staff. In addition, four online Teamtalk sessions were held for staff working in the Forest of Dean. These were attended by 83 members of staff in total.
Primary care (GP practices) and NHS Gloucestershire Clinical Commissioning Group (CCG) The Forest of Dean hospital and Fit for the Future consultations have been regularly 12.1 promoted to all staff working at NHS Gloucestershire Clinical Commissioning Group and in GP practices, Primary Care Networks and the Local Medical Committee via the Primary Care Bulletin. The Primary Care Network have submitted a response to the consultation, which is detailed in Section 6.
3.5 Elected Representatives Members of Parliament Regular MP briefings have taken place prior to and during the Consultation period.
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Gloucestershire County Council (GCC) Gloucestershire County Council Health Overview and Scrutiny Committee Members have received regular updates on the Consultation. Consultation materials have been available to elected members and staff.
Forest of Dean District Council An online Members Seminar was held on 1st December and attended by 14 representatives. Following a presentation, members had the opportunity to participate in a Question and Answer session.
The Council has submitted a motion regarding hospital and primary care facilities in the Forest of Dean to the CCG; This Council fundamentally believes that the entire future of Forest Hospitals and indeed Primary Care facilities needs to be revisited in light of the Covid emergency and mindful that the greater proportion of new build expansion is destined for the South Forest Area. The full submission is included in Appendix 2
3.6 Other community stakeholders and the public Surveys
Two surveys (standard and Easy Read) were developed by the NHS to support the Consultation. These were available as print, FREEPOST return copies in the Consultation booklets and also on line at: https://www.fodhealth.nhs.uk/consultation/ and https://getinvolved.glos.nhs.uk/fit-for-the-future11
A total of 554 completed surveys have been received; 497 full surveys and 57 Easy Read. Most of these were completed online, but 45 full surveys and 20 Easy Read surveys were received as paper versions.
45 individuals who responded to the survey identified themselves as health or care professionals.
Other surveys and petitions 12.1 HOLD (Hands off Lydney and Dilke hospitals) What is HOLD? The HOLD (Hands off Lydney and Dilke hospitals) campaign was launched during an earlier Consultation. In the ‘About’ section of their Facebook page, the group note they are: “Campaigning to retain at least two community hospitals in the Forest of Dean, against the sell-off and closure of the Dilke and Lydney hospital sites and demanding investment, not a single, smaller, new hospital”.
A letter to Gloucestershire Health and Care NHS Foundation Trust is available for download on the HOLD Facebook page. HOLD are asking people to sign and send the letter to the Trust. 38
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A copy of the letter is included in Appendix 2. 20 adapted versions of the HOLD letter, have been received by the Trust.
Petitions At the time of writing no petitions relating to the new hospital in the Forest of Dean have been received by either the CCG or GHC.
Other correspondence Additional emails and letters have been received during the consultation. 3 letter responses were received. 10 email responses were received. These are collated (redacted as appropriate) in full at Appendix 2.
Events NHS Information Bus Tour The Information Bus aims to facilitate partnership working, offering information and activities which support self-care, health and wellbeing and self-management across the communities of Gloucestershire. The Bus is also used a consultation resource to support engagement with the public to inform service planning and design.
An Information Bus Tour to raise awareness of the new hospital in the Forest of Dean and the Fit for the Future consultations commenced on 2 November 2020. Unfortunately due to new Covid-19 restrictions introduced from 5 November 2020, planned Information Bus Dates originally planned for November 2020 were cancelled. Three events had been held prior to lockdown.
Additional Information Bus Tour dates were planned for after 2 December 2020, when lockdown in England ended. The Bus recommenced its Tour on 1 December 2020 in Chepstow, Monmouthshire (where lockdown was not in place) and in Cheltenham on 3 December 2020. See Section 3.7 for details of all Information Bus Tour dates. 92 people visited the Bus during events in the Forest of Dean. 12.1
Cuppa and Chats When the Information Bus Tour was paused in November 2020, locality and countywide online ‘Cuppa and Chats’ were set up to replace the socially distanced face-to-face visits planned. These took the form of a short presentation (including showing of a promotional film) followed by a shared discussion.
The sessions were initially organised at Microsoft Teams meetings, in response to feedback from public participants, the sessions were moved to an alternative platform, Zoom, which is more frequently used by community partners. 39
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Two Cuppa and Chats specifically relating to the new hospital Forest of Dean Consultation were hosted reaching 12 participants.
Targeted activities In addition to the main consultation activities, the consultation sought feedback via community partners and groups identified in the Equality Impact Assessment. Further analysis of responses by various demographics, e.g. age, gender, health and care professionals, does not show any significant variation when compared with the overall themes.
12.1
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3.7 Consultation events activity timeline Week Engagement activity Number engaged with
15 October Gloucestershire Health & Care NHSFT - online 15 awareness raising session for staff based in Forest 22 –28 October Health Overview and Scrutiny Committee (HOSC) 15
29 October – Information bus – Cinderford, Co-Op (Forest of 22 4 November Dean) 5 – 11 November Gloucestershire Health & Care NHSFT – Staff 25 Teamtalk session PPG Network 25
Gloucestershire Health & Care NHSFT – Staff 19 Teamtalk session 12 – 18 Health Overview and Scrutiny Committee (HOSC) 15 November Forest of Dean Locality Reference Group 13
Forest of Dean Community Connectors/KYP 17
19 – 25 Cuppa and Chat - Forest of Dean (using Zoom) 10 November 26 November – Information bus - Chepstow 17 2 December BAME C19 Task and Finish Group 12 attendees – info circulated to full membership Forest of Dean District Council briefing 14
3 – 9 December Information bus – Lydney, Newerne Street car park 32 (Forest of Dean) Cuppa and Chat - Forest of Dean 2
Forest of Dean Primary Care Network 19
10 - 17 December Gloucestershire Health & Care NHSFT - online Q&A 10 12.1 session for staff based in Forest Gloucestershire Health & Care NHSFT – Staff 28 Teamtalk session Information bus - Coleford Clock Tower (Forest of 38 Dean) Gloucestershire Health & Care NHSFT – Staff 11 Teamtalk session
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4. Equality and Engagement Impact Assessment (EEIA) Equality, diversity, Human Rights and inclusion are at the heart of delivering personal, fair and diverse health and social care services. All commissioners and providers of health and social care services have legal obligations under equality legislation to ensure that people with one or more protected characteristics4 are not barred from access to services and decision making processes
The consultation has been informed by the experiencing of managing earlier extensive engagement activities. During earlier engagement relating to the location of the new hospital, an independent Equality Impact Assessment was commissioned. The plan for the consultation was informed by the feedback from these engagement activities, including feedback from NHSE/I Assurance process.
Extract from NHSE/I Assurance Process feedback in relation to communications and engagement: The engagement output report shows that the team have really given people every opportunity to take part in the engagement programme and the resulting output report is very extensive. Full credit for openness and transparency In response to COVID-19 restrictions the Strategy and Plan has been designed to support a ‘socially distanced’ consultation. It includes an Appendix/Briefing which summarises recent advice and guidance regarding online consultation, sets out assumptions and considerations and makes the following observations and conclusions, which will be taken into account during the consultation: Consideration to be paid to online deliberation and engagement are those you should pay attention to regardless of whether engagement is face to face or online. Things such as feeling safe, ensuring transparency and that participants have the facts to be able to make an informed decision would apply regardless of how you engage. Online consultations prove to be most successful when used in conjunction with offline methods such as telephone structured interviews/market research techniques/managed exhibitions. Two-way direct communication is crucial in creating meaningful dialogue – video conferencing software (Zoom, Microsoft Teams etc.) can facilitate this. Online forums should be moderated to keep discussion topics organised and to keep participants safe. 12.1 Think about varying the times of online events – avoid excluding working age participants. Online events should be no longer than 2 hours and comfort breaks should be scheduled. Use creative and interactive dialogue methods for online and offline activities. Paper surveys should be replicated as online surveys.
4 It is against the law to discriminate against someone because of: age; disability; gender reassignment; marriage and civil partnership; pregnancy and maternity; race; religion or belief; sex, sexual orientation. These are called protected characteristics. https://www.equalityhumanrights.com/en/equality-act/protected-characteristics
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Some individuals or groups feel more comfortable sharing their thoughts on their own platforms, rather than official channels designed explicitly for themed discussions. Different marketing messages required to encourage online participation for ‘always’ (compete with other opportunities), ‘seldom’ (relevance, links to pandemic interests) and ‘never’ online (other opportunities or assistance required).
4.1 Consulting people with protected characteristics and others identified in the Equality and Engagement Impact Assessment The consultation took two main routes to reach, gather and record views from people with protected characteristics and others identified in the EEIA: promoting the formal consultation routes and encouraging participation. The consultation survey asks for respondents to provide demographic information (see Section 5.1) We have extended these questions in response to the recommendations of the independent Equality Impact Assessment undertaken in 2018. proactive consultation with targeted groups. The consultation team contacted groups across Gloucestershire using existing well established networks, Community Connectors and Your Circle https://www.yourcircle.org.uk/, (an online directory to help you find your way around care and support and connect with people, places and activities in Gloucestershire).
The Consultation was open to all and consultation activities were designed to facilitate feedback from as wide a cross-section of the local community as possible. The full Equality and Engagement Impact Assessment (EEIA) of the planned consultation activities is available at https://www.fodhealth.nhs.uk/wp-content/uploads/2020/10/Equality-and-Engagement- Impact-Assessment-FOD.pdf
Groups potentially impacted, issues identified and actions taken Our aim with this consultation was to reach a good representation of the local population, whilst making sure we hear from those groups who might be most affected by the proposed changes. We will seek out the views of people from the groups set out below, to gain a better 12.1 understanding of the potential impact on them and to identify ways to lessen any potential negative impacts: Over 65s who are more likely to have long term conditions such as cardiovascular disease, obesity or diabetes and are higher users of community hospital services. People from BAME communities People living with a disability (includes physical impairments; learning disability; sensory impairment; mental health conditions; longterm medical conditions). Adult Carers/Young Carers People living in low income areas. LGBTQ+ people
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Issues identified and action taken (as noted in the EEIA) Less information, less jargon and easy read The Consultation booklet has been reviewed by the Healthwatch Gloucestershire Lay Readers Panel. An Easy Read version of the consultation booklet and survey has been produced by Gloucestershire Health and Care NHS Foundation Trust.
Further engagement to address the homogeneity of participants Targeted opportunities for consultation with protected characteristic groups identified through the EEIA e.g. via Voluntary Sector organisations, Carers Forum, etc. Alternative formats of all consultation materials available on request. Contract in place with telephone (and face to face) interpreters, incl. BSL and for written translation. An introduction to the Consultation, with information about support to enable people to participate, was sent to the Forest of Dean Talking Newspaper.
Paper surveys should be replicated as online surveys Surveys made available on line in regular and easy read formats. People have also been offered assistance to complete surveys over the telephone.
Different marketing messages required to encourage online participation for ‘always’ (compete with other opportunities), ‘seldom’ (relevance, links to pandemic interests) and ‘never’ online (other opportunities or assistance required). A variety of forms of media, print, broadcast, and social media platforms were used. A ‘mailer’ has been delivered to all households in Gloucestershire telling them about the two consultations and how they can get involved.
Liaise with community leaders to encourage participation from the BAME communities, providing support for interpreters Working through community partners, including BAME communities, we aimed to promote opportunities for participation in the consultation. Consultation materials were available in alternative languages on request.
Use creative and interactive dialogue methods 12.1 We used a range of communication and consultation methods: Online, face-to-face (socially distanced), telephone, written.
Online consultations prove to be most successful when used in conjunction with offline methods such as telephone structured interviews/market research techniques/managed exhibitions. We hosted a range of online activities and chat forums via Zoom and our Get Involved in Gloucestershire platform. We invited people to request a booked telephone interview. Although restricted due to Covid19 lockdown measures, we were able to use our Information Bus across the county, visiting three of the market towns in the Forest of Dean. 44
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Online forums should be moderated The Forum function of the Get Involved in Gloucestershire online participation platform is independently moderated.
Varying the times of online events Events were held at different times of day and different days of the week.
Events, e.g. workshops, no longer than 2 hours All scheduled online events were no longer than 90 minutes. Online events were informal and participants encouraged to take a comfort/refreshment break as required.
Some individuals or groups feel more comfortable sharing their thoughts on their own platforms, rather than official channels designed explicitly for themed discussions. We were able to offer a range of platforms, to ensure they worked best for the individual or group: Zoom, Face Time, Microsoft Teams, Webex. Following feedback from participants, our Cuppa and Chat sessions were switched to Zoom. We were also able to offer more traditional methods such as telephone calls: we successfully followed up 33 requests for telephone calls.
Target groups identified through the EIA We promoted the Consultation to representatives from the groups identified through the EEIA process and in conjunction with the Fit for the Future Consultation that was being undertaken simultaneously, sought advice to encourage participation, eg. Advice from the Homeless Healthcare Team, Carers Hub, Age Uk and other community partners.
12.1
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5. A new hospital for the Forest of Dean: Survey Responses All written feedback received via the two Consultation surveys (redacted for personally identifiable information e.g. names) can be found in Appendix 1.
5.1 Respondents to the survey Demographic information about respondents was collected through the survey. Monitoring of equality data requires a two-stage process: data collection and analysis. Gathering good equality data supports legislative requirements in that it aids prevention of discrimination. This is why it is really important to provide an explanation that the process is worthwhile and necessary.
The survey included the following statement: About You: Completing the “About You” section [of the survey] is optional, but the information you give helps to show that people with a wide range of experiences and circumstances have been involved. Your support with this is really appreciated.
Not everyone who responded to the survey completed any/all of the demographic questions. However, the data presented below indicates that a diverse range of respondents, including those groups identified in the Equality and Engagement Impact Assessment, have provided feedback to the consultation.
Demographics: Full survey
Can you tell us the first part of your postcode? eg. GL16
GL14 52 GL15 183 GL16 37 GL17 36 GL18/GL19 8 12.1 HR 2 NP 12 Other 7 Prefer not to say 160
Where analysis has been undertaken based on respondents geographical location, the above postcodes have been grouped into Central (GL14, GL17, GL17 & HR), North (GL18 & GL19) and South (GL15, NP).
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Which age group are you?
Response Response
Percent Total
1 Under 18 0.00% 0 2 18-25 3.23% 12
3 26-35 10.24% 38
4 36-45 16.17% 60
5 46-55 15.90% 59
6 56-65 22.91% 85
7 66-75 20.49% 76
8 Over 75 10.51% 39
9 Prefer not to say 0.54% 2
answered 371
skipped 126
Are you:
Response Response
Percent Total
1 A health or social care professional 12.97% 45
A community partner/member of the 2 80.40% 279 public 3 Prefer not to say 6.63% 23
answered 347
skipped 150
Do you consider yourself to have a disability? (Tick all that apply)
Response Response 12.1
Percent Total
1 No 67.49% 247
2 Mental health problem 7.65% 28
3 Visual Impairment 3.01% 11
4 Learning difficulties 1.09% 4
5 Hearing impairment 4.37% 16
6 Long term condition 15.57% 57
7 Physical disability 10.38% 38
8 Prefer not to say 2.19% 8
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Do you consider yourself to have a disability? (Tick all that apply)
Response Response
Percent Total
9 Other (please specify): 4.92% 18
answered 366
skipped 131
Do you look after, or give any help or support to family members, friends, neighbours or others because of either a long term physical or mental ill health need or problems related to old age? Please do not count anything you do as part of your paid employment.
Response Response
Percent Total
1 Yes 47.27% 173
2 No 47.27% 173
3 Prefer not to say 5.46% 20
answered 366
skipped 131
Which best describes your ethnicity?
Response Response
Percent Total
1 White British 93.01% 346
2 White Other 0.54% 2
3 Asian or Asian British 0.00% 0 4 Black or Black British 0.27% 1
5 Chinese 0.00% 0 6 Mixed 0.00% 0 7 Prefer not to say 4.30% 16 12.1 8 Other (please specify): 1.88% 7
answered 372
skipped 125
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Which, if any, of the following best describes your religion or belief?
Response Response
Percent Total
1 No religion 32.43% 119
2 Buddhist 0.00% 0 Christian (including Church of 3 England, Catholic, Methodist and 59.13% 217
other denominations) 4 Hindu 0.00% 0 5 Jewish 0.00% 0 6 Muslim 0.00% 0 7 Sikh 0.00% 0 8 Prefer not to say 7.90% 29
9 Other (please specify): 0.54% 2
answered 367
skipped 130
Are you:
Response Response
Percent Total
1 Male 30.56% 114
2 Female 66.76% 249
3 Other 0.00% 0 4 Prefer not to say 2.68% 10
answered 373
skipped 124
Do you identify with your gender as registered at birth? 12.1
Response Response
Percent Total
1 Yes 96.19% 353
2 No 0.27% 1
3 Prefer not to say 3.54% 13
answered 367
skipped 130
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Which of the following best describes how you think of yourself?
Response Response
Percent Total
1 Heterosexual or straight 87.05% 316
2 Gay or lesbian 0.28% 1
3 Bisexual 1.65% 6
4 Other 1.10% 4
5 Prefer not to say 9.92% 36
answered 363
skipped 134
Are you currently pregnant or have given birth in the last year?
Response Response
Percent Total
1 Yes 3.81% 14
2 No 78.20% 287
3 Prefer not to say 2.18% 8
4 Not applicable 15.80% 58
answered 367
skipped 130
12.1
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Demographics: Easy Read
Where analysis has been undertaken based on respondents geographical location, the above postcodes have been grouped into Central (GL14, GL17, GL17 & HR), North (GL18 & GL19) and South (GL15, NP).
Which age group are you:
Response Response
Percent Total
1 0 - 18 0.00% 0 2 18-25 0.00% 0 3 26-35 11.76% 6
4 36-45 3.92% 2
5 46-55 17.65% 9 12.1 6 56-65 19.61% 10
7 66-75 25.49% 13
8 75+ 21.57% 11
9 Not saying 0.00% 0 answered 51
skipped 6
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Are you:
Response Response
Percent Total
Someone who works in health or 1 7.55% 4 social care 2 A member of the public 92.45% 49
3 Not saying 0.00% 0 answered 53
skipped 4
Do you have a disability - tick the ones that describe you.
Response Response
Percent Total
1 No 46.15% 24
2 Mental health problem 7.69% 4
3 Problems with your sight 9.62% 5
4 Learning difficulties 0.00% 0 5 Problems with your hearing 0.00% 0 A health problem you have had for a 6 long time like asthma, diabetes, or 34.62% 18
something else 7 Physical disability 13.46% 7
8 Not saying 3.85% 2
answered 52
skipped 5
Do you look after, or give any help and support that you don't get paid for, to other people because they are ill or older? 12.1
Response Response
Percent Total
1 No, I don't 59.62% 31
2 Yes, I do 38.46% 20
3 Not saying 1.92% 1
answered 52
skipped 5
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Please can you tell us which o the groups in our list best describes you? This is called ethnicity.
Response Response
Percent Total
1 White British 96.23% 51
2 White Other 0.00% 0 3 Asian or Asian British 0.00% 0 4 Black or Black British 0.00% 0 5 Chinese 0.00% 0 6 Mixed 0.00% 0 7 Not saying 3.77% 2
answered 53
skipped 4
Please tick if you have any of these religions or beliefs
Response Response
Percent Total
1 None 23.08% 12
2 Buddhist 0.00% 0 3 Christian 65.38% 34
4 Hindu 0.00% 0 5 Jewish 0.00% 0 6 Muslim 0.00% 0 7 Sikh 0.00% 0 8 Other 0.00% 0 9 Not saying 11.54% 6
answered 52
skipped 5 12.1
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Can you say about your gender? Tick the one that describes you.
Response Response
Percent Total
1 Male 26.42% 14
2 Female 71.70% 38
3 Transgender 0.00% 0 4 Non-binary 0.00% 0 5 Not saying 1.89% 1
answered 53
skipped 4
Are you the same gender you were born with?
Response Response
Percent Total
1 Yes 98.11% 52
2 No 0.00% 0 3 Not saying 1.89% 1
answered 53
skipped 4
Can you say how you think of yourself?
Response Response
Percent Total
1 Heterosexual or straight 88.46% 46
2 Gay or lesbian 1.92% 1 12.1 3 Bisexual 1.92% 1
4 Other 0.00% 0 5 Not saying 7.69% 4
answered 52
skipped 5
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Are you pregnant or had a baby in the last year?
Response Response
Percent Total
1 Yes 1.89% 1
2 No 73.58% 39
3 Not saying 3.77% 2
4 This question doesn't apply to me 20.75% 11
answered 53
skipped 4
5.2 Survey Feedback This section sets out the survey feedback received about each of proposed services; Inpatient care; Urgent care; Diagnostic services; and Outpatient services.
The survey included two types of questions: Quantitative questions, which offer a choice for the respondent e.g.
We think that the range of services proposed in this Consultation will meet the needs of local people. Please tell us whether you agree with this statement, for each of the following: Inpatient care, Urgent care, Diagnostic and Outpatient services. Strongly agree Agree Disagree Strongly disagree No opinion
and Qualitative questions which invite the respondent to write a comment 12.1
Please tell us why you think this, e.g. the information you would like us to consider:
Quantitative feedback is shown in a series of charts, whereas qualitative feedback is summarised, noting key themes. Some people did not reply to every question. A full report, including all feedback received in the survey is included in Appendix 1.
Further analysis was undertaken to identify any variation in responses across a number of demographics; age, gender, disability and geographical location. Responses from members of the public/community partners and members of the staff were also separately reviewed. 55
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Data for each of these groups is included in Appendix 1, with any significant variations noted in the summary of feedback below. It is important to note, however, that approx. 25% of respondents did not complete the ‘About you’ section of the survey and are therefore not included in these demographic analyses.
Inpatient care We think that the range of services proposed in this Consultation will meet the needs of local people. Please tell us whether you agree with this statement, for:
Response Response 1. Inpatient care: Percent Total
1 Strongly agree 21.9% 105
2 Agree 21.9% 105
3 Disagree 19.8% 95
4 Strongly disagree 32.6% 156
5 No opinion 3.8% 18
answered 479
The strength of support is dependent upon the individual respondent’s or groups of respondents’ geographical partiality. Respondents from the south of the district are less supportive of the proposed services for inpatient care, compared with those in the central and northern parts of the Forest of Dean.
Central (123 responses) North (7 responses) South (190 responses) Strongly agree 33.3% 42.9% 10.0% Agree 24.4% 42.9 % 18.9% Disagree 16.3% 0.0% 24.2% Strongly disagree 21.2% 14.3% 43.7% No opinion 4.9% 0.0% 3.2%
Analysis of other demographics, e.g. disability, age, ethnicity, health care professionals did not 12.1 show any notable variation in responses between those who shared a certain characteristic and those who did not.
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Qualitative feedback noted that those who agreed with the proposals for inpatient care thought the new hospital would reduce the need for travelling out of the Forest of Dean, but recognised the need to provide high quality care in the community.
A local hospital which we can get access to inpatient Keeping the number of beds to 24 in the and outpatient services will be good and the light of a growing and aging populations travelling will be less than having to go out to will require excellent community care Gloucester or Cheltenham and home based end of life care.
The analysis undertaken seems to As a staff nurse who currently works at the dilke the meet the population needs of people living in the area resources we are having to work with, or lack of inhibits our ability to care for our inpatients to the standard at which everyone should expect from a modern NHS.
Feedback from those who disagreed with the proposals asked for consideration of an increase in the local population and questioned whether the 24 beds provided sufficient capacity to support the needs of people in the Forest of Dean. There were comments about a lack of capacity across the county and the need for end of life care to be provided.
The number of beds proposed is There are numerous patients from the forest inadequate. Although based on the area in hospitals outside the area atm, with all
current number of inpatients at both these new houses being built throughout the
Lydney and The Dilke, it fails to account forest there is no way 24 beds will cover the
for an aging population and an increase 'locals' needs. in population in the area.
12.1 Need to be able to provide end of life care in a hospital - not all patients wish to die at home and no hospice inpatient facility in forest Concerned about reduction in beds. Beds currently occupied by many Glos and Chelt patients as they do not have a community hospital. This will not change.
I feel that consideration should be given to reviewing the bed provision, if there is
insufficient capacity achieved elsewhere in the county forest residents could find the reduced number of beds unavailable to them if otherwise occupied.
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Single rooms There was a mixed response to the proposals for the provision of single ensuite rooms, with some concerns that patients may feel isolated.
Single en suite rooms probably best. Will there be communal spaces and or dinning area to support people to interact when appropriate? Better facilities in the single rooms
would be more beneficial
My main concern is that although I think individual rooms whilst helpful to a degree single rooms are wonderful they are with infection control do not overall aid care or isolating and make observation recovery. difficult.
Urgent care We think that the range of services proposed in this Consultation will meet the needs of local people. Please tell us whether you agree with this statement, for:
Response Response 2. Urgent care: Percent Total
1 Strongly agree 23.4% 112
2 Agree 19.2% 92
3 Disagree 20.3% 97
4 Strongly disagree 34.3% 164
5 No opinion 2.7% 13
answered 478
The strength of support is dependent upon the individual respondent’s or groups of respondents’ geographical partiality. Respondents from the south of the district are much less 12.1 supportive of the proposed services for urgent care, compared with those in the central and northern parts of the Forest of Dean.
Central (122 responses) North (7 responses) South (191 responses) Strongly agree 35.2% 28.6% 11.5% Agree 27.0% 57.1 % 14.7% Disagree 18.0% 0.0% 20.9% Strongly disagree 18.0% 14.3% 50.8% No opinion 1.6% 0.0% 2.1%
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Analysis of other demographics, e.g. disability, age, ethnicity, health care professionals did not show any notable variation in responses between those who shared a certain characteristic and those who did not.
Main concerns that people asked us to consider related to poor access and the proposed opening hours for urgent care in the Forest.
Easy access to urgent care services Urgent care - locating all MIIU services in one area, for Lydney and surrounding areas namely Cinderford, severely disadvantages people will be key. who live in the south of the Forest. Access to local
GPs is becoming increasingly difficult and being able
to call in at a local 'urgent care centre for reassurance is most important.
The distance to travel to the new hospital from Lydney and its surrounding villages is too great for "Urgent" care With hours being 8 am to 8 pm it means for urgent
care (A&E) you will have to go to Glos which can
cause delay to treatment.
Concerned at the lack of emergency cover in the forest between 8.00 pm The urgent care should be open for longer hours. Our child and 8.00 am
had an accident that required treatment this happened late
into an evening but luckily the Dilke was open past 10pm
Urgent care support for the south of the Forest of Dean During earlier engagement about the new hospital, concerns were raised about people 12.1 accessing a single urge care facility located in Cinderford. A committment to undertake a further review of urgent care services in the south of the Forest has therefore been made and, through this Consultation, people were offered the opportunity to be involved in this work. Almost 100 people have expressed an interest in participating in further discussions.
People’s suggestions for how urgent care could be made more accessible for those living in the south of the Forest included an additional facility; working with local GP services; and improved transport links. Feedback received will be used to inform the planned review.
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Diagnostic services We think that the range of services proposed in this Consultation will meet the needs of local people. Please tell us whether you agree with this statement, for:
Response Response 3. Diagnostic services: Percent Total
1 Strongly agree 24.1% 115
2 Agree 31.4% 150
3 Disagree 15.1% 72
4 Strongly disagree 24.5% 117
5 No opinion 4.8% 23
answered 477
The strength of support is dependent upon the individual respondent’s or groups of respondents’ geographical partiality. Respondents from the south of the district are less supportive of the proposed diagnostic services, compared with those in the central and northern parts of the Forest of Dean.
Central (123 responses) North (7 responses) South (190 responses) Strongly agree 39.0% 42.9% 11.1% Agree 36.6% 42.9 % 28.9% Disagree 8.1% 0.0% 19.5% Strongly disagree 13.8% 14.3% 35.3% No opinion 2.4% 0.0% 5.3%
Analysis of other demographics, e.g. disability, age, ethnicity, health care professionals did not show any notable variation in responses between those who shared a certain characteristic and those who did not.
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Qualitative feedback noted support for the proposals which would result in a reduced need to travel outside the Forest of Dean, but also reflected on the overall difficulty in accessing services for those living in the south of the Forest.
Good that diagnostic services will be More diagnostics and minor surgical there, so that people in the forest don’t procedures would be welcome to save the have to travel to Gloucester or Bristol. trips to Gloucester or Cheltenham.
I welcome the additional diagnostic services I like the sound of more diagnostic and over the weekend, but you need to ensure outpatient services that staff are sufficiently competent to provide the right level of care
Lydney hospital is super important for people like me, I can’ drive and I have 4 children. The buses to anywhere are Diagnostic services in one place should not practically impossible and I can’t afford
preclude x ray in Lydney which needs ready a taxi to Cinderford or Gloucester for a access and already has a state of the art hospital visit. It would be detrimental to facility funded by local people. the health of myself and my children.
Outpatient services We think that the range of services proposed in this Consultation will meet the needs of local people. Please tell us whether you agree with this statement, for: 12.1 Response Response 4. Outpatient services: Percent Total
1 Strongly agree 25.9% 124
2 Agree 28.5% 136
3 Disagree 15.1% 72
4 Strongly disagree 26.4% 126
5 No opinion 4.2% 20
answered 478
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The strength of support is dependent upon the individual respondent’s or groups of respondents’ geographical partiality. Respondents from the south of the district are much less supportive of the proposed outpatient services, compared with those in the central and northern parts of the Forest of Dean.
Central (123 responses) North (7 responses) South (190 responses) Strongly agree 38.2% 42.9% 12.6% Agree 35.8% 42.9 % 24.7% Disagree 9.8% 0.0% 20.0% Strongly disagree 13.0% 14.3% 39.5% No opinion 3.3% 0.0% 3.2%
Analysis of other demographics, e.g. disability, age, ethnicity, health care professionals did not show any notable variation in responses between those who shared a certain characteristic and those who did not.
Qualitative feedback noted support for the proposals which would result in a reduced need to travel outside the Forest of Dean, but also reflected on the overall difficulty in accessing services for those living in the south of the Forest.
I think it would be great to also consider outpatient Ortho and Neuro and Respiratory O/P services with the availability to connect with appointments would be REALLY useful if the consultants digitally/ remotely rather than driving to hospital was to have an effective REHAB role. Gloucester /Cheltenham.
We need as many outpatient clinics as possible because getting to This once in a life time opportunity to get it
Gloucester/Cheltenham by car is bad enough, right – don’t combine services assuming they
(time, traffic, parking) but without a car can will work it out. Space is a necessity when mean several buses and a whole day taken. I providing rehabilitation for complex people qu estion the statement on page 21 about the with multiple disabilities. Having all 12.1 range of outpatient clinics provided by community services within the hospital space Gloucester hospital. Recently I have had to will enhance the holistic management of visit orthopaedics several times for follow up patients and the patients journey. That is why consultations. I was told neither of these investing in multidisciplinary teams is the gold standard approach. clinics were available at the Dilke or
Lydney.
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Other comments Many of the comments made in the initial section of the survey focussed on issues outside of the Consultation; the decision to provide one new hospital in the Forest of Dean, which would result in the closure of the existing hospitals; and the agreed location for the new hospital. These issues also provided the main theme for the following questions on potential impact of the proposals and suggestions on how we could limit any negative impacts.
Please tell us about any impact, either positive or negative, that you think any of our proposals could have on you and/or your family?
The positive impact of receiving care in new modern facilities was noted, as was the opportunity to access services more locally within the Forest of Dean.
Having access to better, more up-to-date I think having single rooms will be nicer for services has to be a good thing. people, I think people want to die at home and not in hospital if they can so I agree with this.
I think this is a wonderful opportunity to innovate and
transform services for the Forest of Dean. I think that having a new hospital with more facilities would be thing. more beneficial for myself and my parents as it would reduce
the amount of time it would take to get to the local hospital
rather than have the stress of having to get to Gloucester or Cheltenham.
Positive impact on our family, but only if you can deliver a real choice of the local hospital for 12.1 outpatient services. In my experience you only get an appointment at one of the current hospitals if
you ask for it - the default is always Gloucester.
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The themes in relation to negative impact of the proposals focussed on a loss of services in Lydney and the south of the Forest and the difficulty of travelling to Cinderford for care. There was also concern about the proposed reduction in hours for urgent care.
We feel our needs in the south of the We will be deprived of having services Forest are being ignored and that proposals locally and MIU will be hugely missed. I to base all services in Cinderford will make would go to Gloucester rather than them inaccessible to us as we get older. Cinderford not knowing if it was open or
not or being referred on to there anyway.
I am worried about getting emergency care when I need it and quickly, as well as reassurance or advice eg head bump. I am Urgent care only being available worried we wouldn’t be able to get help between 8am-8pm means outside of over night. There are no positives. The these times a long journey to an already location, reduced hours and beds will be over pressured service in Gloucester. catastrophic. Considering the size of the county of Gloucestershire, 1 A&E is always going to be under pressure and in escalation for the majority of the time - causing long delays and waits for potentially very poorly patients and worrying times for family. I believe it would have a negative impact on my family and the general populace due to lack of access to
care. Cinderford is closer to Gloucester and should not have investment where as Lydney is more accessible and further to any other The journey to Cinderford even by car is harder
hospital. than just driving straight to Gloucester A&E 12.1 which is what many from the south of the Forest will do or they will drive direct to Southmead.
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If you think any of our proposals could have a negative impact on you and/or your family, how should we try to limit this?
Responses to this question may be drawn into three main themes: Improvements in public transport and infrastructure; Retention of existing facilities, or the provision of an new facility in the south of the Forest; Extension of the services proposed, i.e. additional inpatient care, extended hours for urgent care
Need to work with people on transport links, as With regard to transport you should bus may not be suitable and limited taxi services negotiate and ensure through the in the forest. appropriate bodies a more frequent and reliable bus service to serve the southern
area, otherwise it will prove a real problem.
I believe we still need two hospitals so the forest
area is covered properly and Lydney is not disadvantaged. The provision should be growing
not shrinking. It will have a massive impact on
the local community and lives will be lost. . . By leaving our existing hospitals to continue their great work and provide
this new one as an extra to
accommodate the increase in
population..simple..
Try to introduce longer opening hours for MIU
By providing a new centre in Lydney for Urgent care and community services.
At least the equivalent number of 12.1 I am very much in favour of a new hospital but inpatient beds as Lydney & Dilke worry about no end of life care for people to combined for the status quo, .. if you die in hospital. A lot of people who cannot actually want to improve the existing have this at home would hate to go into a care service increase beds by at least 25% home to die.
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5.3 Easy Read survey The Easy Read version of the survey asked three questions: What is good about our plans? What is bad about our plans? What else would you like to tell us?
Themes from the qualitative feedback The themes from the Easy Read survey reflect those in the full survey with people reporting the opportunity to receive care in new modern facilities and the reduction in travel outside the Forest of Dean as “good”. The closure of facilities in Lydney and difficulties for people travelling to Cinderford from the south of the Forest is noted. Concern is also expressed about the reduction in the number of beds available for inpatient care.
What is good about our plans?
Really welcome the plan for new hospital in cinderford - makes financial sense to have A new hospital with appropriate services and access to them in once equipment and layout, which is centralised place - up to date services, conducive to staff and patients alike is
accessibility to all in forest of dean, less stress needed, and this plan meets the
for patients and families having to travel to criteria.
gloucester etc
Providing services where they are needed without long journeys for treatment. Better for environment as well as convenience for patients and staff. Also good for patients' visitors
12.1 Keeping significant services within the Forest Good that diagnostic services will be there, so area. Travelling to GRH can be a nightmare. that people in the Forest don’t have to travel to
Gloucester or Bristol
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What is bad about our plans?
Inpatients Plans: How is reducing the beds Urgent Care: How is closing the current 2 available from 47 to 24? It means a existing hospitals Lydney and the Cinderford significant reduction of nearly 50% (half of going to help urgent Care. what we have now!)
The plans for a new hospital in Cinderford With more and more houses being
with reduced bed capacity does not appear developed in and around the Lydney hospital
practical as the population has and is we will all have further to go when our hospital is needed! increasing, especially in Lydney which has been hit the hardest.
If people do not drive they don’t have the local hospital
The population is growing and I don’t feel one hospital could cope with the demand.
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6. Other feedback received The survey is not the only mechanism for receiving feedback. The following section summarises other feedback received during the Consultation. All written feedback, redacted to maintain individual’s confidentiality, i.e. names and contact information removed, are included in Appendix 2.
Members of the public In total, 28 emails and letters were received from members of the public. This included 20 adapted versions of the HOLD letter that were sent to GHC.
Responses reflect comments made in the survey responses: Increased travel to the new hospital for residents in the south of the Forest and lack of public transport in the district. The new hospital will not have sufficient capacity to meet the needs of the Forest of Dean residents, in particular given the increase in population. The number of beds proposed does not take account of the increase in population.
The HOLD letter notes the environmental impact of additional travel for some in accessing one new site and calls for the decision to close the two existing hospitals to be reversed.
Elected representatives In addition to the motion from the Forest of Dean District Council, correspondence was received from four town/parish councils, and the Green Party.
Responses raised similar concerns to the survey responses: Increased travel to the new hospital for residents in the south of the Forest and lack of public transport in the district. The new hospital will not have sufficient capacity to meet the needs of the Forest of Dean residents, in particular given the increase in population.
Additional suggestions relating to the hospital design and scope of specific services were also included. 12.1
Primary Care Network The Forest of Dean Primary Care Network (PCN), which has membership of GP practices from across the district, submitted a response to the Consultation. The PCN welcomes a new community hospital in the Forest of Dean, but is not supportive of all of the proposals set out in the Consultation. The full response is included in Appendix 2.
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7. Questions and Answers
Throughout the consultation a range of questions have been received from a variety of sources e.g. online discussion groups, Information Bus Tour, survey free text responses. The following questions (and responses) are representative of frequently asked questions.
Question Response Why won’t there be a maternity unit? Guidance by the National Institute for Health and Care Excellence (NICE) on the care of healthy women and their babies during childbirth, recommends that women thought to have a low risk of pregnancy complications would be better served by giving birth at home or at a midwife-led unit. Recognising the unique attributes of the Forest of Dean, careful consideration has therefore been given to the inclusion of a midwife-led birthing unit at the new hospital.
Having reviewed the clinical guidance, the average number of births per annum in the Forest of Dean district and the rights of women to choose the place in which they give birth, the option of a midwife-led unit has been discounted on the basis that a clinically safe and sustainable service could not be provided. We will however, continue to promote home births for women where it is clinically safe and appropriate to do so. Why are you proposing all single ensuite Our older hospitals have a number of rooms? challenges in terms of providing modern health care services and are particularly difficult around infection prevention and control, privacy and dignity, impact of mixed 12.1 sex accommodation and noise and disturbance at night for those in multiple bedded areas.
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Increased privacy and dignity for people if they have their own room with their own en-suite bathroom. People often feel more confident to move around their own room and use the bathroom rather than a commode by the bedside which helps them to keep mobile. There is now a greater use of digital technology which enables patients to keep in touch with their loved ones via virtual means outside of normal visiting hours which they can do without disturbing others. The new hospital will have good social space on the ward where patients will be able to gather including a dining room and activity/therapy room to reduce risk of isolation or loneliness. Given the rising population in the Forest of Based on our evolving approach to care: Dean, how can 24 beds be enough? inpatient rehabilitation provided 7 days a week, care focused on the needs of people who live in the district; and only keeping people in a hospital bed when they will benefit from a continued hospital stay; we are confident that our proposal to provide 24 beds in the new hospital will provide appropriate capacity now and in the foreseeable future.
Our analysis shows that compared with five years ago, the number of residents of the Forest of Dean who have needed a 12.1 community hospital bed has reduced, due to the introduction of more community services. Where Forest residents have needed hospital care they have been admitted to a bed in one of the Forest hospitals 92% - 97% of the time.
Our bed data also shows that at any given time, almost half of the beds in the Forest of Dean are occupied by people from other localities, most typically Gloucester. 70
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Our continued emphasis on community- based services, and introduction of: a specialist stroke rehabilitation in a countywide unit; alternative provision of End of Life care (in line with countywide strategy); and additional bed capacity in Gloucester and Cheltenham will ensure the 24 beds proposed for the new hospital in the Forest of Dean will be sufficient.
Please can I ask 1 straight forward question Throughout the current pandemic the two when the 1 new hospital is built and the hospitals in the Forest of Dean have taken a other 2 have closed, when we have the next mix of both COVID positive and negative pandemic where are the people what have patients. This has been in line with the way not got the illness going to go too for we have utilised all seven of our community treatment. hospitals and we have implemented a I think you will realise that this time we programme of internal zoning to ensure where very fortunate to have 1 hospital that segregation of patients to prevent cross could treat people with the virus and 1 infection. We have also had to take a where the other people with injuries and number of the inpatient beds out of action illnesses could attend. to ensure a COVID secure environment. The current environment has a number of the beds within bays rather than single rooms and thus it is harder to prevent cross infection so it has been necessary to take the additional measures of reducing capacity. We have also kept the Minor Injuries Unit at the Dilke closed as we could not ensure a safe COVID environment due to the size of the facility and access and exit routes.
In planning the new single hospital, our aspiration is that we will incorporate 100% 12.1 single rooms that will enable us to ensure safe infection control practices which means that we do not have to zone by hospital site but will continue as we have done currently, to manage patients within their own safe zone of their individual bedroom. In this way, we can safely respond to a future pandemic without the need to reduce hospital capacity at the time of greatest need.
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This is different to the way in which services within our acute hospitals in Gloucester and Cheltenham have been managed throughout the pandemic in that they have zoned by site as far as they can – this reflects the more different and more complex range of services that they provide and the greater levels of activity and therefore movement that they need to deal with. The majority of people who are admitted to our community hospitals do so after an episode of care at one of our acute hospitals, as such anybody who needs to be discharged into one of our community hospital sites are swabbed before admission so that we are aware of whether they are COVID positive or not and can therefore place them into an appropriate zoned location.
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8. Evaluation and next steps Considerations and learning points for future engagement and communication activities
Our approach to evaluating the effectiveness of our consultation activities locally is to apply a well-known quality improvement methodology, using an iterative process: Plan, Do, Study, Act (PDSA cycle) https://improvement.nhs.uk/documents/2142/plan-do-study-act.pdf
We have applied the following evaluation framework. Engagement (and Consultation), Experience and Inclusion Evaluation Framework developed by The Science and Technologies Facilities Council has developed a useful engagement evaluation framework, https://stfc.ukri.org/files/corporate-publications/public- engagement-evaluation-framework/ We have adapted this to support the STUDY element in our Engagement, Experience and Inclusion PDSA Cycle
Dimension Definition Response Inputs Engagement A comprehensive communications and consultation plan (and was developed to support the consultation activity. This Consultation), plan, assured by NHS England/Improvement, set out the experience and approach to communications and consultation. In response inclusion inputs to pandemic restrictions, the plan was developed to support include the a socially distanced consultation. This included the time, skills and development of more online methods such as the new Get money that are Involved in Gloucestershire online participation platform; invested into The plan was evaluated using an Engagement and Equality delivering Impact Assessment engagement https://www.fodhealth.nhs.uk/wp- activities. content/uploads/2020/10/Equality-and-Engagement- Impact-Assessment-FOD.pdf Outputs Engagement A number of events were held on line. The Information Bus (and Tour provided three socially distanced face to face events. consultation), experience and 3,400 information booklets were distributed in local inclusion communities. 12.1 outputs are the activities we A door to door leaflet drop delivered information about undertake and both the new hospital in the Forest of Dean and the Fit for the resources the Future consultations to 297,000 households in that we create. Gloucestershire. This resulted in over 1,700 requests for information; 495 of which related to the Forest of Dean consultation.
Feedback received included comments on the communications and consultation process itself. Feedback received was a mixture of positive and negative comments.
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Reach Reach has two Total face-to-face (online and bus tour) contacts was more main elements: than 200 (public/community partners) and more than 80 The number of staff. 554 surveys were completed. There were 10 Facebook people posts with a reach of over 56,000. 8 tweets generated over engaged, this 7,000 impressions and over 100 engagements. includes attendance at We do not routinely collect demographic information about events, individuals participating in events/drop-ins etc. completion of surveys, social Demographic information was collected through our survey, media but these questions were optional and consequently were interaction etc. not always completed. However, demography is considered during consultation planning and events/meetings targeted The types or to reach a wide range of communities of interest and those diversity of groups identified though the Equality and Engagement people Impact Assessment. engaged. Processes Processes are A comprehensive communications and consultation plan the way we was developed to support the consultation activity. This plan work to plan, is assured by NHS England/Improvement. develop and deliver our Gloucestershire Health and Care NHS Foundation Trust: engagement, developed Easy Read materials. experience and inclusion activities. They Gloucestershire County Council’s Digital Innovation Fund include our Forum: Informed early planning for online activities and approaches to assisted with awareness raising of the consultation to quality potentially digitally excluded groups. assurance and following good Forest of Dean Locality Reference Group: Supported practice. awareness raising and survey completion within their communities.
Healthwatch Gloucestershire (HWG): HWG Readers Panel 12.1 reviewed a draft of the consultation booklet.
Community Connectors (KYP Coordinators): allowed us space on agendas to share information at online meetings during November 2020 to promote the consultation.
District/Town Councils and Retail partners: Supported the ‘socially distanced’ visits of the Information Bus (outside of Lockdown 2) to locations with maximum footfall across the district. The Forest of Dean District Council also hosted a
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members’ seminars to discuss the consultations.
Others: Many other groups and individuals have helped to raise awareness of the consultation such as Trust members, staff representatives and community and voluntary sector organisations.
Act (following earlier engagement)
The following actions were undertaken following feedback received during earlier engagement: Less information, less jargon and easy read copies of all information. Mailer produced to promote the Consultation and ways to request information and contribute to the Consultation via telephone, survey, letter.
Act (during and following Consultation) The following actions have been/will be undertaken following feedback received during the Consultation to support future communications and engagement:
Information regarding the Consultation was sent to the Forest of Dean Talking Newspaper. Future consultations will endeavour to reach more people with Visual Impairment by: o Placing adverts in Talking newspapers o Using BBC local radio o Focussing on promotion of telephone line and ability to order large print copies of the booklet o Focussing on voice based/telephone based contact as most of people with visual impairment don’t use desktops/laptops and rely on mobile phones.
The consultation used more online participation methods than ever before. These proved to be very popular with groups who may not have engaged with consultations before and facilitated easier access to more people who may not have previously been willing or able to attend face to face events. The One Gloucestershire Communications and Engagement Sub Group will review the current online methods available and 12.1 consider opportunities for maximising their use for future engagement and consultation activities.
9. Copies of this report
This report is available on the FODhealth website at: www.fodhealth.nhs.uk and on the online participation platform Get Involved in Gloucestershire https://getinvolved.glos.nhs.uk . Print copies of the report can be obtained from the
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Engagement and Experience Team by calling Freephone 0800 0151 548 or email: [email protected] For information in alternative formats please see back cover.
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Agenda Item 13
Governing Body /Committee
Meeting Date Thursday 28th January 2021 Report Title Fit for the Future (FFTF) Output of Consultation presentation Executive Summary To update Governing Body on the Output of Consultation, note the ongoing work and approve continuation of the programme. Key Issues The feedback from the consultation must be considered as part of the decision making process Risk Issues: none Management of The programme has been conducted in line with Conflicts of Interest the relevant conflicts of interest policies Financial Impact N/A Legal Issues The feedback from the consultation must be (including NHS considered as part of the decision making Constitution) process Impact on Health A revised FFTF Integrated Impact Assessment Inequalities (IIA) will be completed to take into account the findings of the consultation and incorporated into the Decision Making Business Case Impact on Equality A revised FFTF Integrated Impact Assessment and Diversity (IIA) will be completed to take into account the findings of the consultation and incorporated into the Decision Making Business Case Impact on N/A Sustainable Development Patient and Public The Consultation included the public and patients Involvement Recommendation The Committee/Governing Body is requested to: Formally receive the Interim Output of 13 Consultation Report Note and support the ongoing work to analyse and address the survey qualitative responses. Approve the continuation of the programme to develop the Decision Making Business
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Case (DMBC) Author Micky Griffith Designation FFTF Programme Director Sponsoring Director Ellen Rule, Director of Transformation and (if not author) Service Redesign / Programme Director for the Gloucestershire ICS
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Fit for the Future Developing specialist hospital services in Gloucestershire
Output of Consultation
CCG Governing Body
28th January 2021 251 of 486 251 13.1 252 of 486 252 Tab 13.1 Item 13.1 Forest of Dean Output of Consultation Summary Purpose of this session: Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing
1. Formally receive the Interim Output of Consultation Report* 2. Note and support the ongoing work to analyse and address the survey qualitative responses. 3. Approve the continuation of the programme to develop the Decision Making Business Case (DMBC) 4. The Decision Making Business Case will come to Governing Body in March 2021.
* The Interim Output of Consultation Report and all appendices can be found on the One Gloucestershire website at: https://www.onegloucestershire.net/yoursay/
13.1 Tab 13.1 Item 13.1 Forest of Dean Output of Consultation Summary Consultation Key Facts…
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing • 297,000 door-to-door leaflets distributed, generating 1700+ requests for information • 4,885 consultation booklets distributed • 75+ consultation events • 1000+ socially distanced face-to-face contacts with members of the public + 350+ staff • 140,000 reach on Facebook driven by 20+ posts, leading to 1,500+ engagements & 1,000+ clicks on the link
• 30,000 Twitter impressions and 800 engagements driven by
35+ Tweets. 253 of 486 253 13.1 254 of 486 254 Tab 13.1 Item 13.1 Forest of Dean Output of Consultation Summary Consultation approach & responses… Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Two key consultation routes: 1. Promoting formal consultation routes & encouraging participation – on-line & face to face events, social media, media, County & Borough Councils, PCNs, Governors etc. 2. Proactive consultation with targeted groups as informed by Integrated Impact Analysis (IIA) – BAME community, LGBQT+, gypsy/traveller community, mental health and learning disability groups, frail elderly, long term condition groups, low income areas, people living with a disability, adult & young carers, young people homeless
Responses:
• 700+ survey responses (full & easy read versions)
• ~30% staff (health or social care professional) • 19 separate e-mail/written responses 13.1 Tab 13.1 Item 13.1 Forest of Dean Output of Consultation Summary Level of support for proposals… Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing
[1] View on location of centralised elective colorectal surgery service: Group CGH GRH No opinion
All survey responses 51% (28%) 20% (28%) 30% (45%)
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Staff only 57% 13% 30% 13.1 256 of 486 256 Tab 13.1 Item 13.1 Forest of Dean Output of Consultation Summary Representation
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Fit for the Future survey:
• Proportionally more people from Cheltenham competed the survey • More women than men completed the survey (55% / 39%) • Good age range of respondents from Under 18 - Over 75 years • Between a quarter and a third of responses came from staff • Over 20% of responses came from people who considered themselves to have a disability • Over a quarter of respondents were ‘unpaid’ carers • 15% of respondents were not white British
Targeted consultation activities took place with: people from Black, Asian and Minority Ethnic (BAME) communities, people living with long term conditions such as cardiovascular disease, obesity or diabetes, people living with a disability (includes physical impairments; learning disability; sensory impairment; mental health conditions; long-term medical conditions, Adult Carers and Young Carers, Homeless people, Gypsy/Traveller communities and LGBTQ+ people.
*We only know about survey respondents who completed the ‘About You’ questions in the survey
13.1 Tab 13.1 Item 13.1 Forest of Dean Output of Consultation Summary Main themes from free-text responses Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Fit for the Future survey: The qualitative feedback from completed surveys and correspondence has been grouped into themes under the following headings
• Access • Patient Experience / Staff • Capacity Experience • Diversity • Pilot • Efficiency • Quality • Environment • Resources • Facilities • Transport • Integration (with primary and • Workforce
community services)
• Interdependency 257 of 486 257 13.1 258 of 486 258 Tab 13.1 Item 13.1 Forest of Dean Output of Consultation Summary Fit for the Future Survey: Limiting negative impact
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Survey respondents shared the following mitigations to limit potential negative impacts of centralisation of specialist hospital services:
• Retain services on both sites • Improve Patient Communications • Improve integration between hospitals, community services and GP practices • Reduce the number of patient transfers between Acute hospitals • Build a new Acute Hospital on a Single Site • Improve public transport
• Speed up payment of eligible Travel Claims
• Encourage more staff to work in Gloucestershire
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Addressing themes from consultation
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Examples: • Public transport: Park & Ride sites, inter-site bus (#99) • Ambulance response times and capacity • GRH capacity including beds and Emergency Dept. • New hospital • Partnership with community and primary care and the voluntary sector • Care of patients presenting with mental health problems in ED • Alternative suggestions for service locations
• Trauma and Orthopaedic pilot evaluation information
• Plans to improve services once re-located 259 of 486 259 13.1 260 of 486 260 Tab 13.1 Item 13.1 Forest of Dean Output of Consultation Summary
Public responses received from other organisations Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing
9 written responses were received during the consultation (A-Z) • Cheltenham Borough Council • Cllr Martin Horwood, Liberal Democrat, Cheltenham Borough Council Leckhampton with Warden Hill Parish Council • REACH: Restore Emergency At Cheltenham General Hospital campaign (including REACH survey interim report) • REACH undertook an alternative survey
• Tewkesbury Borough Council
• 4 x members of the public
10 email responses were received from members of the public 13.1 Tab 13.1 Item 13.1 Forest of Dean Output of Consultation Summary Next steps… Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Completing the communication, engagement and consultation for the Fit for the Future programme
• Citizens’ Jury #2 - “What are the most important findings of the public consultation that decision makers should take into account?” - Jan 21 (x8 2hr sessions run by Citizens Juries CIC) • Refresh Integrated Impact Assessment – Jan/Feb • Recommended solution for General Surgery – GHFT on 4th Feb • Consultation review period/ implementation planning – Jan/ Feb • Decision Making Business Case – Jan/ Feb • Decision making - March
• Implementation - April onwards
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Appendix: Further detailed information 13.1 Tab 13.1 Item 13.1 Forest of Dean Output of Consultation Summary Journey to Consultation
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing 263 of 486 263 13.1 264 of 486 264 Tab 13.1 Item 13.1 Forest of Dean Output of Consultation Summary What the Fit for the Future consultation is about The purpose of the consultation was to seek views on the future provision of five Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing specialist hospital services in Gloucestershire:
• Acute Medicine (Acute Medical Take). This is the coordination of initial medical care for patients referred to the Acute Medical Team by a GP or the Emergency Departments and where decisions are made as to whether patients need a hospital stay.
• Gastroenterology inpatient services; medical care for stomach, pancreas, bowel or liver problems.
• General Surgery conditions relating to the gut. Specifically, emergency general surgery, planned Lower Gastrointestinal (GI) (colorectal) and day case Upper and Lower GI surgery.
• Image Guided Interventional Surgery (IGIS) including vascular surgery. IGIS is where the surgeon uses instruments with live images to guide the surgery.
• Trauma and Orthopaedic inpatient services (T&O) diagnosis and treatment of conditions
relating to the bones and joints.
13.1 Tab 13.1 Item 13.1 Forest of Dean Output of Consultation Summary What the Fit for the Future consultation is not about Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing • Cheltenham General Hospital Accident & Emergency (A&E) Department: A public commitment has been made to the future of the Accident and Emergency (A&E) Department in Cheltenham.
• COVID-19 Temporary Changes: some of the medium to long term changes proposed relate to some of the same clinical services where temporary changes have had to be made recently in order to keep our hospitals safe.
• Outpatients, Community and Primary Care Services: No changes to
outpatient, community or primary care services are included within this
consultation. 265 of 486 265 13.1 266 of 486 266 Tab 13.1 Item 13.1 Forest of Dean Output of Consultation Summary Our approach to communications and consultation
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing • Working with others • Equality and Engagement Impact Analysis (EEIA) • Groups potentially impacted, issues identified and actions taken • Issues identified pre-consultation in the EEIA and action taken ahead of consultation
• Covid 19: A socially distanced consultation
13.1 Tab 13.1 Item 13.1 Forest of Dean Output of Consultation Summary Communications: Developing understanding and supporting Fit for the Future consultation
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing • Door to Door awareness raising leaflet • Media releases, Media advertising and stakeholder briefings • Printed engagement booklets • ‘Your Say’ area on the One Gloucestershire Health website and Get Involved in Gloucestershire online participation platform • Further engagement to address the homogeneity of participants • Social media: Facebook and Twitter • Staff communication and engagement Other stakeholder communication and engagement • Elected Representatives: MP briefings, District/Borough Council Member Seminars
• REACH Campaign, regular meetings 267 of 486 267
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268 of 486 268 Tab 13.1 Item 13.1 Forest of Dean Output of Consultation Summary Public Consultation Activities Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing • Gloucestershire Media: Live social media partnership (@GlosLiveOnline) • Gloucestershire Hospitals: Facebook live (@GlosHospital) • Gloucestershire Patient Participation Group Network • NHS Information Bus Tour • Cuppa and Chats • Targeted activities • Fit for the Future Surveys
• Other surveys and petitions
13.1 Tab 13.1 Item 13.1 Forest of Dean Output of Consultation Summary Consulting people with protected characteristics/others identified in the Independent Integrated Impact Analysis Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing • Black, Asian and Minority Ethnic (BAME) communities, in particular people aged over 65 • People with mental health conditions [and learning disabilities] • Over 65s who are more likely to have long term conditions such as cardiovascular disease, obesity or diabetes • Frail older people who are more likely to experience falls • People from BAME communities who are living with a long term condition • People living with a disability (includes physical impairments; learning disability; sensory impairment; mental health conditions; long-term medical conditions)
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Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Continued:
• Young people • Adult Carers and Young Carers • Homeless people (and rough sleepers)
• Gypsy/Traveller communities
• LGBTQ+ people • People living in low income areas
13.1 Tab 13.1 Item 13.1 Forest of Dean Output of Consultation Summary Fit for the Future Survey: Impact of our proposals on you and your family
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing The predominant impact identified from respondents from all areas of the county is Access to centralised services; whether at Cheltenham General Hospital or Gloucestershire Royal Hospital.
Frequently respondents have linked Access with either expected improvement in quality of services or deterioration in quality of services.
Several respondents highlight Environmental aspects of
increased travel.
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Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing 9 written responses were received during the consultation (A-Z): • Cheltenham Borough Council [Access, Capacity, Interdependency + commitment to Cheltenham General Hospital A&E] • Cllr Martin Horwood, Liberal Democrat, Cheltenham Borough Council [Capacity, Access, Pilot + timing of consultation] • Leckhampton with Warden Hill Parish Council [Capacity, Access, Pilot + timing of consultation] • REACH: Restore Emergency At Cheltenham General Hospital campaign (including REACH survey interim report) [Capacity, Access, Interdependency, Facilities, Quality, Pilot + commitment to Cheltenham General Hospital A&E] • Tewkesbury Borough Council [Access + commitment to Cheltenham General Hospital A&E] • 4 x members of the public [1: Quality, Resources, Workforce, Facilities, Staff Experience, Pilot. 2: Workforce. 3: Quality, Patient Experience. 4: Efficiency, Resources, Capacity, Workforce]
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Other correspondence/written responses
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing 10 email responses were received from members of the during the consultation from members of the public 1. Efficiency, Resources. 2. Access, Resources. 3. Patient Experience, Access, Resources, Facilities, Integration (use North Cotswolds Community Hospital). 4. Integration (use North Cotswolds Community Hospital), Access. 5. Access, Integration (use North Cotswolds Community Hospital). 6. Access. 7. Access + commitment to Cheltenham General Hospital A&E Department. 8. Access, Patient Experience. 9. Interest in Stroke services. 10. Copy of Member of the Public Letter 4: Efficiency, Resources, Capacity,
Workforce
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Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing During the consultation, members of the consultation team spoke to participants about matters unrelated to the Fit for the Future proposals. Other subjects included:
• national and local response to the Coronavirus pandemic, including practical questions about Covid-19 testing and vaccination • timing of the consultation taking place during a pandemic • feedback about services such as primary care (GP) services and mental health services.
There were a significant number of messages of thanks to health and care
staff and other frontline workers for their efforts to maintain services during the pandemic.
13.1 Tab 13.1 Item 13.1 Forest of Dean Output of Consultation Summary REACH Survey
REACH created an alternative survey to gather views to inform their response to the Fit for the Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Future consultation proposals [ from REACH website) https://www.reachnow.org.uk/
REACH launch their Fit for the Future Survey (19 November 2020) REACH are concerned that the One Gloucestershire Fit for the Future survey that forms part of the consultation has been constructed in such a manner that the results can be used to justify a decision that the respondents would not have supported. Because of this REACH have chosen to launch their own survey, to gather the real preferences of those local people in Gloucestershire and surrounding areas, who will be affected by these proposals.
The REACH survey asked different questions to those in the Fit for the Future Survey and Fit for the Future Easy Read Survey.
REACH survey: Respondents generally did not support any proposals to centralise specialist services at Gloucestershire Royal Hospital; for some proposals respondents were neutral as they believed services should be available in both Cheltenham and Gloucester. For day case services, respondents wanted these provided in multiple sites in Gloucestershire* Respondents believed that a permanent reconfiguration along the lines of the T&O “Pilot Study” should not be enacted until the results of the “Pilot” have been fully evaluated.
*NB community hospital services did not form part of the Fit for the Future consultation
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Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Appendix 1: Survey responses by specific groups: All appendices are available at: • Full survey www.onegloucestershire.net • Easy Read • Feedback from targeted groups (identified through independent Integrated Impact Assessment) from Full survey • BAME • Over 66 living with a disability • BAME living with a long term condition • People living with a disability • People with mental health problems and/or learning difficulties • Unpaid Carer • People who identify as LGBTQ+ • People who live in 12 most deprived wards in Gloucestershire (Indices of Deprivation 2019)
• Staff • Public and Community Partners
• Postcodes from East of county • Postcodes from West of county
13.1 Tab 13.1 Item 13.1 Forest of Dean Output of Consultation Summary Further Updates Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing
The feedback from the consultation, the recommendations and observations of the Citizens’ Jury and the final decision made by the CCG Governing Body will be published at: www.onegloucestershire.net/yoursay
and shared on the online participation platform Get Involved in Gloucestershire at: https://getinvolved.glos.nhs.uk
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Contents Executive Summary
INTRODUCTION Purpose of this Report Making the best use the information provided in this Report
PART 1 1. Background 1.1 What the Fit for the Future consultation is about 1.2 What the Fit for the Future consultation is not about 1.3 Consultation process 1.4 Next Steps: Completing the communication, engagement and consultation for the Fit for the Future programme 1.5 Providing feedback to you on the consultation and decisions
2. Our approach to communications and consultation 2.1 Working with others 2.2 Equality and Engagement Impact Analysis (EEIA) 2.2.1 Groups potentially impacted, issues identified and actions taken 2.2.2 Issues identified pre-consultation in the EEIA and action taken ahead of consultation 2.3 Covid 19: A socially distanced consultation 2.4 Communications: Developing understanding and supporting Fit for the Future consultation 2.5 Staff communication and engagement 2.6 Other stakeholder communication and engagement 2.7 Public Consultation Activities 2.8 Consulting people with protected characteristics and others identified in the Independent Integrated Impact Analysis 2.9 District/Borough Council Member Seminars 2.10 Consultation events activity timeline
PART 2 3. Responses to the consultation 3.1 Demographic information
4. Survey Feedback 4.1 Acute Medicine (Acute Medical Take) 13.2 4.2 General Surgery (emergency general surgery, planned Lower Gastrointestinal [GI] / colorectal surgery and day case Upper and Lower GI surgery) 4.2.1 Emergency General Surgery 4.2.2 (i) Planned Lower GI (colorectal) surgery 4.2.2 (ii) Planned Lower GI: Location 4.2.3 Planned day case, Upper and Lower GI 4.3 Image Guided Interventional Surgery (IGIS) including Vascular Surgery
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4.3.1 IGIS Hub and Spoke 4.3.2 Vascular Surgery 4.4 Gastroenterology inpatient services 4.5 Trauma and Orthopaedics (T&O) inpatient services 4.6 Impact of our proposals on you and your family 4.7 Limiting negative impact 4.8 Anything else you want to tell us
5 Other correspondence/written responses 5.1 REACH Survey – summary interim results 5.2 Other comments received during the consultation (Not directly related to the Fit for the Future consultation proposals)
6. Addressing themes from the Consultation
7. Questions and Answers
8. Evaluation 8.1 Considerations and learning points for future engagement and communication activities 8.2 ACT (following Fit for the Future engagement) 8.3 ACT (following Fit for the Future consultation)
9. Copies of this report
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Fit for the Future Interim Output of Consultation Report Executive Summary
Fit for the Future: Developing specialist hospital services in Gloucestershire Consultation Key Facts Consultation proposals focussed on five specialist services: Acute Medicine (Acute Medical Take), General Surgery: Upper and Lower Gastrointestinal (including Emergency General Surgery), Image Guided Interventional Surgery (including Vascular Surgery), Gastroenterology inpatient services and Trauma and Orthopaedic inpatient services. Approximately 5000 Consultation booklets distributed across the county. 297,000 door-to-door leaflets distributed, generating 1700+ requests for information 75+ consultation events. More than 1000 socially distanced face-to-face contacts with members of the public/over 350 staff. 20+ Facebook posts with a reach of over 140,000 with over 1,500 ‘engagements’ which included over 1,000 clicks on the link in the post. 35+ tweets generated over 30,000 impressions and almost 800 engagements. 700+ Fit for the Future surveys completed [110+ paper copies received, 1 telephone survey completed; the remainder being online].
Fit for the Future Survey responses
Acute Medicine (Acute Medical Take) Preferred option to develop: A ‘centre of excellence’ for Acute Medicine (Acute Medical Take) at Gloucestershire Royal Hospital. 67.61% (Easy read: 72.09%) strongly supported or supported the proposal 24.83% (Easy read: 18.6%) strongly opposed or opposed the proposal
Emergency General Surgery Preferred option to develop: to develop: A ‘centre of excellence’ for Emergency General Surgery at Gloucestershire Royal Hospital. 68.31% Fit for the Future survey respondents strongly supported or supported the proposal. Easy read survey respondents: 66.67% strongly supported or supported 13.2 the proposal 23.44% Fit for the Future survey respondents strongly opposed or opposed the proposal. Easy read survey respondents: 22.99% strongly supported or supported the proposal
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Planned Lower GI (colorectal) surgery Preferred option to develop: to develop: A ‘centre of excellence’ for Planned Lower GI (colorectal) general surgery at Cheltenham General Hospital (CGH) or Gloucestershire Royal Hospital (GRH). 79.1% Fit for the Future survey respondents strongly supported or supported the proposal. Easy read survey respondents: 72.84%) strongly supported or supported the proposal. 7.83% Fit for the Future survey respondents strongly opposed or opposed the proposal. Easy Read survey respondents: 14.81% strongly opposed or opposed the proposal.
Where do you think we should do planned Lower GI (Colorectal) General Surgery? 50.76% Fit for the Future survey respondents chose Cheltenham General Hospital. 27.50% Easy Read respondents chose Cheltenham General Hospital. 20.27% Fit for the Future survey respondents chose Gloucestershire Royal Hospital. 27.50% Easy Read respondents chose Gloucestershire Royal Hospital. 30.30% Fit for the Future survey respondents had no opinion. 45% Easy Read respondents had no opinion.
Planned day case, Upper and Lower GI Preferred option to develop: to develop: A ‘centre of excellence’ for planned day case Upper and Lower GI (colorectal) surgery at Cheltenham General Hospital (CGH). 73.49% Fit for the Future survey respondents strongly supported or supported the proposal. (Easy read respondents: 67.47% strongly supported or supported the proposal. 8.52% Fit for the Future survey respondents strongly opposed or opposed the proposal. Easy read respondents: 13.25% strongly opposed or opposed the proposal.
Image Guided Interventional Surgery (IGIS) including Vascular Surgery Preferred option to develop: to develop: A 24/7 Image Guided Interventional Surgery (IGIS) ‘Hub’ at Gloucestershire Royal Hospital and a ‘Spoke' at Cheltenham General Hospital. 66.54% Fit for the Future survey respondents strongly supported or supported the proposal. Easy read respondents: 76.54%) strongly supported or supported the proposal. 15.39% Fit for the Future survey respondents (Easy read: 9.88%) strongly opposed or opposed the proposal. Easy read respondents: 9.88% strongly opposed or opposed the proposal. 13.2
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Vascular Surgery Preferred option to develop: to develop: A ‘centre of excellence’ for Vascular Surgery at Gloucestershire Royal Hospital. 60.27% Fit for the Future survey respondents strongly supported or supported the proposal. Easy read respondents: 68.35% strongly supported or supported the proposal. 19.97% Fit for the Future survey respondents strongly opposed or opposed the proposal. Easy read respondents: 15.19% strongly opposed or opposed the proposal.
Gastroenterology inpatient services Preferred option to develop: A ‘centre of excellence’ for Gastroenterology inpatient services at Cheltenham General Hospital. 71.96% Fit for the Future survey respondents strongly supported or supported the proposal. Easy read respondents: 68.35% strongly supported or supported the proposal. 6.67% Fit for the Future survey respondents strongly opposed or opposed the proposal. Easy read respondents: 10.13% strongly opposed or opposed the proposal.
Trauma and Orthopaedics (T&O) inpatient services Preferred option to develop: to develop: Two permanent ‘centres of excellence’ for Trauma at Gloucestershire Royal Hospital and Orthopaedics at Cheltenham General Hospital. 76.02% Fit for the Future survey respondents strongly supported or supported the proposal 10.53% Fit for the Future survey respondents strongly opposed or opposed the proposal The Easy read survey was divided into two questions: Trauma: Support: 70.51% Oppose: 12.82% Not sure: 16.67% Orthopaedics: Support: 73.08% Oppose: 14.10& Not sure: 12.82%
Themes Responses to the consultation focussed on the following themes: Access; Capacity; Diversity; Efficiency; Environment; Facilities; Interdependency; Integration (with primary and community services); Patient Experience / Staff Experience; Pilot; Quality; Resources; Transport; and Workforce.
Who got involved? In terms of the reach of the consultation, demographic information is known about those 13.2 survey respondents who chose to provide ‘About You’ information in their survey responses. There is a broad representation of groups in responses to the survey. There is extended reach through the targeted activities, which ensured voices from all groups identified in the Independent Integrated Impact Assessment had an opportunity to be heard e.g. carers, homeless people, Black, Asian and Minority Ethnic communities.
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During the consultation, participants took the opportunity to access information, ask questions and comment on the national and local response to the coronavirus pandemic. Many people expressed their gratitude to NHS and care staff and recognised Gloucestershire’s diverse communities’ collective acts of support for colleagues, friends, families and neighbours.
A detailed summary of feedback received can be found in Part 2. All feedback received can be found in the online Appendices to this Report.
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INTRODUCTION
Fit for the Future Consultation Purpose of this Report The Fit for the Future Interim Output of Consultation Report is intended to be used as a practical resource for One Gloucestershire partners; to provide them with information about how the public, community partners and staff feel about the Fit for the Future proposals for change in order to inform their decision making in 2021. One Gloucestershire is a partnership between the county’s NHS and care organisations to help keep people healthy, support active communities and ensure high quality, joined up care when needed. The NHS partners of One Gloucestershire are: NHS Gloucestershire Clinical Commissioning Group (CCG) Primary care (GP) providers Gloucestershire Health and Care NHS Foundation Trust (GHC) Gloucestershire Hospitals NHS Foundation Trust (GHT) South Western Ambulance Services NHS Foundation Trust (SWAST)
This Report will form part of the evidence considered by a second independently facilitated Citizens’ Jury, to be held in January 2021. This Report will be shared widely across the local health and care community and is available to all on the One Gloucestershire website www.onegloucestershire.net and on the online participation platform Get Involved in Gloucestershire https://getinvolved.glos.nhs.net
This interim report will be updated before decisions are made to include: the output of the Citizens Jury#2; the outcome of the Elective Lower Gastrointestinal (GI) (colorectal) surgery location discussions; the output of the updated independent Integrated Impact Assessment and other relevant information received. The updated report will be published on the One Gloucestershire website (link above) and shared with decision makers in order for them to give conscientious consideration to all relevant information prior to making decisions about the proposals. One Gloucestershire partners are invited to consider the feedback from consultation and indicate how it has influenced their decision making. Full details of the next steps for the Fit for the Future Programme can be found in Section 1.4.
This Report has been prepared by the One Gloucestershire Communications and 13.2 Engagement Group. This report is produced in both print and on-line (searchable PDF) formats. For details of how to obtain copies in other formats please turn to the back cover of this Report.
We would like to thank everyone who has taken the time to share their views and ideas.
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Making the best use the information provided in this Report This report is divided into two parts: Part 1 provides background information about the Fit for the Future Programme, the co-development of the consultation proposals and the consultation planning and activities. Part 2 provides a summary of the feedback received during the consultation. The final section of this report is an evaluation of the consultation activity. This report is supported by a series of online Appendices.
There are elements of feedback which will be relevant and of interest to all readers; these can be easily found in the main body of the report. All feedback received can be found in a series of online Appendices. These Appendices include all comments collated during the consultation, including copies of individual submissions received, in addition to the FIT FOR THE FUTURE survey responses. The theming of the qualitative feedback received through the Fit for the Future survey presented in this report has been undertaken by members of the One Gloucestershire Communications and Engagement Group using SmartSurvey.
Some respondents may have answered the formal consultation survey as well as giving feedback in other ways, such as sending a letter or participating in a discussion event. All feedback received has been read and coded into themes such as: ‘access’, ‘workforce’ and ‘quality’. Please note that individual’s comments may cover more than one theme. All qualitative feedback received by representatives of One Gloucestershire partners during the consultation period is available in the online Appendices. The information provided in this report and Appendices will be used by decision makers to ‘conscientiously consider’1 all feedback received.
Appendices All appendices are available at: www.onegloucestershire.net
Appendix 1: Survey responses by specific groups:
i) Full survey ii) Easy Read iii) Feedback from targeted groups (identified through independent Integrated Impact Assessment) from Full survey2 a. BAME b. Over 66 living with a disability c. BAME living with a long term condition 13.2 d. People living with a disability e. People with mental health problems and/or learning difficulties
1 One of the Gunning Principles that have formed a strong legal foundation from which the legitimacy of public consultations is often assessed. 2 Due to the smaller number of responses to the Easy Read survey, further analysis by demographic has not been completed in order to avoid potentially identifying individuals. 9
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f. Unpaid Carer g. People who identify as LGBTQ+ h. People who live in 12 most deprived wards in Gloucestershire (Indices of Deprivation 2019) i. Staff j. Public and Community Partners k. Postcodes from East of county l. Postcodes from West of county
Appendix 2: Other Correspondence
Appendix 3: Glossary
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PART 1
1. Background
Over the last few years the NHS in Gloucestershire Fit for the Future programme has been involving local people and staff in looking at potential ways to develop specialist hospital services in Gloucestershire. Through this process the ‘centres of excellence’3 approach has been designed.
Through the earlier Fit for the Future Engagement in 2019 and during earlier conversations about the NHS Long Term Plan in 2018, the NHS in Gloucestershire has been involving staff, patients, local people and the public in looking at a number of services and developing potential ‘solutions’. The Fit for the Future Consultation is the latest element of the engagement cycle4 to develop the Gloucestershire response to the NHS Long Term Plan, which began in 2018.
1. Development of our local NHS Long Term 6. Fit for the Plan (informed by earlier Future engagement feedback) Consultation (2020)
5. Fit for the Future Engagement: 2. Countywide public / Developing potential solutions. Output of community partner /staff Engagement Report published on ICS engagement - What matters website, considered by ICS partners and to you? shared with HOSC.
3. LTP Engagement 4. LTP Outcome of Engagement Report, Feedback (NHS and published on One Gloucestershire Healthwatch) Integrated Care System (ICS) website, collated and considered by ICS partners and shared Outcome of with Health Overview and Scrutiny Engagement Committee (HOSC) Report prepared 13.2
3 Centres of excellence: bringing staff, equipment and facilities together in one place to provide leading edge care and create links with other related services and staff. 4 Previous engagement activities can be found at: www.onegloucestershire.net/yoursay/
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The aims of the Fit for the Future programme are to:
Improve health outcomes Reduce waiting times and ensure fewer cancelled operations Ensure patients receive the right care at the right time in the right place Ensure there are always safe staffing levels, including senior doctors available 24/7 Support joint working between services to reduce the number of visits you have to make to hospital Attract and keep the best staff in Gloucestershire.
To achieve these things and to make the most of developing staff skills, precious resources and advances in medicine and technology, the Fit for the Future programme looks at how some specialist hospital services at Gloucestershire Royal and Cheltenham General could be configured to make best use of both hospital sites. This move towards creating ‘centres of excellence’ at the two hospitals is not new and this approach reflects the way a number of other services are already provided e.g. Cancer Services in Cheltenham and Children’s services in Gloucester.
1.1 What the Fit for the Future consultation is about The purpose of the consultation was to seek views on the future provision of five specialist hospital services in Gloucestershire:
Acute Medicine (Acute Medical Take). This is the coordination of initial medical care for patients referred to the Acute Medical Team by a GP or the Emergency Departments and where decisions are made as to whether patients need a hospital stay.
Gastroenterology inpatient services; medical care for stomach, pancreas, bowel or liver problems.
General Surgery conditions relating to the gut. Specifically, emergency general surgery, planned Lower Gastrointestinal (GI) (colorectal) surgery and day case Upper and Lower GI surgery.
Image Guided Interventional Surgery (IGIS) including vascular surgery. IGIS is where the surgeon uses instruments with live images to guide the surgery.
Trauma and Orthopaedic inpatient services (T&O) diagnosis and treatment of conditions relating to the bones and joints. 13.2
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1.2 What the Fit for the Future consultation is not about
Cheltenham General Hospital Accident & Emergency (A&E) Department A public commitment has been made to the future of the Accident and Emergency (A&E) Department in Cheltenham. The service will remain consultant led and there will be no change to the opening hours. The proposals for change described in the Fit for the Future consultation do not include the A&E Department at Cheltenham General Hospital, post pandemic, the department will revert to being a 7-day consultant led A&E unit between 8am and 8pm and a nurse led unit between 8pm and 8am. This is the A&E service model that has been in place at Cheltenham since 2013.
COVID-19 Temporary Changes Fit for the Future is not about the COVID-19 temporary changes made in 2020. However, some of the medium to long term changes proposed relate to some of the same clinical services where temporary changes have had to be made recently in order to keep our hospitals safe.
Outpatients, Community and Primary Care Services The focus of this consultation is five specialist inpatient services provided at Cheltenham General and Gloucestershire Royal Hospitals. No changes to outpatient, community or primary care services are included within this consultation.
1.3 Consultation process The Fit for the Future public and staff consultation started on 22 October 2020 and ran until 17 December 2020.
There have been a number of innovative ways the NHS has involved local people and staff during the consultation, from online events, to a ‘socially distanced’ Information Bus Tour and a door-to-door mail-drop of an information leaflet delivered by Royal Mail to all households in Gloucestershire. Full details of the consultation process can be found in Section 2.
1.4 Next Steps: Completing the communication, engagement and consultation for the Fit for the Future programme
Citizens’ Jury 13.2 A second Jury, independently facilitated by Citizens Juries CIC, will be held in January 2021 to consider the feedback from this consultation. 18 independently recruited jurors (not the same jurors who participated in Jury #1), representative of local communities from a broad range of demographics, will receive evidence from a range of witnesses, record their observations and make their recommendations to decision makers of the NHS organisations involved. This will include key feedback from the consultation process, which will be taken into account when making a final decision on the future configuration of the five specialty 13
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acute hospital services. The Citizens’ Jury will be hosted online; audio recordings of the plenary sessions will be available on request from Citizens Juries CIC, witness presentation recordings and slides will be available on the One Gloucestershire website https://www.onegloucestershire.net/yoursay/fit-for-the-future-developing-specialist- hospital-services-in-gloucestershire/ . Details will be publicised nearer the time.
Elective Lower Gastrointestinal (GI) (colorectal) surgery – no preferred option proposed in the consultation The Fit for the Future consultation did not propose a preferred option for Elective Lower Gastrointestinal (GI) surgery; two options were described. The next step is to select one of the two options for this service; to co-locate at either CGH or GRH to take forward for a decision.
This will be carried out at the beginning of February 2021 and will be a two stage process. Firstly an appraisal by the Trust Leadership Team of Gloucestershire Hospitals NHS Foundation Trust using the feedback from consultation to obtain a recommendation, with the option chosen by the Trust Board and then a final decision made by the NHS Gloucestershire Clinical Commissioning Group Governing Body in March 2021 (see Decision below). The following information will be reviewed:
Feedback from the Public Consultation Citizen’s Jury #2 output Presentations on the two options Pre-Consultation Business Case and attachments Financial Information Beds and resource requirements Workforce plans including rotas
Consultation review period There will then be a consultation review period, where Gloucestershire Hospitals NHS Foundation Trust and NHS Gloucestershire Clinical Commissioning Group will carefully consider all of the feedback.
Decision A final decision will be made about the Fit for the Future proposals at the CCG Governing Body meeting on 11 March 2021. This will be live streamed on the internet. 13.2 Process of implementation If the proposals set out in this consultation are supported by the Governing Body of the Clinical Commissioning Group; then the Emergency General Surgery, Gastroenterology and Trauma & Orthopaedics inpatient services changes will be made permanent. The timescale for other changes will be determined by a number of factors such as estates, staff recruitment and training. The F Programme structure will remain in place with programme and project managers working with clinical staff within the specialties to develop and then 14
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deliver detailed implementation plans. Plans to involve local people in the implementation and evaluation process are being developed.
1.5 Providing feedback to you on the consultation and decisions The feedback from the consultation, the recommendations and observations of the Citizens’ Jury and the final decision made by the CCG Governing Body will be published at: www.onegloucestershire.net/yoursay and shared on the online participation platform Get Involved in Gloucestershire https://getinvolved.glos.nhs.uk
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2. Our approach to communications and consultation
2.1 Working with others
The planning and delivery of the Fit for the Future consultation has been supported by many external groups: The Consultation Institute: The consultation process, including this Interim Output of Consultation Report, has been Quality Assured by The Consultation Institute5. A Consultation Institute Advisor worked with the Fit for the Future programme, acting as a critical friend; each stage of the consultation planning and activity was formally signed-off by a Consultation Institute Assessor, ensuring a totally independent element in the consultation process. The six stages, or gateways, of the Quality Assurance process are: o Scope and Governance o The Project Plan o Consultation Document Review o Mid-Point Review o Closing Review o Final Report (at the time of publication, The Consultation Institute is reviewing this interim report). Inclusion Gloucestershire: Assisted with the development of Easy Read materials. Gloucestershire County Council’s Digital Innovation Fund Forum: Informed early planning for online activities and assisted with awareness-raising of the consultation to potentially digitally excluded groups. Friends from the Friendship Café in Gloucester City: Supported awareness raising and survey completion within diverse communities. Healthwatch Gloucestershire (HWG): HWG Readers Panel reviewed an early draft of the full consultation booklet and made suggestions for changes, which were incorporated into the final version. A HWG representative will be a member of the independent Oversight Panel for the second Fit for the Future Citizens’ Jury. Aneurin Bevan Health Board (ABHB): ABHB facilitated the translation of the summary consultation booklet into Welsh, and facilitated an Information Bus visit to Chepstow Hospital in Monmouthshire to enable residents living close to the Wales England Border, who might access services in Gloucestershire the opportunity to find out more about the consultation. 13.2
5 https://www.consultationinstitute.org/services/quality-assurance/ https://www.consultationinstitute.org/wp-content/uploads/2019/12/Quality-Assurance.pdf
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Know Your Patch (KYP) Coordinators: KYPs allowed us space on agendas to share information at online meetings during October and November 2020 to promote the consultation. District/Borough Councils and Retail partners: Supported the ‘socially distanced’ visits of the Information Bus (outside of Lockdown 2) to locations with maximum footfall across the county. District and Borough Councils also hosted members’ seminars to discuss the Fit for the Future consultation. Local media: Gloucestershire Live, BBC Radio Gloucestershire and GFM Radio Others: Many other groups and individuals have helped to raise awareness of the consultation such as Trust Governors, staff-side representatives, hospital volunteers and community and voluntary sector organisations such as homelessness support charities.
Thank you to everyone who has supported this consultation.
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2.2 Equality and Engagement Impact Analysis (EEIA)
Equality, diversity, Human Rights and inclusion are at the heart of delivering personal, fair and diverse health and social care services. All commissioners and providers of health and social care services have legal obligations under equality legislation to ensure that people with one or more protected characteristics6 are not barred from access to services and decision making processes.
The consultation has been informed by the experience of managing earlier extensive engagement activities. The approach and detailed plan for communications and consultation was informed by feedback from those engagement activities, including feedback from NHSE/I Assurance process.
Extract from NHSE/I Assurance Process feedback in relation to communications and engagement:
The engagement output report shows that the team have really given people every opportunity to take part in the engagement programme and the resulting output report is very extensive. Full credit for openness and transparency Would benefit from an accompanying glossary to explain all the inevitable acronyms and terminology sprinkled throughout people’s quotes The engagement for Fit for the Future described in the PCBC and engagement output report was proportionate, targeted and had due regard for protected groups. From feedback received, the system is in a good place to know what the county as a whole think and the locations where the most negatively impacted populations live Further engagement to address the homogeneity of participants in Phase 1. In response to COVID-19 restrictions the Strategy and Plan has been designed to support a ‘socially distanced’ consultation. It includes an Appendix/Briefing which summarises recent advice and guidance regarding online consultation, sets out assumptions and considerations and makes the following observations and conclusions, which will be taken into account during the consultation: Consideration to be paid to online deliberation and engagement are those you should pay attention to regardless of whether engagement is face to face or online. Things such as feeling safe, ensuring transparency and that participants have the facts to be able to make an informed decision would apply regardless of how you engage. Online consultations prove to be most successful when used in conjunction with offline methods such as telephone structured interviews/market research techniques/managed exhibitions. Two-way direct communication is crucial in creating meaningful dialogue – video 13.2 conferencing software (Zoom, Microsoft Teams etc.) can facilitate this.
6 It is against the law to discriminate against someone because of: age; disability; gender reassignment; marriage and civil partnership; pregnancy and maternity; race; religion or belief; sex, sexual orientation. These are called protected characteristics. https://www.equalityhumanrights.com/en/equality-act/protected-characteristics
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Online forums should be moderated to keep discussion topics organised and to keep participants safe. Think about varying the times of online events – avoid excluding working age participants. Online events should be no longer than 2 hours and comfort breaks should be scheduled. Use creative and interactive dialogue methods for online and offline activities. Paper surveys should be replicated as online surveys. Some individuals or groups feel more comfortable sharing their thoughts on their own platforms, rather than official channels designed explicitly for themed discussions. Different marketing messages required to encourage online participation for ‘always’ (compete with other opportunities), ‘seldom’ (relevance, links to pandemic interests) and ‘never’ online (other opportunities or assistance required).
The FIT FOR THE FUTURE proposals for change have not been implemented as they are subject to this consultation. Two of the services in scope for the consultation are currently piloting the proposed changes and have been evaluated.
The impact of potential changes
We have worked with independent analysts from Mid and South Essex University Hospitals to complete an Integrated Impact Assessment (which covers Health Inequalities and Equality) of the proposed development of ‘centres of excellence’ for the specialist services described in the Fit for the Future consultation. This can be found at www.onegloucestershire.net/yoursay
The analysis considered a wide range of information, including feedback from the Engagement, to describe how different groups of people who are likely to access and experience health services, could be impacted by the proposed changes for each of the combinations of specialist services. Impact analysis, as part of the evaluation of the two pilot changes (Gastroenterology and Trauma & Orthopaedic inpatient services) has been undertaken locally with the support of the Local Authority Public Health Department. A Lay Reference Group made up of patient, public and VCS representatives was established to support the Impact Analysis and Solutions Appraisal activities.
In addition to the independent Integrated Impact Assessment (IIA) of the proposals, an Equality and Engagement Impact Analysis (EEIA) of the planned consultation activities has also been undertaken. 2.2.1 Groups potentially impacted, issues identified and actions taken 13.2 Our aim with this consultation was to reach a good representation of the local population, whilst making sure we hear from those groups who might be most affected by the proposed changes. We sought out the views of people from the groups, set out below, during the consultation to gain a better understanding of the potential impact on them and to identify ways to lessen any potential negative impacts:
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Black, Asian and Minority Ethnic (BAME) communities, in particular people aged over 65 People with mental health conditions Over 65s who are more likely to have long term conditions such as cardiovascular disease, obesity or diabetes Frail older people who are more likely to experience falls People from BAME communities who are living with a long term condition People living with a disability (includes physical impairments; learning disability; sensory impairment; mental health conditions; long-term medical conditions). Adult Carers and Young Carers Homeless people Gypsy/Traveller communities LGBTQ+ people People living in low income areas.
2.2.2 Issues identified pre-consultation in the EEIA and action taken ahead of consultation
Less information, less jargon and easy read The Consultation booklet was reviewed by the Healthwatch Gloucestershire Lay Readers Panel. An Easy Read version of the consultation booklet and survey was produced by Inclusion Gloucestershire. A summary version of the consultation booklet was produced.
Accompanying glossary recommended There is an accompanying glossary in the full consultation document (which is available in print and online).
Further engagement to address the homogeneity of participants Targeted opportunities for consultation with protected characteristic groups identified through the Impact Analysis e.g. via the Homeless Healthcare Team, Carers Forum etc. Alternative formats of all consultation materials available on request. Contract in place with telephone (and face to face) interpreters, incl. BSL and for written translation.
Paper surveys should be replicated as online surveys 13.2 Surveys were available on line in regular and easy read formats. People were also offered assistance to complete surveys over the telephone.
Different marketing messages required to encourage online participation for ‘always’ (compete with other opportunities), ‘seldom’ (relevance, links to pandemic interests) and ‘never’ online (other opportunities or assistance required).
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All forms of media, print, broadcast, and social media platforms were used. An awareness raising leaflet was delivered to all households by Royal Mail in Gloucestershire telling them about the consultation and how they could get involved.
Liaise with community leaders to hold specific workshops within the BAME communities with community support for interpreters We contacted local groups, including BAME communities to arrange culturally appropriate opportunities for participation in the consultation e.g. Information Bus visit to Gloucester Mosque at their invitation [Unfortunately we were unable to attend the Mosque visit due to Covid-19 Lockdown 2 restrictions. However, we liaised with local community leaders about alternative ways to promote the consultation, including WhatsApp and interview on local Community Radio7 ]
Use creative and interactive dialogue methods We used a range of methods: Online, face-to-face (socially distanced), telephone, written.
Online consultations prove to be most successful when used in conjunction with offline methods such as telephone structured interviews/market research techniques/managed exhibitions. We hosted online activities, chat forums and Live discussions recorded on YouTube [In response to feedback after the first Live discussion, broadcast was moved to FaceBook Live for better reach]. We invited people to call us to leave a message to book telephone interviews. We toured our Information Bus to all localities in the county and to the Mosque in Gloucester [see note above].
Online forums should be moderated The Forum function of the Get Involved in Gloucestershire online participation platform is independently moderated. The Gloucestershire Live Face Book Events were hosted by an independent chair and questions were moderated.
Varying the times of online events Events were held at different times of day and different days of the week 13.2 Events, e.g. workshops, no longer than 2 hours
7 https://gloucesterfm.com/ 7 December 2020, Community Link Show – repeated 8 December 2020 21
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All scheduled events were no longer than 90 minutes, with online events mostly lasting 30-45 minutes. Most events were online and we make it clear that participants could get up, have a comfort/refreshment break
Some individuals or groups feel more comfortable sharing their thoughts on their own platforms, rather than official channels designed explicitly for themed discussions. We offered to use the platforms, which worked best for the individual or group: Zoom, Face Time, Microsoft Teams, Webex – We completed DPIA (Data Protection Impact Assessments) for any new platforms requested. We also offered more traditional methods such as telephone calls.
Target groups identified through the IIA Representatives from the groups identified in the IIA were contacted to discuss methods to facilitate participation in the consultation. Example: Advice from the Homeless Healthcare Team, Age UK, Carers Hub
The Fit for the Future consultation was open to all with activities designed to facilitate feedback from as wide a cross-section of the local community as possible. The full EEIA can be found via the following link: https://www.onegloucestershire.net/wp-content/uploads/2020/10/Equality-and- Engagement-Impact-Assessment-FINAL-1.pdf
The Pre Consultation Business Case independent Integrated Impact Assessment can be found via the following link: https://www.onegloucestershire.net/wp- content/uploads/2020/12/Appendix-14a_Annex_IIA.pdf
The independent Integrated Impact Assessment will be updated to take into account the response to consultation. The updated assessment will be included in the Decision Making Business Case, which will be available on the One Gloucestershire website.2.3
2.3 Covid 19: A socially distanced consultation
A traditional consultation process would include many of the methods described below, such as producing information, hosting discussion events and developing surveys. One factor to be taken into account with this consultation was the reduced opportunity to 13.2 engage with people face-to-face due to pandemic public health restrictions. Therefore a largely ‘socially distanced’ consultation was planned. In order to maximise opportunities to raise awareness of the consultation and opportunities to get involved the following methods were used.
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2.4 Communications: Developing understanding and supporting Fit for the Future consultation A range of communications and consultation methodologies were used during the Fit for the Future consultation. This section describes the wide ranging approach taken to promoting the Fit for the Future consultation and the range of involvement opportunities. In summary:
Door to Door awareness raising leaflet The NHS commissioned the Royal Mail to deliver a leaflet to all households in Gloucestershire. One Gloucestershire commissioned Royal Mail to deliver297,000 Fit for the Future leaflet to all Gloucestershire postcodes. Where residents have chosen Royal Mail Door to Door opt out, they will not have received this information8
This was a key method for ensuring that people not able to access materials on-line were able to engage with the consultation. The leaflet included brief information about the Fit for the Future consultation and also the Forest of Dean Community Hospital consultation; which has been running concurrently9. The mailer included a freepost reply slip to request information or a telephone call.
1,743 requests for information were received (1,286 items posted, all other items were sent by email). Many people requested more than one item or documents relating to both live consultations. o Fit For the Future (1,248) 13.2 . Long 226 (162 sent by post) . Short 587 (415 sent by post)
8 https://www.royalmail.com/sites/default/files/D2D-Opt-Out-Application-Form-2015.pdf
9 Details of the Forest of Dean Community Hospital Consultation can be found at: https://www.fodhealth.nhs.uk/consultation/ 23
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. Easy Read 256 (193 sent by post) . Pre Consultation Business Case 180 (132 sent by post) o Forest of Dean Community Hospital (495) . Long 308 (239 sent by post) . Easy Read 187 (145 sent by post) 116 requests for telephone call backs o Fit for the Future (83) o Forest of Dean Community Hospital (33)
Media releases and stakeholder briefings This included: launch materials – media release and stakeholder briefing media statements reinforcing key messages and involvement opportunities a further open stakeholder letter sent to community stakeholders by email including Patient Participation Groups, local authorities, voluntary and community organisations Foundation Trust Membership communications promoting the consultation
Hardcopy engagement booklets Approximately 5,000 booklets were widely distributed to a range of public places including Cheltenham General and Gloucestershire Royal Hospitals, community pharmacies, GP surgeries and libraries. The booklets included the survey and information detailing the ways people could get involved.
‘Your Say’ area on the One Gloucestershire Health website and Get Involved in Gloucestershire online participation platform All consultation materials can be found at: Fit for the Future: Developing urgent and hospital care in Gloucestershire: https://www.onegloucestershire.net/yoursay/ Get Involved in Gloucestershire is an online participation space where anyone can share views, experiences and ideas about local health and care services. Information about the consultation including activities can be found at https://getinvolved.glos.nhs.uk/fit-for-the-future
Further engagement to address the homogeneity of participants Targeted opportunities for consultation with protected characteristic groups were identified through the Equality and Engagement Impact Analysis e.g. via the Homeless Healthcare Team, Carers Forum etc. Alternative formats of all consultation materials available on 13.2 request. Contract in place with telephone (and face to face) interpreters, incl. BSL and for written translation. An introduction to the Consultation, with information about support to enable people to participate, was sent to Talking Newspapers
Social media Social media was used extensively to support the consultation and planned activity covered topics such as promotion of how people could get involved, films, Information Bus Tour and 24
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Cuppa and Chat events, promotion of the booklet and survey, and promotion of the online clinical discussions.
Facebook During the engagement there were a total of 22 Facebook posts from the One Gloucestershire account, with a total reach of 91, 14110. There were 5,555 ‘engagements’ with these posts (i.e. actions such as comments, likes or shares) of which 444 clicked the links in the post. There were also three sponsored boosts across the period of the consultation, including a post to launch the consultation, our intro to Fit for the Future video, and to promote the Q&A sessions. Each of these posts also linked to the One Gloucestershire website. This achieved a total reach of 142,512* with 1,793 ‘engagements’ which included 1,016 clicks on the link in the post.
Twitter During the engagement period there were 38 tweets and retweets from the One Gloucestershire account, with a total of 30,088 impressions. There were 791 ‘engagements’ with these tweets (i.e. actions such as link clicks, retweets, likes, or comments) of which 97 were retweets and 107 were clicks through to the One Gloucestershire website. Activity on Twitter covered the themes referred to in the Facebook section above.
Media Advertising As well as the methods described above, the initial Information Bus events were advertised in local media titles including Gloucester Citizen, Gloucestershire Echo, The Forester, Wilts & Glos Standard, Stroud News & Journal, Cotswold Journal and Gloucestershire Gazette. We also took out sponsored digital adverts with the titles listed above, which went out via their websites and social media channels. These pushed people to the main Fit for the Future consultation page where people could find our documents, videos and details for how to get involved online or offline.
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2.5 Staff communication and engagement
Gloucestershire Hospitals NHS Foundation Trust staff
Four main programmes of internal communication and engagement were rolled out to support staff.
1) Corporate communications:
Video communication to all staff: Executives regularly updated staff on the programme of work as part of the fortnightly Vlog shared with all staff and hosted on the Trust intranet. To enable greater uptake the intranet has also been made mobile friendly so staff can keep up to date via their own personal device at a time of their choosing.
Key statistics: Total page views: 3,242 13.2 unique views: 2,786 Average time on Vlog: 09m:16s
Global emails: As well as video format, programme leads regularly updated staff on developments in written format via global emails which go out to all staff 3 times a week. This messaging regularly linked back to the intranet page where staff could find out more and were actively encouraged to complete the online survey. Unfortunately due to
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restrictions with Outlook software there’s no tracking device that enables tracking of email updates. However, intranet tracking is available and is covered in the next section.
Intranet: The intranet was used a platform to share all the latest information including opportunities for staff to get involved, learn more about the programme and how to complete the online survey.
Key statistics: Total page views: 795 Unique page views: 647 Average time on page: 04:39
Website: In addition to the main website platform (onegloucestershire.net), the Hospitals Trust also uploaded an information update (media release) to its website (www.gloshospitals.nhs.uk).
Key statistics: Total page views: 394 unique views: 339 average time on page: 02:32
2) Staff online discussion forum
Throughout the consultation staff were offered 3 dedicated online sessions to learn more about the programme. Typically each session would include an introduction, overview of the programme, the case for change and the opportunity each afforded. The sessions were clinically supported and executive lead. Staff were invited to participate and ask live questions which were shared and answered.
Monday, 2nd November: x 4 participants Tuesday, 8th December: x 6 participants Monday, 14th December: No participants
3) Staff drop in sessions
Information points were established at busy thoroughfares across the hospitals. These were staffed on 10 separate occasions for three hours throughout the period of the consultation. This qualitative approach was designed to understand in more detail the views of staff. Consultation booklets were also distributed widely in staff areas across both Cheltenham General and Gloucestershire Royal Hospital. Total number of contacts made with staff: 351 13.2
Themes that emerged: Awareness levels varied: some staff were well informed and knowledgeable while others less so Anecdotally awareness levels appeared to increase throughout the consultation There was some confusion in relation to COVID temporary/emergency changes and long-term strategic proposals for changes as part of Fit for the Future
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From those staff, who were engaged, the following themes emerged: Broadly there was support for the centres of excellence vision Staff understood the benefits of a greater separation between emergency and elective services across both sites Staff could point to inefficiencies and duplication which didn’t optimise opportunities for better patient care and staff working There was a level of anxiety in relation to bed modelling and access to theatres, equipment and wards Staff had preferences over which site they preferred to work Staff wanted to continue to work within the same team
4) Staff ambassadors
Clinical and managerial leaders supported the programme within their divisions and teams and were encouraged to take the message to them as part of the consultation programme. Clinical and managerial leaders were reminded of the importance of this responsibility during regular corporate and clinical leadership meetings such as the Trust’s Leadership Team meeting. By having ambassadors widely dispersed across the hospitals they acted as touch points and support pillars for clinical colleagues, administrative and managerial staff.
Primary care (GP practices) and NHS Gloucestershire Clinical Commissioning Group (CCG) The Fit for the Future consultation has been regularly promoted to all staff working at NHS Gloucestershire Clinical Commissioning Group and in GP practices, Primary Care Networks and the Local Medical Committee via the Primary Care Bulletin. The consultation was promoted at a meeting of the countywide Primary Care Clinical Network Clinical Directors.
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2.6 Other stakeholder communication and engagement
Elected Representatives
Members of Parliament Regular MP briefings have taken place prior to and during the Fit for the Future consultation period.
Gloucestershire County Council (GCC) Gloucestershire County Council Health Overview and Scrutiny Committee Members have received regular updates on the FIT FOR THE FUTURE programme and consultation. Consultation materials have been available to elected members and staff.
District and Borough Councils A series of Fit for the Future Members Seminars have taken place across the county. Following presentations, members had the opportunity to participate in Question and Answer sessions.
REACH Campaign
A series of constructive meetings were held throughout the consultation with representatives of REACH11. These meetings provided an opportunity to share information and to respond to questions. During the consultation period REACH produced an alternative survey to the NHS Fit for the Future survey. Details of the REACH survey and responses to it have been shared with the Fit for the Future consultation team and can be found in Part 2.
11 https://www.reachnow.org.uk/ extract from website: 13.2
The REACH (Restore Emergency At Cheltenham General Hospital) campaign was launched by Cheltenham Chamber of Commerce, which is now working with local businesses, local residents and other campaign groups to achieve the following objective: “To have a fully functioning, fully staffed A&E Department operating 24/7 re-instated at Cheltenham General Hospital, which serves a population of at least 200,000 in Cheltenham, Tewkesbury Borough and the North Cotswolds, at the earliest possible opportunity.” 29
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2.7 Public Consultation Activities
Gloucestershire Media: Live social media partnership (@GlosLiveOnline) Underpinning the ‘socially distanced’ approach to consultation was a new and ground breaking partnership with local media stakeholder Gloucestershire Media. In terms of the format six half hour productions were broadcast live via Glos Media’s Facebook channel (as well as Glos Hospitals Facebook channel) during peak period. Chaired by an independent figure well-known in the local community and presented as a Q&A public session with hospital clinicians, the sessions were broadcast at 12.30pm each Wednesday (from 4th November – 9th December).
Each session focussed on each of the individual service proposals under the Fit for the Future public consultation programme e.g. acute medicine, gastroenterology inpatient services, trauma & orthopaedics, general surgery and image guided interventional surgery. The exception to that was the first broadcast which went out as a COVID special on 4th November. The strength of the broadcasts was the level of clinical representation and participation. Under the partnership arrangement other local media outlets including the BBC were given access to the content produced as well as access to the hospitals and clinicians.
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Gloucestershire Media: Live social media partnership (@GlosLiveOnline) Analytics:
Table 1 (analytics of the broadcast)
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Platform Date Subject Reach Comments Likes Shares Views
Facebook 11/11/2020 Gastroenterology Glos Live: Inpatient Services 49,500 74 54 7 10,000 Glos Hos: 14,366 23 29 17 18/11/2020 Acute Medicine Glos Live: 58,000 69 54 7 11,000 Glos Hos: 3,187 16 31 5 25/11/20 T&O Glos Live: 20,000 36 23 3 6,000 Glos Hos: 3,789 25 27 6 02/12/2020 General Surgery Glos Live: 16,000 17 27 2 6,500 Glos Hos: N/A N/A N/A N/A 09/12/2020 IGIS Glos Live: 33,234 29 54 1 8,800 Glos Hos: 3,900 0 28 5
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Table 2 (analytics of the promotional material)
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Platform Date Subject Reach Comments Likes Shares
Facebook 10/11/2020 Gastroenterology 28,800 60 16 6
11/11/2020 Gastroenterology 20,300 19 34 4
17/11/2020 Acute Medicine 27,700 44 15 2
24/11/2020 T&O 14,400 41 7 1
01/12/2020 General Surgery 11,000 0 3 2
04/12/2020 T&O 30 1 9 2
08/12/2020 IGIS 8,000 0 7 2
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Gloucestershire Hospitals: Facebook live (@GlosHospitals)
Running parallel to the Gloucestershire Media partnership described above was the Hospitals Trust’s own Facebook live production. Clinically led and executive supported, all 7 sessions were broadcast live via the Trust’s Facebook channel. In a similar way to the Gloucestershire Media productions, each session was dedicated to an individual service proposal and led by those specialist clinicians. Typically each session would include an introduction, overview of the service, the case for change and the opportunity each afforded. The public were invited to participate and ask live questions which were shared and answered.
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Gloucestershire Hospitals: Facebook live (@GlosHospitals): Analytics:
Platform Date Subject Reach Comments Likes Shares Views
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Facebook 02/12/2020 Acute Medicine 18,277 5 24 2 2.5k
03/12/2020 Gastroenterology 3,099 0 11 4 1.4k Inpatient Services 03/12/20 General Surgery 2113 1 5 1 970
04/12/2020 IGIS 3,072 9 8 14 1.4k
04/12/2020 T&O 30 1 9 2 1.4k
YouTube* 02/11/2020 Acute Medicine N/A 1 3 N/A 146
* The Hospitals Trust switched from YouTube to Facebook in response to increased audiences and greater accessibility. The Trust ran an additional broadcast on Acute Medicine to ensure the full sequence of service proposals had been broadcast.
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Gloucestershire Patient Participation Group Network https://getinvolved.glos.nhs.uk/ppg-network All GP practices in England are required to have a patient participation group. The Gloucestershire PPG Network is organised by Gloucestershire Clinical Commissioning Group (CCG). It is designed to provide a space for PPG members from across the county to share their experiences with one another in order for each PPG to learn and continue to provide an effective role in their practice.
NHS Gloucestershire CCG involves PPG members in engagement and consultation work, provides support to PPG’s on an individual basis and also provides opportunities for PPG’s to learn and develop. In addition, NHS Gloucestershire CCG hosts a quarterly network meeting. However, during the current pandemic this has moved to holding meetings virtually using MS Teams. An Extraordinary PPG Network meeting to focus solely on the Fit for the Future and Forest of Dean new community hospital consultations attended by 25 PPG members was held in November 2020.
NHS Information Bus Tour
The Information Bus aims to facilitate partnership working, offering information and activities which support self-care, health and wellbeing and self-management across the communities of Gloucestershire. The Bus is also used a consultation resource to support engagement with the public to inform service planning and design.
Prior to the launch of the consultation, the Bus was used during September 2020 to promote the new Get Involved in Gloucestershire online participation platform.
An Information Bus Tour to raise awareness of the consultation, to gather views and answer 13.2 questions commenced on 2 November 2020. Unfortunately due to new Covid-19 restrictions introduced from 5 November 2020, planned Information Bus Dates originally planned for November 2020 were cancelled. However all these dates were re-provided in December once lockdown in England ended and Gloucestershire moved into Tier 2. Three events had been held prior to lockdown. The Bus was used as a venue for Covid-19 staff testing while it was off the road.
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The Bus recommenced its Tour on 1 December 2020 in Chepstow, Monmouthshire (where lockdown was not in place) and in Cheltenham on 3 December 2020.
Chepstow Hospital Tesco, Tewkesbury Road Cheltenham
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During the consultation 433 people visited the Information Bus. See Section 2.10 for details of all Information Bus Tour dates.
Cuppa and Chats
When the Information Bus Tour was paused in November 2020, locality and countywide online ‘Cuppa and Chats’ were set up to replace the socially distanced face-to-face visits planned. These took the form of a short presentation (including showing of an information film) followed by a shared discussion.
The sessions were initially organised as Microsoft Teams meetings, in response to feedback from public participants, the sessions were moved to an alternative platform, Zoom, more frequently used by community partners.
8 ‘Cuppa and Chats’ were hosted reaching 44 participants.
Targeted activities
In addition to the main consultation activities, the consultation sought feedback from groups identified in the independent Integrated Impact Assessment. Details of how we have engaged these groups in the consultation can be found below in section 2.8.
Fit for the Future Surveys
Two surveys (standard and Easy Read) were developed by the NHS to support the FIT FOR THE FUTURE engagement. These were available as print, FREEPOST return copies in the engagement booklets and also on line at: https://www.onegloucestershire.net/yoursay/fit-for-the-future-developing-specialist- hospital-services-in-gloucestershire/ and https://getinvolved.glos.nhs.uk/fit-for-the-future
A total of 713 Fit for the Future surveys have been received. This included 110+ Freepost paper surveys, 1 telephone survey with the remainder online.
Other surveys and petitions 13.2 REACH created an alternative survey to gather views to inform their response to the Fit for the Future consultation proposals. [Extract from REACH website) https://www.reachnow.org.uk/
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REACH launch their Fit for the Future Survey (19 November 2020) REACH are concerned that the One Gloucestershire Fit for the Future survey that forms part of the consultation has been constructed in such a manner that the results can be used to justify a decision that the respondents would not have supported. Because of this REACH have chosen to launch their own survey, to gather the real preferences of those local people in Gloucestershire and surrounding areas, who will be affected by these proposals. “We believe it is vital that the public can actively engage in this consultation. We are not convinced that the One Gloucestershire survey enables the public to express clear responses to some of the key points, which is why we have chosen to produce our own Fit for the Future survey. “We would encourage as many people as possible to take part in our survey and allow their views to be heard. We will be making the results of this survey public and will be sharing them with One Gloucestershire. To help the general public understand some of the fairly complex issues involved we have also produced a non- medical persons’ guide to some of the key points”
The results from the REACH survey have been shared with the One Gloucestershire Communications and Engagement Team and are included in the detailed summary of consultation feedback in Part 2 of this report. REACH has also provided a formal response to the consultation which can be found in the online appendices.
Petitions At the time of writing no petitions relating to Fit for the Future have been received by NHS partners of One Gloucestershire.
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2.8 Consulting people with protected characteristics and others identified in the Independent Integrated Impact Analysis
The consultation took two main routes to reach, gather and record views from people with protected characteristics and others identified in the independent Integrated Impact Analysis: promoting the formal consultation routes and encouraging participation. The consultation survey asks for respondents to provide demographic information (see Part 2) proactive consultation with targeted groups. The consultation team contacted groups across Gloucestershire using existing well established networks and Your Circle https://www.yourcircle.org.uk/, which is a local online directory to help you find your way around care and support and connect with people, places and activities in Gloucestershire. The following describes activities undertaken to encourage participation from these groups and themes from their responses to the consultation where possible without identifying individual’s responses.
Black, Asian and Minority Ethnic (BAME) communities, in particular people aged over 65 There are a number of responses to the survey from people from BAME communities (39 people identified as: White Other, Asian or Asian British, Black or Black British, Chinese, Mixed who complete the ‘About you’ survey questions). A small number of respondents from BAME communities also indicated they were aged over 66. Members of the consultation team worked with Friends from the Friendship Café in Gloucester City to supported awareness raising and survey completion within diverse communities. Information about the consultation was shared with the members of the Impact of COVID- 19 on BAME Community/Groups Gloucestershire Task and Finish Group. Consultation materials were shared with the Gloucestershire VCS Alliance BAME/Diverse Communities Forum. An interview on the Community Link Programme on Gloucester FM Radio promoted the consultation to listeners. Gloucester FM community radio station, has an emphasis on local issues, information, advice and music reflecting Gloucestershire’s multi-cultural community https://gloucesterfm.com/
People with mental health conditions [and learning disabilities] There is a good response to the survey from people who indicated they have a disability (including mental health problem or learning disability). During the consultation, members of the consultation team attended all Know Your Patch meetings across the county to promote Fit for the Future and the Get Involved in Gloucestershire online participation 13.2 platform. Know Your Patch builds networks for those working with individuals and groups to help people stay independent for longer and to lead full and happier lives. Know Your Patch has a network of organisations in each district in Gloucestershire. These networks meet quarterly for networking and discussion and communicate through email bulletins and updates. These networks help connect VSCE and statutory organisations together for effective partnership working https://knowyourpatch.co.uk/networks/ Information about
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the consultation was also shared with the Mental Health and Learning Disability Partnership Boards.
The online appendices includes reports of the responses from all survey respondents, who completed the ‘About You’ questions in the survey, who stated they had a mental health problem or a learning disability.
Over 65s who are more likely to have long term conditions such as cardiovascular disease, obesity or diabetes There is a good response to the survey from people aged 66 and over, and also from people who indicated they have a disability. Staff from Gloucestershire Health and Care NHS Foundation Trust, working in Cardiac Rehabilitation, have been provided with consultation materials. The Gloucestershire Heart Support Group, HeartSmart (Cirencester), Heart to Heart Exercise Group and Where the Heart Is Group, were provided with information about the consultation to share with members of their groups. Visits were made to the Cardiac Ward and Coronary Care Unit at Cheltenham General Hospital and Gloucestershire Royal Hospital to provide awareness raising flyers, summary booklets and full booklets for clinical staff to share with patients who were well enough to read of them. Information about the consultation was also shared via email with 20 members of the Gloucester Diabetes Support Group and at a Gloucestershire Stroke Zoom Café attended by 5 members.
Frail older people who are more likely to experience falls The activities described above for Over 65s with long terms conditions apply to this group as well. Contact was also made with the local branch of Age UK to promote the consultation.
The online appendices provide a report of the responses from all survey respondents, who completed the ‘About You’ questions in the survey, who are over 66 and who stated they had a disability.
People from BAME communities who are living with a long term condition There is a proportional response to the survey from people from BAME communities. A small number of respondents from BAME communities also indicated they had a disability. As referenced above, members of the consultation team worked with Friends from the Friendship Café in Gloucester City to supported awareness raising and survey completion within diverse communities. Information about the consultation was shared with the members of the Impact of COVID- 19 on BAME Community/Groups Gloucestershire Task and Finish Group. An interview on the Community Link Programme on Gloucester FM Radio promoted the consultation to listeners. Gloucester FM community radio station, has an emphasis on local issues, information, advice and music reflecting Gloucestershire’s multi-cultural community 13.2 https://gloucesterfm.com/
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The online appendices provide a report of the responses from all survey respondents, who completed the ‘About You’ questions in the survey, who are from BAME communities and who stated they had a disability.
People living with a disability (includes physical impairments; learning disability; sensory impairment; mental health conditions; long-term medical conditions) There is a good response to the survey from people who indicated they have a disability. As above, during the consultation, members of the consultation team attended all Know Your Patch meetings across the county to promote Fit for the Future and the Get Involved in Gloucestershire online participation platform.
Know Your Patch builds networks for those working with individuals and groups to help people stay independent for longer and to lead full and happier lives. Know Your Patch has a network of organisations in each district in Gloucestershire. These networks meet quarterly for networking and discussion and communicate through email bulletins and updates. These networks help connect VSCE and statutory organisations together for effective partnership working https://knowyourpatch.co.uk/networks/
Information about the consultation was also shared with the Learning Disability Partnership 13.2 Board and Physical Disability and Sensory Impairment Partnership Board who have a total of 179 members between them. Information about the consultation was directly targeted by the Integrated Disabilities Commissioning Hub to 31 members involved of the Building Better Transport Links (BBTL) group, who are looking at better transport arrangements for people with disabilities. The consultation also targeted people with visually impairment through representatives from the Sight Loss Council, the Macular Society and Royal National Institute for the Blind; following their advice information was sent to Gloucestershire’s
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network of talking newspapers and Fit for the Future VLOGs, as well as written updates, were added to social media channels.
The online appendices provide a report of the responses from all survey respondents, who completed the ‘About You’ questions in the survey, who stated they had a disability.
Young people The Gloucestershire Hospitals NHS Foundation Trust Youth Group held a discussion group about the Fit for the Future consultation proposals. Members were encouraged to visit the Get Involved in Gloucestershire online participation platform. 2 Youth Ambassadors created short films, which were shared on social media, to encourage young people to get involved. One member of the Youth Group sent a formal written response to the consultation.
Adult Carers and Young Carers There is a good response to the survey from people who indicated that (unpaid) they look after, or give any help or support to family members friends, neighbours or others because of either a physical or mental health need or problems related to old age. During the consultation members of the consultation team attended carers group meetings to talk about the Fit for the Future consultation including Gloucestershire Hospitals NHS Foundation Trust Carers Hospitals Reflections and Experience Group and YACTION – Young Adult Carers Group. The groups both emphasised the importance of good clear communications around any proposed changes and the need to work closely and in partnership with carers.
YACTION in action, we talked about Fit for the Future, while together we crafted Christmas decorations. 13.2
The online appendices provide a report of the responses from all survey respondents, who completed the ‘About You’ questions in the survey, who stated they were unpaid carers.
Homeless people (and rough sleepers) Homelessness is not a characteristic the survey collects. Therefore, in order to ensure the feedback from homeless people can be identified, enhanced targeted activity has taken
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place to raise awareness of Fit for the Future and Get Involved in Gloucestershire; and to collect feedback specific to the consultation proposals and any other issues of importance to homeless people. Members of the consultation team have attended several meetings of groups who support homeless people in Gloucestershire: Gloucester Homeless Forum, Cheltenham Housing & Care Forum, Cheltenham Open Door, Cheltenham Housing Aid Centre and also engaged with the Homeless Specialist Nurse.
Summary of feedback: - Requests were made for more outreach services, in particular in Cheltenham and for the local NHS to ensure that, whichever hospital vulnerable people were admitted to, they are treated well and with dignity.
Gypsy/Traveller communities Members of the consultation team met with the Travellers’ Welfare Officer to discuss the Fit for the Future consultation proposals. General comments about the experience of travelling families of Gloucestershire NHS service related to the attitude of NHS staff to travelling families, in particular from ward staff when visiting family members in hospital. Respect for travelling families and understanding of what is important to them, such as space, was highlighted. Constructive suggestions were recorded regarding improvement to communications and information sharing. These will be taken forward in 2021.
LGBTQ+ people There is a good response to the survey regarding sexual orientation, with a small number of respondents describing themselves as LGB. No respondents to the survey, who completed the ‘About You’ questions stated that they did not identify with the gender they were registered with at birth. 1 respondent to the survey, who completed the ‘About You’ questions stated they were transgender. Information about the consultation was shared with the members of the Gloucestershire LGBT+ partnership and there was an opportunity to raise awareness of the consultation when the NHS Information Bus supported the LGBTQ+ partnership as a mobile venue during Hate Crime week in September 2020.
The online appendices provide a report of the responses from all survey respondents, who completed the ‘About You’ questions in the survey, who identified as LGBTQ+ [The combined number is greater than 10]
People living in low income areas Low income is not a characteristic the survey collects. However, there is information within local data which records indices of deprivation and shows which areas of the county are most likely to be low income areas. Extract from Inform website: https://inform.gloucestershire.gov.uk/deprivation/overview/ 13.2
The Indices of Deprivation 2019 are national measures based on 39 indicators, which highlight characteristics of deprivation such as unemployment, low income, crime and poor access to education and health services. The 2019 indices offer an in-depth approach to pinpointing small pockets of deprivation. Each indicator was based on
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data from the most recent time point available. Using the latest data available means there is not a single consistent time point for all 39 indicators. https://inform.gloucestershire.gov.uk/media/2094524/gloucestershire_deprivation_ 2019_v13.pdf
….There are 12 areas of Gloucestershire in the most deprived 10% nationally for the overall IMD. [9 of the 12 are in Gloucester District Council: GL1, GL2 and GL4 postcode areas, 2 in Cheltenham GL50 and GL51 and 1 in the Forest of Dean GL14. 1. Podsmead 1 Gloucester 621 (n=national rank out of 32,844 small areas or neighbourhoods called Lower-layer Super Output Areas in England12) 2. Matson and Robinswood 1 Gloucester 735 3. Westgate 1 Gloucester 1,183 4. Kingsholm and Wotton 3 Gloucester 1,456 5. Westgate 5 Gloucester 1,579 6. St Mark’s 1 Cheltenham 2,178 7. Moreland 4 Gloucester 2,221 8. St Paul’s 2 Cheltenham 2,368 9. Cinderford West 1 Forest of Dean 2,729 10. Tuffley 4 Gloucester 2,801 11. Matson and Robinswood 5 Gloucester 2,948 12. Barton and Tredworth 4 Gloucester 3,126
Employment status is one of the indices of deprivation. Information available on the Inform website the latest available unemployment data for October and November 2020 indicates that Barton and Tredworth ward in the GL1 postcode of Gloucester has the highest claimant rate (Job Seekers Allowance and Universal Credit) in Gloucestershire. https://inform.gloucestershire.gov.uk/media/2102589/unemployment-bulletin-147-oct- 20.pdf and https://inform.gloucestershire.gov.uk/media/2103578/unemployment-bulletin- 148-nov-20.pdf
The Fit for the Future consultation survey collects top level postcode information (first part of the postcode e.g. GL16 or GL3) to avoid potential for identifying individual survey respondents.
The online appendices provide a report of the responses from all survey respondents, who completed the ‘About You’ questions in the survey, who stated they lived in the GL1 postcode area and who lived in GL1, GL2, GL4, GL50, GL51 and GL14.
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2.9 District/Borough Council Member Seminars
Representatives from One Gloucestershire NHS partners attended a series of District/Borough Council Member Seminars. Discussions were on the following themes:
Centres of Excellence approach Impact of centralisation of services on patient access and choice Impact of proposals on planned operations being cancelled in future Centres of Excellence – positive separation of planned and urgent care, potential to reduce reliance on private sector for planned procedures Centralisation: NHS benefits (efficiency) balanced against impact on the public (social costs) Ambulances need to know which hospital to bring patients to Hospitals are only one part of the patient journey, they need to work in partnership with community and primary care and the voluntary sector One Gloucestershire borders many counties and Wales, consider cross-border flow of patients
Cheltenham General Hospital A&E Department Confirmation requested regarding A&E arrangements a Cheltenham General Hospital reverting to pre-Covid service and clarification of what the pre-Covid arrangements were. Covid temporary changes – challenges with Ambulance delayed at Gloucestershire Royal Hospital (GRH) and capacity at GRH.
Communications Patients understanding of which services are provided at each hospital now and in the future Communications and Public Relations more innovation needed to meet diverse communities’ requirements The public need to know which services are available, where and at what times of the day and night Level of Clinical support for the proposals Sustainability/Estates How hospitals keep up to date with new developments/treatments The plans for increasing 7 day working Consideration should be given to building one new Acute General Hospital for 13.2 Gloucestershire – more efficient
Transport/Access/Rurality Centralising services results in longer travel times for patients and visitors Rural transport infrastructure poor in county Ambulance response times in rural areas of the county
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2.10 Consultation events activity timeline
Week Activity Number engaged Protected with Characteristic (where applicable) 22 –28 Health Overview and Scrutiny 15 October Committee (HOSC) Stroke Zoom Café 5 Disability
Get Involved in Gloucestershire (GIG) 6 with Gloucestershire Hospitals NHS Foundation Trust (GHT) Governors 29 October – Tewkesbury Know Your Patch (KYP) 13 Multi Voluntary 4 November Community Sector (VCS) Information bus – Cheltenham, High 55 Street Information bus – Cinderford, Co-Op 22 (Forest of Dean) Information bus – Gloucester, Quays 37
Stroud and Berkeley Vale Patient 16 Participation Group (PPG) Acute Medicine Clinical Q&A YouTube 15 Live GIG with GHT Governors 6
GHT Carers focus group 15 Carers
Gloucester Homeless Forum 30 Homeless (professionals/VCS) GHT Youth Group 18 Age, young adults
Primary Care Network (PCN) Clinical 16 Directors Cotswolds KYP 27 Multi VCS
Friendship Café 4 BAME
GHT Staff drop ins and ward visits 134 Health Professionals 13.2 GHT staff online discussion forum 4 Health Professionals 5 – 11 KYP Gloucester 38 Multi VCS November PPG Network 25
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Stroud and Berkeley Vale PPG 16
GHT staff online discussion forum 6 Health Professionals GHT Governors 15
Gloucestershire Live Gastroenterology 10,000 views Inpatient service (Facebook Live) Combined reach - 63,866 12 – 18 Cuppa and Chat - Stroud (using 2 November Microsoft Teams) Forest of Dean Locality Reference 13 Group Cuppa and Chat – Cotswolds (using 3 Microsoft Teams) HOSC 15
Forest of Dean Community 17 VCS organisations; Connectors/KYP housing associations BAME/Diverse communities Forum Online link sent BAME (VCS Alliance) KYP Stroud 49 Multi VCS
Cheltenham Borough Council 21 Members Seminar Gloucestershire Live Acute Medicine 11,000 views (Facebook Live) Combined reach – 61,187 RNIB (SW Facebook group) up to 2500 Disability followers Macular society Gloucestershire 9 Disability meeting Gloucester diabetes support group 20 Disability
Cancer Patient Reference Group 13 Disability
Cuppa and Chat – Tewkesbury (using 6 Zoom) 19 – 25 Cuppa and Chat - Forest of Dean (using 10 November Zoom) 13.2 GHT reflections and experience group 15
Housing and Support Forum 24 Health Inequalities
Gloucester City Council Members 14 Seminar
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Cuppa and Chat – Cheltenham (using 7 Zoom) Gloucestershire Live Trauma & 6,000 views Orthopaedics (Facebook Live) Combined reach – 23,789 26 November Information bus - Chepstow 17 – 2 December Alney Practice PPG 12
Cuppa and Chat – Gloucester (using 7 Zoom) BAME C19 Task and Finish Group 12 and information BAME sent to full membership Forest of Dean District Council briefing 14
Acute Medicine Clinical Q&A Facebook 2,500 views Live Reach – 18,277 Gloucestershire Live General Surgery 6,500 views (Facebook Live) Combined reach – 16,000 (not on GHT Facebook page) 3– 9 December Tewkesbury Borough Council briefing 10
Information bus –Cheltenham, High 31 Street Information bus – Cheltenham, Tesco 12
Cuppa and Chat – Fit for the Future 7 (using Zoom) Information bus – Lydney, Newerne 32 Street car park (Forest of Dean) Gastroenterology Clinical Q&A 1,400 views Facebook Live Reach 3,099 Cuppa and Chat - Forest of Dean 2
Information bus – Gloucester, Quays 17
Information bus – Gloucester, Tesco St 24 Oswald’s Road General Surgery Clinical Q&A Facebook 970 views Live Reach – 2,113 13.2 Information bus – Stroud, Tesco 25
Image Guided Interventional Surgery 1,400 views (IGIS) Clinical Q&A Facebook Live Reach – 3,072 Trauma & Orthopaedics Clinical Q&A 1,400 views Facebook Live Reach – 3,000
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Information bus – Cirencester Market 37 Place (Cotswolds) Forest of Dean PCN 19
Information bus – Stow Market Place 58 (Cotswolds) 10 -17 Information bus – Tewkesbury, Spring December Gardens car park 28
Cotswold District Council 11
Information bus - Coleford Clock 38 Tower (Forest of Dean)
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PART 2
3. Responses to the consultation
Feedback to the consultation was received in two main ways:
Fit for the Future survey (Main and Easy Read) responses 713 Surveys received (Paper copies: 81 Fit for the Future Survey and 32 Fit For the Future Easy Read) Other correspondence/written responses
The qualitative feedback from completed surveys and correspondence has been grouped into a series of themes under the following headings (A to Z): Access Capacity Diversity Efficiency Environment Facilities Interdependency Integration (with primary and community services) Patient Experience / Staff Experience Pilot Quality Resources Transport Workforce
All written feedback received (redacted for personally identifiable information e.g. names) can be found in the online appendices.
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3.1 Demographic information
Respondents to the Fit for the Future surveys (Main and Easy Read)
Demographic information about respondents was collected by the Fit for the Future surveys. Monitoring of equality data requires a two-stage process: data collection and analysis. Gathering good equality data supports legislative requirements in that it aids prevention of discrimination. This is why it is really important to provide an explanation that the process is worthwhile and necessary.
The Fit for the Future survey included the following statement:
About You: Completing the “About You” section [of the survey] is optional, but the information you give helps to show that people with a wide range of experiences and circumstances have been involved. Your support with this is really appreciated.
The Fit for the Future Easy Read survey included the following statement:
About You: You don’t have to fill in this information, but it will help us know that we have asked a lot of different people what they think about our ideas.
Not everyone who responded to the survey completed any/all of the demographic questions. However, the data presented below indicates that a diverse range of respondents from all protected characteristic groups, and those identified in the Independent Integrated Impact Assessment have provided feedback to the consultation.
Targeted activities aimed to extend the reach of the Consultation and collect data on all protected groups, as recommended in earlier Equality Impact Assessments. Analysis of the survey responses shows there is a broad representation of most groups. Initial analysis of responses by various demographics, e.g. age, gender, health and care professionals, does not show any significant variation compared with the overall themes. The independent Integrated Impact Assessment will be updated to take into account the response to consultation. The updated assessment will be included in the Decision Making Business Case, which will be available on the One Gloucestershire website.
The level of support for each proposal from staff and public is included in the summary information below. Further information about targeted engagement with some of these groups can be found in Section 2.8. 13.2
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Demographic Information about Fit for the Future surveys (Main and Easy Read) respondents
Fit for Future Survey What is the first part of your postcode? e.g. GL16, GL3
Cheltenham 25%
Cotswolds 9%
Forest of Dean 6%
Gloucester 14%
Stroud 9%
Tewkesbury 5%
Prefer not to say 32%
Fit for Future Survey Easy Read What is the first part of your postcode? e.g. GL16, GL3
Cheltenham 21%
Cotswolds 10%
Forest of Dean 22%
Gloucester 18%
Stroud 8%
Tewkesbury 2%
Prefer not to say 18%
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Fit for the Future Survey
Which age group are you:
Response Response
Percent Total
1 Under 18 1.65% 8
2 18-25 2.06% 10
3 26-35 10.91% 53
4 36-45 12.35% 60
5 46-55 18.72% 91
6 56-65 22.22% 108
7 66-75 18.93% 92
8 Over 75 11.32% 55
9 Prefer not to say 1.85% 9
answered 486
skipped 138
Fit for the Future Survey Easy Read
Which age group are you:
Response Response
Percent Total
1 0 - 18 1.27% 1
2 18-25 1.27% 1
3 26-35 1.27% 1
4 36-45 3.80% 3
5 46-55 8.86% 7
6 56-65 20.25% 16
7 66-75 43.04% 34
13.2 8 75+ 20.25% 16
9 Not saying 0.00% 0
answered 79
skipped 10
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Fit for the Future Survey
Are you:
Response Response
Percent Total
1 A health or social care professional 29.57% 144
2 A community partner 1.64% 8
3 A member of the public 62.63% 305
4 Prefer not to say 6.16% 30
answered 487
skipped 137
Fit for the Future Survey Easy Read
Are you:
Response Response
Percent Total
Someone who works in health or 1 7.50% 6
social care
2 A member of the public 88.75% 71
3 Not saying 3.75% 3
answered 80
skipped 9
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Fit for the Future Survey
Do you consider yourself to have a disability? (Tick all that apply)
Response Response
Percent Total
1 No 72.16% 350
2 Mental health problem 4.54% 22
3 Visual Impairment 2.89% 14
4 Learning difficulties 0.41% 2
5 Hearing impairment 5.36% 26
6 Long term condition 17.32% 84
7 Physical disability 4.74% 23
8 Prefer not to say 3.09% 15
answered 485
skipped 139
Fit for the Future Survey Easy Read
Do you have a disability - tick the ones that describe you.
Response Response
Percent Total
1 No 50.00% 37
2 Mental health problem 9.46% 7
3 Problems with your sight 9.46% 7
4 Learning difficulties 4.05% 3
5 Problems with your hearing 14.86% 11
A health problem you have had for a 6 long time like asthma, diabetes, or 36.49% 27 something else
7 Physical disability 8.11% 6 13.2 8 Not saying 1.35% 1
answered 74
skipped 15
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Fit for the Future Survey Do you look after, or give any help or support to family members, friends, neighbours or others because of either a long term physical or mental ill health need or problems related to old age? Please do not count anything you do as part of your paid employment.
Response Response
Percent Total
1 Yes 28.30% 135
2 No 67.51% 322
3 Prefer not to say 4.19% 20
answered 477
skipped 147
Fit for the Future Survey Easy Read
Do you look after, or give any help and support that you don't get paid for, to other people because they are ill or older?
Response Response
Percent Total
1 No, I don't 75.68% 56
2 Yes, I do 22.97% 17
3 Not saying 1.35% 1
answered 74
skipped 15
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Fit for the Future Survey
Which best describes your ethnicity?
Response Response
Percent Total
1 White British 84.71% 410
2 White Other 3.72% 18
3 Asian or Asian British 2.48% 12
4 Black or Black British 0.62% 3
5 Chinese 0.00% 0 6 Mixed 0.62% 3
7 Prefer not to say 7.23% 35
8 Other (please specify): 0.62% 3
answered 484
skipped 140
Other (please specify): (3)
1 Why is this relevant to the survey
2 European
3 White English
Fit for the Future Survey Easy Read
Please can you tell us which of the groups in our list best describes you? This is called ethnicity.
Response Response
Percent Total
1 White British 93.59% 73
2 White Other 1.28% 1
3 Asian or Asian British 1.28% 1
4 Black or Black British 0.00% 0
5 Chinese 0.00% 0 13.2 6 Mixed 1.28% 1
7 Not saying 2.56% 2
answered 78
skipped 11
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Fit for the Future Survey
Which, if any, of the following best describes your religion or belief?
Response Response
Percent Total
1 No religion 39.38% 191
2 Buddhist 0.41% 2
Christian (including Church of 3 England, Catholic, Methodist and 48.04% 233
other denominations) 4 Hindu 0.41% 2
5 Jewish 0.41% 2
6 Muslim 1.65% 8
7 Sikh 0.00% 0 8 Other 1.44% 7
9 Prefer not to say 8.25% 40
answered 485
skipped 139
Fit for the Future Survey Easy Read
Please tick if you have any of these religions or beliefs
Response Response
Percent Total
1 None 19.74% 15
2 Buddhist 0.00% 0
3 Christian 71.05% 54
4 Hindu 0.00% 0
5 Jewish 0.00% 0
6 Muslim 0.00% 0
7 Sikh 0.00% 0 13.2 8 Other 1.32% 1
9 Not saying 7.89% 6
answered 76
skipped 13
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Fit for the Future Survey
Are you:
Response Response
Percent Total
1 Male 38.76% 188
2 Female 54.64% 265
3 Transgender 0.21% 1
4 Prefer not to say 6.39% 31
answered 485
skipped 139
Fit for the Future Survey Easy Read
Can you say about your gender? Tick the one that describes you.
Response Response
Percent Total
1 Male 49.37% 39
2 Female 48.10% 38
3 Transgender 0.00% 0
4 Non-binary 1.27% 1
5 Not saying 1.27% 1
answered 79
skipped 10
13.2
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Fit for the Future Survey
Do you identify with your gender as registered at birth?
Response Response
Percent Total
1 Yes 93.81% 455
2 No 0.00% 0 3 Prefer not to say 6.19% 30
answered 485
skipped 139
Fit for the Future Survey Easy Read
Are you the same gender you were born with?
Response Response
Percent Total
1 Yes 94.74% 72
2 No 2.63% 2
3 Not saying 2.63% 2
answered 76
skipped 13
13.2
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Fit for the Future Survey
Which of the following best describes how you think of yourself?
Response Response
Percent Total
1 Heterosexual or straight 86.21% 419
2 Gay or lesbian 1.85% 9
3 Bisexual 1.65% 8
4 Other 0.21% 1
5 Prefer not to say 10.08% 49
answered 486
skipped 138
Fit for the Future Survey Easy Read
Can you say how you think of yourself?
Response Response
Percent Total
1 Heterosexual or straight 90.79% 69
2 Gay or lesbian 1.32% 1
3 Bisexual 1.32% 1
4 Other 0.00% 0
5 Not saying 6.58% 5
answered 76
skipped 13
13.2
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Fit for the Future Survey
Are you currently pregnant or have given birth in the last year?
Response Response
Percent Total
1 Yes 1.46% 7
2 No 68.75% 330
3 Not applicable 24.17% 116
4 Prefer not to say 5.63% 27
answered 480
skipped 144
Fit for the Future Survey Easy Read
Are you pregnant or had a baby in the last year?
Response Response
Percent Total
1 Yes 0.00% 0 2 No 52.56% 41
3 Not saying 1.28% 1
4 This question doesn't apply to me 46.15% 36
answered 78
skipped 11
13.2
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4. Survey Feedback
This section sets out the survey feedback received about each of the specialist services (Acute Medicine, Gastroenterology inpatient services, General Surgery (emergency general surgery, planned Lower Gastrointestinal [GI] / colorectal surgery and day case Upper and Lower GI surgery), Image Guided Interventional Surgery (IGIS) including Vascular Surgery, and Trauma and Orthopaedics (T&O) inpatient services).
The Fit for the Future survey included two types of questions: Quantitative questions, which offer a choice for the respondent e.g. Acute Medicine (Acute Medical Take) Please tell us what you think about our preferred option to develop: A ‘centre of excellence’ for Acute Medicine (Acute Medical Take) at Gloucestershire Royal Hospital. Strongly support Support Oppose Strongly oppose No opinion and Qualitative questions which invite the respondent to write a comment Please tell us why you think this, e.g. the information you would like us to consider:
As mentioned previously, the qualitative feedback from completed surveys and correspondence has been grouped into themes under the following headings (A to Z): Access Capacity Diversity Efficiency Environment Facilities Integration (with primary and community services) Interdependency Patient Experience / Staff Experience Pilot Quality 13.2 Resources Transport Workforce
In this report, illustrative quotations have been selected from the free-text responses from the survey for each of the proposals and other correspondence received. All free text
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responses and other correspondence can be found in the online appendices at: https://www.onegloucestershire.net/yoursay/fit-for-the-future-developing-specialist- hospital-services-in-gloucestershire/
4.1 Acute Medicine (Acute Medical Take) Preferred option to develop: A ‘centre of excellence’ for Acute Medicine (Acute Medical Take) at Gloucestershire Royal Hospital. 67.61% (Easy read: 72.09%) of all survey respondents either strongly supported or supported the proposal 24.83% (Easy read: 18.6%) of survey respondents either strongly opposed or opposed the proposal 7.55% (Easy Read: 9.3%) of survey respondents had no opinion
72.03% of staff respondents either strongly supported or supported the proposal 66.23% of respondents excluding staff either strongly supported or supported the proposal
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Fit for the Future Survey
Please tell us what you think about our preferred option to develop: A ‘centre of excellence’ for Acute Medicine (Acute Medical Take) at Gloucestershire Royal Hospital.
Response Response
Percent Total
1 Strongly support 36.07% 215
2 Support 31.54% 188
3 Oppose 11.24% 67
4 Strongly oppose 13.59% 81
5 No opinion 7.55% 45
answered 596
skipped 28 Fit for the Future Survey Easy Read
What do you think about having the service for Acute Medicine (Acute Medical Take) at Gloucestershire Royal Hospital? Acute medicine is treatment and assessment for things like very bad headaches, chest pain, pneumonia or asthma
Response Response
Percent Total
1 Good idea 72.09% 62
2 Bad idea 18.60% 16
3 Not sure 9.30% 8
answered 86
skipped 3
13.2
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Qualitative Themes: Acute Medicine (Acute Medical Take)
The following quotes are from survey responses either supporting or opposing the preferred option. Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing The quotes included below are illustrative of key themes in the feedback received regarding Acute Medicine:
Themes in the responses to the proposal relating to Acute Medicine are (A-Z): Access; Capacity; Efficiency; Interdependency; Patient Experience; Quality; Resources; Transport; and Workforce.
Acute Medicine (Acute Medical Take) Preferred option to develop: A ‘centre of excellence’ for Acute Medicine (Acute Medical Take) at Gloucestershire Royal Hospital. 67.61% (Easy read: 72.09%) of survey respondents either strongly supported or supported the proposal 24.83% (Easy read: 18.6%) of survey respondents either strongly opposed or opposed the proposal 7.55% (Easy Read: 9.3%) of survey respondents had no opinion
Supporting the proposal Opposing the proposal It's a rational use of limited resources. Concentration of I do not think that Gloucester Royal Hospital will cope with all the acute specialist people, and specialist kit, absolutely makes sense, and services that you wish to base there. They cannot cope with the influx of research shows that it produces better outcomes. [Quality, patients at the moment particularly at night. These plans do not improve Resources, Workforce] patient experience they merely allow the trust to attempt to save money [Capacity, Resources, Patient Experience]
Creating CoEs across the county will inevitably create a good Damaging effect on the local community, as it disproportionately affects deal more traversing of the county for patients. I can empathise vulnerable individuals with protected characteristics. Concerns about bed with the desire to make best use of resources. [Access, space at GRH. Concerns about a bottleneck effect at GRH - if you double the amount of traffic, you need to double the width of the road, ALL roads,
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Resources] leading in and out. Leading on to concerns about the lack of funding for SWAS [Ambulance Service] as per their financial outlook to provide the
additional ambulance service coverage. Flawed notion of attracting high Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing quality staff from a business/management perspective. Gloucestershire's market has competitors in Bristol, Birmingham (to an extent), Oxford, and of course London. Centralised services will not enable GHNHSFT to outcompete these, leaving us with 'the best of the rest'. This would have been the case whether centralisation occurred or not, thus centralisation itself is a moot point. Flawed concept of 'extra time' to care. This will inevitably lead to cost savings (perhaps instructed by ministers, and not immediately) by reducing staff numbers to provide current levels of care, only now at one site. [Capacity, Transport / Access, Staff/Resources]
Having a centre of excellence for acute medicine at GRH makes a Cheltenham and surrounding villages and other small towns in lot of sense, but it is important to reflect on what centre of Gloucestershire deserve to have their own "Acute Medical Take" at CGH. excellence might be appropriate for CGH, perhaps chronic or Travelling is difficult enough in Gloucestershire and Gloucester Royal ongoing care? I think it is very important to ensure that CGH is Hospital has very inadequate and expensive parking. This is a very busy not appear to be downgraded and is valued as a site for quality tourist town with many festivals bringing thousands of people to the town care provision.[Quality] and it is a very poor decision to only have a centre of excellence in Gloucester. We need our own A & E and also our own Acute Medical Take I am not opposed to Gloucester having its own centre but both places should be treated the same. Gloucester is a very large county stretching from the borders of Wales to the edge of Oxfordshire and Worcestershire. [Transport / Access]
Makes absolute sense to have a Centre of excellence. I believe CGH should offer equal services to GRH and not all resources
Paramedics and GP's will know where to take and send
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associated patients rather than pot luck between two options. diverted to Gloucester. [Access] [Efficiency, Quality]
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing I agree with this ONLY if the A&E at Cheltenham is maintained at The preferred option would mean that people living in the east of the same level they were pre-COVID. [Access] Gloucestershire would have to travel further for urgent medical care. [Transport / Access]
All acute services including the ED and both takes should be on a I think it should be split between the 2 hospitals so that you can go to the single site (GRH) to allow for CGH to be developed into a major nearest hospital to where you live. I see no reason that both hospitals elective cancer surgery hub. [Quality] cannot have enough or share staff so that this can happen [Transport / Access, Staff/Resources]
The idea of creating centres of excellence at both of the two The provision for Emergency, consultant led 24/7 care on the East of the excellent large hospitals in Gloucestershire makes sense. It is County is essential for best outcomes for the aging population given how worth remembering that the other specialist inpatient services, overcrowded Glos A&E is. Therefore anything which doesn't re-provide the which have already centralised at either CGH or GRH e.g. cancer highest tier of A&E at CGH puts patients at more immediate risk of poor services at CGH and children’s services at GRH, are working outcomes IMO. [Quality and Capacity] really well for patients. [Interdependency]
Centralisation of this speciality will ensure that the clinicians It worries me hugely that the town the size of Cheltenham already hasn't got with the right skills are always available. It will reduce risks to 24/7 Consultant Led A&E services. This seems another plan to reduce this the public and reduce the need for potential transfer either to even further. I worry about increased time to get emergency help for my another facility or out of county. [Quality] children and elderly parents by having to travel to another town. [Quality, Transport / Access]
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Having centres of excellence is ideal providing it does reduce waiting time, and ensures operations are not cancelled. All expertise in one place so if second opinion is needed there is Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing someone to consult immediately without the necessity of a follow up visit somewhere else. [Quality]
After having experienced 'in patient ' services at both CGH and GRH on two separate occasions resulting from pneumonia. I would fully support the objective of developing a 'centre of excellence' at GRH. The disadvantage of extra travelling for Cheltenham residents is outweighed by the improved facilities, better use of and more focused staff. [Quality]
Presume staffing a single acute centre is easier than two, making the care it can provide more consistent and 'guaranteed'. Only reason my response is 'Support' and not 'Strongly Support' is the extra 10 miles I would need to travel. [Quality, Transport/Access]
I believe that there must be economies of scale in forming specialist centres. One whole is more beneficial than two halves in this case. This should mean savings in the cost of staff, equipment, spares and consumables, after an initial cost to physically create the unit. Some may get emotional about losing a service in 'their' area, but as a relative newcomer to the area, the hospitals are physically so close together, with good
transport links between the two, I would consider the benefits to
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outweigh this. [Staff/Resources]
With stretched specialised NHS resources concentrating Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing particular but different Specialists at each hospital makes sense. I am also reassured that A&E will remain at Cheltenham hospital as we live in Bourton-on-the-Water so need to be confident that the closeness of A&E in Cheltenham in an emergency provides a much better chance of survival rather than going all the way to far side of Gloucester from here. [Transport/Access]
Neutral and other correspondence examples
Neutral A centre of excellence is a title conferred on a centre by other institutions and is not something you can simply decide to be. Aspiration to excellence is essential but not if this is considered zero sum - i.e. we can aspire to be a centre of excellence in A and therefore B will not be excellent. Also there are currently services which are already considered excellent: does the Trust know what these are and do the various plans consider that aspiring to excellence in one domain might strip and already considered excellent service of its status? REACH survey “It is hard to imagine a General Hospital without acute medical beds. Cheltenham is a General Hospital, it needs to supply beds for both surgical and medical patients. Removing medical beds from Cheltenham is essentially downgrading this hospital and masking it less important, like asset stripping!” It is admirable to want to keep all your experts on one site. However, I fear the sheer numbers of people needing to be seen at any one venue are not practicable. Better, surely to see people at two sites, meaning they can be treated in half the time. If in a critical condition, then surely any extra waiting time endangers the patient. That includes transit time.
International evidence shows centres of excellence provide better care for patients. It also helps to recruit the best people to work there. If you have a serious heart attack in Gloucestershire at present you may be diverted to Bristol as this is where the best treatment is available. What is
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wrong with wanting that here in Gloucester.”
Other correspondence Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Centralisation of the acute medical service onto a single site at Gloucestershire Royal Hospital (GRH) will place very significant pressure on bed availability, even with the planned expansion of the acute admissions unit at GRH. For any acute medical centralisation to be successful, the Trust must make every effort to transfer elective activity to CGH.
Given the close links set out in the consultation document between the Emergency Departments and the acute medical beds, and if Cheltenham A&E is indeed to reopen, there seems an obvious risk of this proposal … failing the test of the criteria of transfer of patients between sites and travel times and risk which will inevitably be higher if an acutely ill patient has to be transferred between Cheltenham ED to an acute medical bed in Gloucester to be admitted.
…any proposal under Fit for the Future regarding acute medicine must ensure adequate twenty four hour provision of emergency medical care to support the inpatient population in Cheltenham as well as the ED on the east side of the county… …Whilst REACH would prefer to see the option of a continuing acute medical take at Cheltenham, REACH recognises the need for future resilience planning to allow local healthcare to continue in case of any future pandemic or health emergency.
I feel that emergency care should be predominantly at GRH and planned day cases should mainly take place at CGH. This would in my opinion make the best use of resources including staff as well as equipment.
The only useful comments I can make relate to Cheltenham where we live. I therefore have of course a natural predilection to use a Cheltenham hospital in preference to one in Gloucester for any purpose…especially emergency treatment.
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4.2 General Surgery (emergency general surgery, planned Lower Gastrointestinal [GI] / colorectal surgery and day case Upper and Lower GI surgery)
4.2.1 Emergency General Surgery Preferred option to develop: to develop: A ‘centre of excellence’ for Emergency General Surgery at Gloucestershire Royal Hospital. 68.31% (Easy read: 66.67%) of all survey respondents either strongly supported or supported the proposal 23.44% (Easy read: 22.99%) of survey respondents either strongly opposed or opposed the proposal 8.24% (Easy Read: 10.34%) of survey respondents had no opinion
77.62% of staff respondents either strongly supported or supported the proposal 65.01% of respondents excluding staff either strongly supported or supported the proposal
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Emergency General Surgery
Fit for the Future Survey
Please tell us what you think about our preferred option to develop: A ‘centre of excellence’ for Emergency General Surgery at Gloucestershire Royal Hospital.
Response Response
Percent Total
1 Strongly support 35.71% 195
2 Support 32.60% 178
3 Oppose 10.62% 58
4 Strongly oppose 12.82% 70
5 No opinion 8.24% 45
answered 546
skipped 78 Fit for the Future Survey Easy Read
What do you think about having the service for Emergency General Surgery at Gloucestershire Royal Hospital? These are emergency operations on the gut which is where you digest food
Response Response
Percent Total
1 Good idea 66.67% 58
2 Bad idea 22.99% 20
3 Not sure 10.34% 9
answered 87
skipped 2
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Qualitative Themes: Emergency General Surgery
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing The following quotes are from survey responses either supporting or opposing the proposal. The quotes included below are illustrative of key themes in the feedback received regarding Emergency General Surgery services. Themes in the responses to the proposal relating to Emergency General are (A-Z): Access; Capacity; Efficiency; Interdependency; Patient Experience; Quality; Resources; Transport; Workforce
Emergency General Surgery Preferred option to develop: Preferred option to develop: to develop: A ‘centre of excellence’ for Emergency General Surgery at Gloucestershire Royal Hospital. 68.31% (Easy read: 66.67%) of survey respondents either strongly supported or supported the proposal 23.44% (Easy read: 22.99%) of survey respondents either strongly opposed or opposed the proposal 8.24% (Easy Read: 10.34%) of survey respondents had no opinion
Supporting the proposal Opposing the proposal It [Gloucestershire Royal Hospital] is bigger hospital and easy for This would further reduce/support the case for reducing the provision of the access (not confusing as opposed to CGH which is a maze and highest tier of A&E at CGH (East) so should not be considered. [Access] patients are constantly lost). [Access, Patient Experience]
If acute care services are to be centred at GRH it makes sense for There needs to be more than one centre as GRH may be unavailable through the emergency general surgery to also be at GRH to avoid a disaster, infection or overloading. Currently GRH A&E is too busy. transfers of very sick patients. [Interdependency] [Capacity]
This is important BUT is not and should not be seen as mutually There should be surgery facilities at both sites, and both should be exclusive to a centre of excellence in pelvic resection. "excellent". Transferring emergency patients to GRH wastes precious time [Interdependency] and could risk lives. [Quality]
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Skilled teams can provide care needed People may have to According to the Royal College of Surgeons "Patients requiring emergency travel, but for a good outcome it is worth it. [Access/Travel, surgical assessment or treatment are among the most unwell patients in the Quality] NHS. Often elderly, frail and with significant other health problems, the risk Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing of death or serious complication is unacceptably high." This means the increasing unacceptable the risk to patients of making them travel from east of Cheltenham travel through the town and a further 10 miles to GRH. [Quality, Access]
More efficient use of staff. The more surgeries completed the Cheltenham is a General hospital and should have surgical beds, including better the surgeons become and so patient outcomes should emergency surgery. What sort of hospital would Cheltenham become if improve. [Efficiency, Quality] medical patients and surgical emergencies were transferred to GRH. This is exercise is about downgrading Cheltenham, which currently has the facilities to offer high quality care. This will have an impact on the A&E department, essentially turning it into a minor injuries unit. [Quality]
It is a good idea, except… that as we are on the edge of the Many people from Cheltenham and North Gloucestershire would die on the county Gloucestershire is further away. [Access] way to Gloucester Royal. The traffic at many times of the day is appalling in Gloucester. You seem to be considering Cheltenham as a small village when in fact it has a population of 112,700. When you include the Cotswolds it rises to 196,300. With the regular increases of population throughout the year this should surely make a difference to your decision. [Quality, Access/Transport]
Better to have emergency care in one place with a full team of Having all your 'specialist' staff in one area may be better and more cost experts. Planned surgery can then take place at Cheltenham. effective for you but as always it's the patients who suffer. Traveling to and [Quality] from Gloucester is not easy for those without their own transport. Even if
the patient is transported to Gloucester by ambulance, once discharged they
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have still got to find their own way home, probably still feeling very unwell. They may not have friends with a car or have sufficient funds to cover the cost of a taxi, which leaves the bus, if it is running and if it is not full - not Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing very good for infection control following surgery. There is also historically a poor reputation for infection control at GRH. I would not feel confident going there for anything serious. [Access/Transport, Quality]
To centralise services, staff, expertise and equipment at one site. The key word is Emergency. All emergencies should be treated as close as If this ensures that planned surgery is protected and not possible to the point at which the emergency was recognised. Unnecessary impacted by emergencies, then I would strongly support this travel is best avoided and may introduce stress to the detriment of the option. [Efficiency, Quality] patient. [Access/Transport, Quality]
Improve patient outcomes, centralised care with specialists The current system, with surgery at both hospitals, is better for anyone who: available to review patients as all based at Gloucester. Staff has money issues lacks transport has complex needs of any type I morale and retention. Improve care of patients including access understand the desire to group services together for the NHS' logistical sake, to SAU and patient flow. Reduce cancellation of specific surgical but for anyone who struggles, in any way, being themselves in another town procedures. Improve quality of care provided. [Quality, or having their loved ones in another town creates complications and Workforce] unhappiness as mentioned in my previous answer. By doing this, you prioritise those with money, time and head space to cope with these extra complications, and disadvantage anyone who struggles in any way. [Access/Transport, Resources]
If emergency treatment is performed at one hospital, GRH, it As with all your proposals to centralise services the problem is that of access leaves planned surgery at the other, CGH, not liable to for patients and their families. Whilst many have access to private transport interruption for emergency surgery. [Quality] a very large minority do not and they are frequently the elderly and less
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financially secure. For these people centralisation poses a major difficulty in accessing your services unless you propose to offer free transport between the sites. Even for those with private transport difficulties in accessing Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing parking at either site pose difficulties and high costs. [Access/Transport]
A centre of excellence is essential and you shouldn't spread your resources. The hospitals are close enough that no areas should be disadvantaged. [Access/Transport, Resources, Quality]
Specialisation usually leads to higher quality service and the attraction of most able doctors. [Quality, Workforce]
Neutral and other correspondence examples
REACH SURVEY
So, essentially work that was performed at 2 sites is now all going to be at GRH alone. Does that mean staffing is still the same as if catering for the needs of 2 hospitals but just at GRH or more likely the poor sods at GRH will be doing double the work they originally would have done. Whilst houses continue to be built and the population continue to expand. This is cost cutting surely whilst stretching I presume an already stretched workforce.
Centralising may be easier for people delivering the service, but means patients nearly always have to travel greater distances. This can mean extreme discomfort for some, me included, but a lot more stress for patients…
This will allow a fully staffed surgical team to manage these patients. They should not have to wait to be seen until a doctor can leave the operating theatre.
Other correspondence
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Centralisation of emergency general surgery and the acute medical onto a single site at GRH may increase bed pressure in that unit. If centralisation proceeds for emergency general surgery at GRH it is vital that all elective activity is centralised at CGH, so that elective patients can be treated without disruption from emergency bed pressures or indeed future pandemics. Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing
It seems to me that option C3 – centralising emergency general surgery in Gloucester – can accord with good practice but if and only if it is combined with Option C5 and C11 to centralise planner lower GI surgery and day case general surgery at Cheltenham.
I feel that we should establish a General Surgery Centre of Excellence at GRH with centralised Emergency General Surgery alongside centralised planned Upper GI service and newly centralised planned Lower GI Service. Planned day case for both upper and lower GI surgery to be centralised at CGH.
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4.2.2 (i) Planned Lower GI (colorectal) surgery Preferred option to develop: to develop: A ‘centre of excellence’ for Planned Lower GI (colorectal) general surgery at Cheltenham General Hospital (CGH) or Gloucestershire Royal Hospital (GRH).
79.1% (Easy read: 72.84%) of all survey respondents either strongly supported or supported the proposal 7.83% (Easy read: 20.27%) of survey respondents either strongly opposed or opposed the proposal 13.06% (Easy Read: 12.35%) of survey respondents had no opinion
85.31% of staff respondents either strongly supported or supported the proposal 76.84% respondents excluding staff either strongly supported or supported the proposal
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Planned Lower GI (colorectal) surgery
Fit for the Future Survey
Please tell us what you think about our preferred option to develop: A ‘centre of excellence’ for Planned Lower GI (colorectal) general surgery at Cheltenham General Hospital (CGH) or Gloucestershire Royal Hospital (GRH).
Response Response
Percent Total
1 Strongly support 44.59% 239
2 Support 34.51% 185
3 Oppose 4.66% 25
4 Strongly oppose 3.17% 17
5 No opinion 13.06% 70
answered 536
skipped 88
Fit for the Future Survey Easy Read
What do you think about having the planned Lower GI (Colorectal) General Surgery in one hospital? These are planned, not emergency, operations on the lower part of the gut.
Response Response
Percent Total
1 Good idea 72.84% 59
2 Bad idea 14.81% 12
3 Not sure 12.35% 10
answered 81
skipped 8
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4.2.2 (ii) Planned Lower GI: Location
Fit for the Future Survey
In supporting our preferred option to create a single site 'centre of excellence', where do you think a ‘centre of excellence’ for Planned Lower GI (colorectal) general surgery should be developed?
Response Response
Percent Total
1 Cheltenham General Hospital (CGH) 50.76% 268
Gloucestershire Royal Hospital 2 20.27% 107
(GRH)
3 No opinion 30.30% 160
answered 528
skipped 96
Fit for the Future Survey Easy Read
Where do you think we should do planned Lower GI (Colorectal) General Surgery? These are planned, not emergency, operations on the lower part of the gut.
Response Response
Percent Total
1 Cheltenham General Hospital 27.50% 22
2 Gloucestershire Royal Hospital 27.50% 22
3 Don't mind 45.00% 36
answered 80
skipped 9
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Qualitative Themes: Planned Lower GI (colorectal) Surgery
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing The following quotes are from survey responses either supporting or opposing the proposal. The quotes included below are illustrative of key themes in the feedback received regarding Planned Lower GI (colorectal) Surgery. Themes in the responses to the proposal relating to Planned Lower GI (colorectal) Surgery are (A-Z): Access; Capacity; Efficiency; Facilities; Interdependency; Patient Experience; Quality; Resources; Transport and Workforce.
Planned Lower GI (colorectal) Surgery Preferred option to develop: A ‘centre of excellence’ for Planned Lower GI (colorectal) general surgery at Cheltenham General Hospital (CGH) or Gloucestershire Royal Hospital (GRH). 79.1% (Easy read: 72.84%) of survey respondents either strongly supported or supported the proposal 7.83% (Easy read: 20.27%) of survey respondents either strongly opposed or opposed the proposal 13.06% (Easy Read: 30.30%) of survey respondents had no opinion Supporting the proposal Opposing the proposal Based on my support for emergency care at Gloucester, You should be able to go to nearest hospital for treatment, staff should be presumably it would make room at Cheltenham for this area of split between the 2 hospitals if necessary so this can be done. [Access] non-urgent operations. [Capacity, Facilities]
Good to have a centre of excellence. Attracts staff and makes Lower GI surgical provision impacts on other surgical specialties including good effective use of both equipment and staff. [Workforce, gynae oncology. Gynaecology is linked to Obstetrics, an acute specialty Efficiency] based in Gloucester. Acute gynaecology, including acute gynae oncology admissions, is based in Gloucester hospital. It is not possible to move this acute provision as the registrars cross cover Gynaecology and Obstetrics when on shifts. Moving gynae oncology with Lower GI to Gloucester would provide better training and ward safety for patients.[Interdependency]
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Please bear in mind any treatments taken prior to appointments It is easier for elderly, disabled, and very sick people to travel to their nearest which may make a long journey very difficult. [Patient hospital. Some of the people in this category will not be able to either drive Experience] themselves or travel on public transport. An unfamiliar environment may be Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing distressing for them, and it may be more difficult for their families to visit if they are further away. Therefore, all procedures should be available in all hospitals, not in one centre. [Access/Transport]
I have had fantastic service and a colorectal resection at GRH. Unless there is a shortage of staff with the correct expertise I do not see why This started with the Bowel Cancer Screening at Stroud Hospital, a single centre of excellence in Gloucester is a fair option for Cheltonians. It’s and two operations at GRH, with follow up care. The care and a long journey and a real challenge for elderly patients - visiting and dedication of all the staff at GRH has been exemplary, and I am collection of discharged patients becomes far more challenging especially so grateful to them! Of course if CGH was chosen, as long as the for those restricted to public transport. [Access/Transport, Staff, Resources] staff moved also, then the service would be just as excellent. A slight fear I have that when I think merge and provide an ever better service', the accountants hear 'merge, provide the same service, and cut costs'. The latter really would be a betrayal of trust. [Quality, Patient Experience, Resources] Need to locate the planned specialties into CGH if emergency medicine and surgery are going to GRH. [Interdependency]
Separating emergency from planned services should prevent cancellations and create the right number of beds for the planned procedures. Co-locating with other pelvic services makes sense as I suspect they often need to work together. [Patient Experience, Capacity, Interdependency]
GRH surgical bedspace already limited; conversely beds
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available at CGH for increased surgical work. Transfer to all planned colorectal work to GRH would increase already high pressure on surgical bed availability. Centralising lower GI at Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing CGH would make use of existing surgical cover and surgical nursing staff with less bed pressures than at GRH. Benefits to be had from concentrating all colorectal lists at a single site - CGH the obvious option as currently has less bed pressure than GRH but still has required surgical and nursing expertise. Gastroenterology already at CGH which would benefit those patients who need input from gastro medics whilst under care of Lower GI surgeons. [Capacity, Quality, Patient Experience)
Gloucestershire Royal is the most modern of the two hospitals and parts of the Cheltenham Hospital are 200 years old and unsuitable for 21st century health care provision. The most recent blocks in College Road Cheltenham could be used to complement the services provided at the Gloucester base. [Facilities]
Having experienced this service, I know that the present set-up works well. CGH is already a centre of excellence for cancer, colorectal surgery is integral to that service, it makes common sense to fully embed this at CGH. Further, I am aware that moving this service to GRH is not popular with staff and could result in the loss of crucial expertise. Staff retention is a critical issue at all times - conserve what you have. [Patient Experience,
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Workforce, Resources]
Specialist staff in one place should mean collaboration in terms
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing of quickly dealing with patient problems. Quick treatment/ diagnosis of Crohn’s can reduce the need for surgery, less time off work and a better quality of life! [Workforce, Quality]
Neutral and other correspondence examples
Neutral It has been mooted for some time, so that GRH would become the 'hot' hospital, while CGH would take 'cold surgery'. This seems to have been an accepted version of things to come, so it is no surprise, and for me, there is no good reason to oppose All planed surgery should be subject of a centre of excellence, at both hospitals, not just Lower GI
REACH survey It would be sensible to have this service at CGH with gynaecological oncology. Whilst there may be a case for centralising at Cheltenham - certainly not at GRH - this could only be considered in the light of decisions made on other issues. There seems to me the danger of progressively demoting Cheltenham as a centre of excellence, but there has also to be regard to the needs of patients in the west of the county.
After opposing centralisation for the first 2 at Gloucester and Cheltenham is my local hospital I can’t agree for the people of Gloucester having the same problem of getting to Cheltenham.
Other correspondence Elective major colorectal surgery should be centralised onto a single site at CGH. This centralisation will help to create a large elective Cancer Hospital, with reference to pelvic surgery.
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Where do you think we should do planned Lower GI (Colorectal) General Surgery?
50.76% (27.50% Easy Read) survey respondents chose Cheltenham General Hospital 20.27% (27.50% East Read) of survey respondents chose Gloucestershire Royal Hospital 30.30% (45% Easy Read) had no opinion Staff: o Cheltenham General Hospital (CGH) 56.64% o Gloucestershire Royal Hospital (GRH) 13.29% o No opinion 30.07% Public and Community Partners: o Cheltenham General Hospital (CGH) 48.14% o Gloucestershire Royal Hospital (GRH) 22.37% o No opinion 30.85%
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Cheltenham General Hospital Neutral Gloucestershire Royal Hospital
As I have mentioned, public views will revolve Remain with both sites as both large GRH is a larger site, has better facilities and is
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing how location, for example, will affect the populations. Travelling to either site difficult if more accessible for visitors. I have had individual. CGH is closer to me than GRH so not in either town/ city. Keep both therefore surgery in CGH in the past and felt the this is obviously my choice. That is naive and quicker and more local access. Helps reduce facilities were poor and the care was lacking. there are many many far more important carbon and, safety) health risks involved in It is also very difficult for visitors to find factors that should determine the location. I traveling somewhere to park. really don't understand how public consultation on this matter assists the process.
Having benefited from this excellent service, I believe that you are wrong in trying to I live in Stroud and find it easier to get to GRH and still under their care, I would really like decide one place against the other hospital. and easier to park the car. the service in Cheltenham to be bolstered. I Gloucester Royal is full to capacity and often live at the extreme Northern tip of the difficult to reach because of its situation. The county, and Gloucester Hospital would have best solution would be to build a new hospital been a nightmare for family visits, and for me at Staverton and put any "centres of getting home from the multiple operations I excellence" there. This idea, whilst not likely have had. Given the fantastic care I had at to ever be considered, would be a perfect Cheltenham, I would be keen for it not to be solution. There is plenty of space at moved Staverton and the surrounding land. Sites at Gloucester and Cheltenham could be then be sold at a huge profit
1. co-located with other pelvic cancer services Whichever site has best capacity of operating I think it makes more sense to have surgical (urology, gynae-oncology) 2. co-located with theatres and staffing for this proposal units for upper and lower GI surgery in one
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oncology 3. co-located with gastroenterology location inpatient care 4. Protected bedbase from emergency admissions (if going with the Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing emergency hub in GRH) and allows screened admissions only in the covid era 5. Ease of access to HDU / ITU for all planned major resections 6. Separated (geographically) elective v emergency care as recommended by a) GIRFT, b) Current President of the RCS Eng (Prof Neil Mortensen) c) external senate review
To co-locate with urology and gynae- Again, it doesn't matter which site, so long as Greater diversity in Gloucester oncology. By taking elective lower GI from the service is there and available and ensure GRH space would be freed up for other capacity and effective care for needs. Gloucestershire residents. In my mind it would make sense to have a particular specialist treatment at both sites i.e. GRH is centre of excellence for XX and CGH is centre of excellence for YY. So that one or other site does not become defunct.
A strong case has been made for both. On Care needs to be taken in assessing the user I think a centre of excellence, a single one balance I think CGH. demographic to make a suitable choice. would benefit the local and wider community Ideally it would be in the centre of the most by being situated in Gloucester. common user base.
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If the 24hr A&E is at GRH, then the planned Very important to have separate sites for I understand that there can some crossover surgery to be at CGH. emergency and elective surgery for better between Upper and Lower GI* and this patient experience and outcome suggests to me that collocating them would Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing be wise provided that there is sufficient space and facilities at GRH. *Last year I had emergency Lower GI surgery carried out at CGH by an Upper GI consultant (excellent outcome!)
CGH should be the site for all planned activity Both hospitals should have their own I know the GRH team are fantastic, but have colorectal services. had no dealings with CGH.
I believe it would be sensible to try and Keep both hospitals operating as hospitals for If you think upper GI surgery needs to be on ensure that CGH takes on planned / elective all services. This centre of Excellence the same site as emergency general surgery, surgery with lower risks involved, and that "concept" is in my opinion RUBBISH. Stop surely the same should apply to colorectal GRH is responsible for caring for emergency pretending that you are offering a better surgery. If you are struggling to run the surgery. However, I also appreciate that this service when you are diluting what is already general surgery service on two sites at the could result in specialist surgical cover available moment why would you want to set a service required across both sites rather than just that continues to run general surgery on two covering one and could be confusing for the sites? public if there is general surgery offered at both sites.
I think that the 'reputation' of Cheltenham Crucial item for me is that there is an equal All major General surgery located with acute Hospital needs to be preserved if balance between what is in Cheltenham and services makes common sense. emergencies go to Gloucester, even if in a what is in Gloucester....with equal numbers of new way, so putting excellent planned essential services in each. It must not be
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operations in Cheltenham would be good. Gloucester is the centre with bits in Cheltenham
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Due to other specialities already doing pelvic As it is planned surgery the patient can It makes sense for all GI (lower and upper) surgery in this hospital. Surely a 'centre of arrange transport beforehand so I don't see services to be in one hospital excellence' would allow surgeons to assist any issues and advise each other when required.
Would seemingly make best sense to locate we live in Stroud - now my son has I would like Gloucester to be a better option this at CGH to create a centre of excellence transitioned into adult IBD services we have for care, this should be improved so that it is for pelvic resection; and to keep this surgery had infusions in GRH, consultant appointment more viable than having to travel to service entirely separated from the pressures in GRH and MRI in Chelt - the travel relatively Cheltenham to visit people. of the Emergency General Surgery at GRH (as easy for us so wherever means staff travelling suggested in the consultation booklet)' less.
Calmer atmosphere. Better patient Although my own experience has been of [GRH] Better parking for staff and visitor experience. having colorectal surgery at GRH, I think options more mid-way for Forest patient and location for this is less important than visitors. Near to train links. concentrating the expertise at one centre.
It would appear logical to have all cancer I've put no opinion because transport is about Just because it is the nearest hospital to services on one site and given Cheltenham’s the same for both, and planning a service is a where I live, I should imagine anyone living preeminent role in cancer treatment then all complex task that looks at a wide range of near to Cheltenham would choose the related services should be located there, information. I trust One Gloucestershire to Cheltenham one as their option make a good choice.
most of the issues are probably cancer At the moment, both CGH and GRH seem to It seems likely that management of related so it makes sense to put this in have a Planned Lower GI general surgery complications would be best on the site with
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Cheltenham with the existing unit - although facility. I think the decision on which location the most robust emergency cover the buildings at Cheltenham are in dire need to invest more excellency should mostly be of refurbishment and modernising focused on statistic and medical opinion, such Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing as estimated time of arrival from one location to the hospital; percentage of local and not local patients who come to the hospital; accessibility to the yard; transportation accessibility etc. While Cheltenham could be more easily accessible, in my opinion, GRH offers facilities on Upper GI general surgery, which could contribute to the treatment of exceptional patients who may need assistance with both.
If the plan is to have the Day Case focussed at a cold, elective hospital allows access to beds, As above, the premises at Gloucester are CGH it would seem to be sensible to have the ITU, and allows all the relevant surgical superior and those at Cheltenham have fallen rest of the GI provision on the same site specialities to work closely together to deliver way behind. In my view Cheltenham should excellent care. The removal of colorectal have constructed a new hospital to replace surgery from CGH would mean that urology Cheltenham General in the hospital building and gynae-oncology may not be able to stay, boom of the 1990s and early 2000s when a which would put more pressure on GRH large number of towns and cities constructed new hospitals, such as Worcester, Swindon, Birmingham, Stratford -on-Avon, Hereford, Taunton, etc. etc. Cheltenham missed out then and a new replacement for Cheltenham General is unlikely now
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Consultants and staff are fed up. Colorectal On your facebook live session the consultant Elective days-case/short stay surgery in a worked at Cheltenham before stop fixing said that 12 out of 15 consultants supported dedicated unit in CGH. Resectional lower GI things that aren’t broken. Wasting good this model, shouldn't you be listening to what surgery co-located with emergency general Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing theatres, what’s the point in not using the experts think as they provide the service surgery in GRH. something we already have. And you have and should know how it works. amazing nurses and HCAs with colorectal experience in Cheltenham that will not go to Gloucester.
This builds on already established reputation Either. But a Centre of excellence makes Needs to be co-located with the emergency and allows other interdependent excellent sense. general surgery service. services to continue to flourish because they have ongoing on site, immediate lower GI surgical support. Removing lower GI surgical support from CGH would diminish urological, gynaecological oncology, gastroenterology and oncology services. Specifically gynaecological oncology simply could not operate in the same way and all ovarian cancer surgery would need to move to GRH to facilitate appropriately supported radical surgery within any governance framework
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4.2.3 Planned day case, Upper and Lower GI
Preferred option to develop: to develop: A ‘centre of excellence’ for planned day case Upper and Lower GI (colorectal) surgery at Cheltenham General Hospital (CGH). 73.49% (Easy read: 67.47%) of all survey respondents either strongly supported or supported the proposal 8.52% (Easy read: 13.25%) of survey respondents either strongly opposed or opposed the proposal 17.99% (Easy Read: 19.28%) of survey respondents had no opinion
79.58% of staff respondents either strongly supported or supported the proposal 71.24% of respondents excluding staff either strongly supported or supported the proposal
Fit for the Future Survey
Please tell us what you think about our preferred option to develop: A ‘centre of excellence’ for planned day case Upper and Lower GI (colorectal) surgery at Cheltenham General Hospital (CGH).
Response Response
Percent Total
1 Strongly support 38.07% 201
2 Support 35.42% 187
3 Oppose 5.11% 27
4 Strongly oppose 3.41% 18
5 No opinion 17.99% 95
answered 528
skipped 96 Fit for the Future Survey Easy Read
What do you think about having the service for General Surgery Day Cases (Upper and Lower GI) at Cheltenham General Hospital? These are operations on the gut which is where you digest your food. People have their operation and go home the same day.
Response Response
Percent Total
1 Good idea 67.47% 56
2 Bad idea 13.25% 11 13.2 3 Not sure 19.28% 16
answered 83
skipped 6
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Qualitative Themes: Planned day case Upper and Lower GI (colorectal) surgery The following quotes are from survey responses either supporting or opposing the proposal. The quotes included below are illustrative of key themes in the feedback received regarding Planned day case Upper and Lower GI (colorectal) surgery. Themes in the responses to the proposal Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing relating to Planned day case Upper and Lower GI (colorectal) surgery are (A-Z): Access; Capacity; Efficiency; Facilities; Interdependency; Quality; Resources and Workforce.
Planned day case Upper and Lower GI (colorectal) surgery Preferred option to develop: A ‘centre of excellence’ for planned day case Upper and Lower GI (colorectal) surgery at Cheltenham General Hospital (CGH). 73.49% (Easy read: 67.47%) of survey respondents either strongly supported or supported the proposal 8.52% (Easy read: 13.25%) of survey respondents either strongly opposed or opposed the proposal 17.99% (Easy Read: 19.28%) of survey respondents had no opinion
Supporting the proposal Opposing the proposal There aren't enough staff to go around, so we need to make best Don't like the single site option, would like both hospitals to offer as many use of those we have. [Resource/Workforce] treatments as possible [Access].
Cheltenham already has this function so it would be sensible to Why not at both, this involves improving Cheltenham at the expense of maintain this service. [Efficiency] Gloucester. [Access]
This type of surgery is at most risk of cancellation when This is a bad decision and the people of the forest of dean and Monmouth emergency pressures are high. We should have access to deserve better. [Access] protected facilities so these operations are not cancelled. This will be good for CGH as more planned surgery will be performed there than in GRH. [Patient Experience, Capacity]
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One of your consultants proposed a model for low risk patients This proposal is another way of saying that CGH becomes a hospital for day which included patients staying in hospital for one or two nights case surgery only, chiefly benign conditions, i.e. not a proper hospital in the having their operation in Cheltenham to reduce the risk of sense that is understood by most people. Since there is not room for all Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing cancellation. This sounds like a good idea as long as there is inpatient GI surgery on the site, to embrace this option is a sure fire way of capacity. [Patient Experience, Capacity] ensuring that the malignant bowel surgery would have to be moved elsewhere (GRH), which is probably why it has been packaged up this way. Is CGH envisaged as a proper cancer hospital or not? If it is, then the malignant bowel surgery should take place there and not benign day case procedures instead. [Capacity]
Would require better facilities at Cheltenham general in my I don't support having only one centre for anything, given the size and opinion hospital dated and tired in appearance. [Facilities] demographic of Glos. [Access]
I have experience of this and know that the process is well As with all your proposals to centralise services the problem is that of access embedded in CGH, with highly skilled specialists. Further, this for patients and their families. Whilst many have access to private transport type of surgery is usually directly associated with colorectal a very large minority do not and they are frequently the elderly and less surgery e.g. stoma loop reversal, it makes sense for the surgeon financially secure. For these people centralisation poses a major difficulty in who created the loop to reverse it thus maintaining continuity. accessing your services unless you propose to offer free transport between [Interdependency] the sites. Even for those with private transport difficulties in accessing parking at either site pose difficulties and high costs. [Access/Transport]
On the focus of Cheltenham General Hospital as an elective It needs to be Gloucester more central for Gloucestershire. [Access] centre this fits well. The pelvic centre of excellence with the arthroplasty, gyno and urinary would all work well together
although it may reduce the General Surgery pool slightly at GRH.
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[Interdependency]
Having an excellent readily available service that treats me even Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing if I have to travel is preferred to waiting and perhaps getting a second class service because of a dilution of resources/service simply to accommodate operating on both sites. It is 7 miles not travelling to the moon. [Patient Experience, Quality, Access]
If planned centre of excellence for lower GI general surgery will be in Cheltenham it is only sensible for day cases upper and lower surgery to be there also. [Interdependency]
Neutral and other correspondence examples
Neutral Concentration in one centre is the most important issue. Day case can be done anywhere
REACH survey These day procedures should remain dispersed throughout all the hospitals to reduce demand on a centralised location, freeing up resources for more critical procedures. Dispersal of the service will serve local communities much better and help to ensure the viability of the community hospitals. It seems unnecessary to centralise this service and, (forgive me), appears a bit of a sop to CGH after proposed removal of so many of their services. Spreading the workload of minor procedures over many local sites seems sensible and popular with the public who prefer to travel to their nearest site.
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4.3 Image Guided Interventional Surgery (IGIS) including Vascular Surgery Preferred option to develop: to develop: A 24/7 Image Guided Interventional Surgery (IGIS) ‘Hub’ at Gloucestershire Royal Hospital and a ‘Spoke' at Cheltenham General Hospital.
66.54% (Easy read: 76.54%) of all survey respondents either strongly supported or supported the proposal 15.39% (Easy read: 9.88%) of survey respondents either strongly opposed or opposed the proposal 18.08% (Easy Read: 13.58%) of survey respondents had no opinion
63.12% of staff respondents either strongly supported or supported the proposal 67.81% of respondents excluding staff either strongly supported or supported the proposal
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4.3.1 IGIS Hub and Spoke
Fit for the Future Survey
A 24/7 Image Guided Interventional Surgery (IGIS) ‘Hub’ at Gloucestershire Royal Hospital and a ‘Spoke' at Cheltenham General Hospital.
Response Response
Percent Total
1 Strongly support 32.69% 170
2 Support 33.85% 176
3 Oppose 8.85% 46
4 Strongly oppose 6.54% 34
5 No opinion 18.08% 94
answered 520
skipped 104
Fit for the Future Survey Easy Read
What do you think about having a 24 hour 7 days a week IGIS Hub at Gloucestershire Royal Hospital and an IGIS Spoke at Cheltenham General Hospital? A Hub is the main place something happens, and a Spoke is linked to the Hub. IGIS is Image-guided Interventional Surgery. This is where cameras are used inside the body so the surgeon can see what is going on.
Response Response
Percent Total
1 Good idea 76.54% 62
2 Bad idea 9.88% 8
3 Not sure 13.58% 11
answered 81
skipped 8
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4.3.2 Vascular Surgery
Preferred option to develop: to develop: A ‘centre of excellence’ for Vascular Surgery at Gloucestershire Royal Hospital. 60.27% (Easy read: 68.35%) of all survey respondents either strongly supported or supported the proposal 19.97% (Easy read: 15.19%) of survey respondents either strongly opposed or opposed the proposal 19.77% (Easy Read: 17.72%) of survey respondents had no opinion
58.86% of staff respondents either strongly supported or supported the proposal 60.8% of respondents excluding staff either strongly supported or supported the proposal
Fit for the Future Survey
A ‘centre of excellence’ for Vascular Surgery at Gloucestershire Royal Hospital.
Response Response
Percent Total
1 Strongly support 29.26% 151
2 Support 31.01% 160
3 Oppose 9.50% 49
4 Strongly oppose 10.47% 54
5 No opinion 19.77% 102
answered 516
skipped 108
Vascular Surgery Fit for the Future Survey Easy Read
What do you think about having the Vascular Surgery at Gloucestershire Royal Hospital? Vascular is about blood vessels
Response Response
Percent Total
1 Good idea 68.35% 54 13.2 2 Bad idea 15.19% 12
3 Not sure 17.72% 14
answered 79
skipped 10
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Qualitative Themes: Image Guided Interventional Surgery (IGIS).
The following quotes are from survey responses either supporting or opposing the proposal. The quotes included below are illustrative of key Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing themes in the feedback received regarding Image Guided Interventional Surgery (IGIS). Themes in the responses to the proposal relating to Image Guided Interventional Surgery (IGIS) (A-Z): Access; Efficiency; Facilities; Interdependency; Quality; Resources and Workforce.
Image Guided Interventional Surgery (IGIS) Preferred option to develop: A 24/7 Image Guided Interventional Surgery (IGIS) ‘Hub’ at Gloucestershire Royal Hospital and a ‘Spoke' at Cheltenham General Hospital. 66.54% (Easy read: 76.54%) of survey respondents either strongly supported or supported the proposal 15.39% (Easy read: 9.88%) of survey respondents either strongly opposed or opposed the proposal 18.08% (Easy Read: 13.58%) of survey respondents had no opinion
Supporting the proposal Opposing the proposal I believe it is good to have different hospitals with different Heart attack patients need treatment at closest hospital this would be specialisms. This will also promote inter hospital information better than using Bristol but should be available on both sites. [Access] exchange. I presume Cheltenham would be a spoke and therefore provide back up. [Efficiency]
The major IGIS is acute related often so should be with the I would not support anything being moved from Cheltenham to Gloucester. trauma and stroke unit. However, Cheltenham General Hospital [Access] as a spoke would allow elective investigations and pelvic and oncology to occur. [Interdependency]
Important to rationalise and make optimum use of very Most cases are already performed in Cheltenham and it should be the main Hub because it already has a new purpose built facility costing several
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expensive and latest equipment. [Efficiency, Resources] millions. It would be hugely wasteful to remove this service from Cheltenham. [Facilities, Resources]
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Such a move would avoid duplication of expensive equipment. Vascular services currently at CGH with IGIS, alongside urology, cardiology The proposal refers to a 24/7 hub, my support is conditional on and cancer services. GRH is run down with tower block wards which are not this meaning availability 24 hours a day 7 days a week. suitable for all these services. [Interdependency, Facilities] [Efficiency, Access]
If EGS and Acute Medical Take are located at GRH, then it makes Extreme nature of emergency IGIS means the time delay going from good sense to make GRH the hub for IGIS. It would also seem Cheltenham to Gloucester would be far too risky re. Loss of life to a patient sensible for there to be a 'spoke' at CGH to work alongside who may, for example's sake, live just across the road from CGH. oncology, urology and other specialisations there. [Access, Quality] [Interdependency]
Have had heart surgery and this would have helped me at the I do not understand why, following the presumed logic elsewhere in this time and taken away the need to attend Oxford. Great for consultation why the IGIS service needs a 'hub and spoke model'. There is no bringing the specialists to Gloucestershire to work. Open up the convincing argument made for this on any rationalisation, financial, staffing service to more charitable funds. [Patient Experience, Access, or any other basis. Just create a centre of excellence based on sensible Resources] criteria and get on with it. [Efficiency, Resources]
Key point of focus at GRH. It is unclear to me why you would want a spoke at CGH. Resources staff and equipment would be split. Imaging equipment requires ongoing maintenance programme better focused at one location. [Efficiency, Resources]
Centralised approach is good. The equipment needed to
undertake these investigations are often expensive, particularly
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the imaging equipment. Staffing levels are often difficult to maintain and are often difficult to recruit. State of the art equipment will help to attract highly trained staff. [Resources, Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Workforce]
I support this on the basis that fewer people would need to travel outside of the county for treatment. We need to start thinking 'Gloucestershire' when considering these matters. If people are having to travel further beyond county boundaries then it makes sense to centralise some services here. That said good to see there would be an IGIS spoke at CGH to support specialties there. [Access]
Appears to be specialist treatment needing expensive specialist equipment operated by experts. Given this seems better to centralise as one service - some people may travel a little further but far fewer would need to travel out of county at evenings/weekends. Going to hospital unexpectedly (or even planned) is not a good experience so removing a longer journey with some of the complications this can lead to seems a beneficial step. [Access, Patient Experience]
Neutral and other correspondence examples Strongly support the concept but if this is elective work wouldn't it be sensible to base it at cgh and have a spoke at grh?
This set up should be in the best site for the overall plan. IGIS is an increasingly import part of urgent clinical care so it makes sense to create a hub and spoke approach.
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There is a …rationale for locating imaging-led services at Cheltenham which is the presence there of the Cobalt charity’s unique Imaging Centre…which they say ‘have increased patient comfort, shorter scanning times and deliver superior image quality’.
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing
Qualitative Themes: Vascular Surgery
The following quotes are from survey responses either supporting or opposing the proposal. The quotes included below are illustrative of key themes in the feedback received regarding Vascular Surgery. Themes in the responses to the proposal relating to Vascular Surgery (A-Z): Access; Capacity; Diversity; Facilities; Interdependency; Patient Experience; Quality; Resources and Workforce.
Vascular Surgery Preferred option to develop: A ‘centre of excellence’ for Vascular Surgery at Gloucestershire Royal Hospital. 60.27% (Easy read: 68.35%) of survey respondents either strongly supported or supported the proposal 19.97% (Easy read: 15.19%) of survey respondents either strongly opposed or opposed the proposal 19.77% (Easy Read: 17.72%) of survey respondents had no opinion Supporting the proposal Opposing the proposal Better facilities and car-parking at GRH. [Facilities, Access] I think Vascular should remain at CGH. Only a relatively short time ago much investment was made to establish a centralised service at CGH. Going forward with future phases of Fit for the Future there will be a need to have established services at CGH and this is one that could fit and not compromise safety. [Resources, Quality]
Having Vascular surgery at GRH will mean that vascular surgery Provide services at both hospitals, provides for the two large population will be able to support the emergency services better. sites and better for outlying areas. Provides back up for either place. Better
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[Interdependency] for patients requiring emergency support. [Access, Quality]
Why not? The importance is that the unit exists and is available I feel emergency and elective vascular surgery should be split so that Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing 24/7 as and when. [Access, Patient Experience] emergency work is aligned with the surgical take whilst elective work continues at CGH. This will ensure there is critical care capacity available to support the elective work otherwise there is likely to be an ever increasing pressure on ICU beds at GRH. [Interdependency, Capacity]
BME communities have higher rates as diversity to Cheltenham This should be in CGH where the available beds are, and where there is the and Gloucester - GRH is perfectly placed. [Access, Diversity] state of the art interventional theatre. [Capacity, Facilities]
Vascular is predominantly a service where patients can be The wards at GRH are not fit for practice. They are overcrowded, beds too suffering from a life threatening event (AAA) that requires close together increasing the infection risk. The tower block appears immediate intervention in a theatre designed for this type of generally dirty. Your report reads that if you live in a deprived area (25% of surgery. I think splitting Vascular across two sites will provide a Gloucester population) you will get preferential treatment on your door step sparse clinical cover across two sites rather than strong cover on and blow the rest of the county. Given that most vascular issues occur in the one site. I can see the intrinsic link between IGIS and Vascular over 65 age group and these people are spread out across the county if you and therefore wherever the IGIS hub is, Vascular should be live at Morton/Bourton area East Gloucestershire, you won’t stand much centralised to and vice versa. [Interdependency, Workforce] chance of survival. [Facilities, Access, Diversity]
This should be concentrated at Gloucestershire Royal and it is Vascular surgery carries a burden of heavy emergency list use, often at not asking too much for patients needing such procedures to unpredictable times. This has impacted the emergency theatre provision at have them carried out at Gloucester. [Access] GRH such that, even with an extra emergency theatre and consultant anaesthetist on site, access to emergency surgery in a timely fashion has deteriorated for all specialties. CGH would be well placed in terms of facilities and aftercare provision to re-accommodate vascular surgery after the recent experimental transfer to GRH. The fully equipped and recently
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provisioned IR theatre at CGH is currently lying fallow much of the time and is superior to anything available in GRH. [Capacity, Facilities]
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing I believe that some thought should be given to maintaining I appreciate that these skills cannot be shared between too sites but for some 'low risk' non urgent vascular capability for some elective emergencies people living in many of the remote parts of Gloucestershire vascular surgery at Cheltenham General Hospital. [Access] they need quicker access to a hospital and Gloucester is far from us. [Access]
Hard to have IGIS at GRH and vascular at CGH so makes sense. [Interdependency]
You need the technology to do this and therefore would be good to be in Gloucestershire. Need to have the wards set up for this close to the theatres. Will pull in staff and money by having a centre of excellence. Increase the number of specialist nurses. [Resources, Workforce]
Neutral and other correspondence examples
This service was previously being managed well at CGH but if it not possible to split elective e.g. IGIS and emergency vascular surgery then I believe it would be preferable to keep it on the GRH emergency site and then consider the "spoke" option at CGH for the elective surgery. Splitting this service will have an impact on the intensity / quality of Therapy those patients will receive unless additional funding is provided to support splitting this service across sites.
It depends where other surgical specialties are cited.
REACH survey “Given the installation of a £2.5 million facility at CGH six years ago it would be hard to justify moving the centre now.
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I understand that vascular surgery was recently transferred from CGH to GRH as an 'emergency COVID measure'; staff and accommodation were drastically reduced. I can see no reason why this service should not be reinstated at CGH as soon as possible, It is a nonsense to waste the valuable and well regarded vascular operating theatre. Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing
Other correspondence The majority of arterial vascular surgery is elective, it would seem entirely reasonable that this should be located at the elective Centre of Excellence at the CGH.
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4.4 Gastroenterology inpatient services
Preferred option to develop: A ‘centre of excellence’ for Gastroenterology inpatient services at Cheltenham General Hospital.
71.96% (Easy read: 68.35%) of all survey respondents either strongly supported or supported the proposal 6.67% (Easy read: 10.13%) of survey respondents either strongly opposed or opposed the proposal 21.37% (Easy Read: 21.52%) of survey respondents had no opinion
68.08% of staff respondents either strongly supported or supported the proposal 73.44% of respondents excluding staff either strongly supported or supported the proposal
Fit for the Future Survey
A permanent ‘centre of excellence’ for Gastroenterology inpatient services at Cheltenham General Hospital.
Response Response
Percent Total
1 Strongly support 39.41% 201
2 Support 32.55% 166
3 Oppose 3.92% 20
4 Strongly oppose 2.75% 14
5 No opinion 21.37% 109
answered 510
skipped 114 Fit for the Future Survey Easy Read
What do you think about us carrying on doing Gastroenterology at Cheltenham General Hospital after the pilot? Gastroenterology is where tests or treatment are needed for the stomach, bowel, liver and pancreas for things like Crohn’s Disease and stomach ulcers
Response Response
Percent Total
1 Good idea 68.35% 54 13.2
2 Bad idea 10.13% 8
3 Not sure 21.52% 17
answered 79
skipped 10
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Qualitative Themes: Gastroenterology Inpatient Services
The following quotes are from survey responses either supporting or opposing the proposal. The quotes included below are illustrative of key Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing themes in the feedback received regarding Gastroenterology inpatient services. Themes in the responses to the proposal relating to Gastroenterology inpatient services are (A-Z): Access; Capacity; Interdependency; Quality; Resources; Staff experience; Transport and Workforce.
Gastroenterology Inpatient Services Preferred option to develop: A ‘centre of excellence’ for Gastroenterology inpatient services at Cheltenham General Hospital. 71.96% (Easy read: 68.35%) of survey respondents either strongly supported or supported the proposal 6.67% (Easy read: 10.13%) of survey respondents either strongly opposed or opposed the proposal 21.37% (Easy Read: 21.52%) of survey respondents had no opinion
Supporting the proposal Opposing the proposal This has been piloted successfully and seems a sensible balance As with all your proposals to centralise services the problem is that of access between the two hospitals. [Access, Quality] for patients and their families. Whilst many have access to private transport a very large minority do not and they are frequently the elderly and less financially secure. For these people centralisation poses a major difficulty in accessing your services unless you propose to offer free transport between the sites. Even for those with private transport difficulties in accessing parking at either site pose difficulties and high costs. [Access / Transport]
Efficient use of resources, access to specialist staff at all times, Both hospitals need a centre of excellence due to the size of the population no waiting for them to travel from GRH to CGH and vice-versa. and the location of the services. [Access] The total patient capacity must still remain the same (and hopefully higher!), not reduce as a result. [Access, Capacity,
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Workforce, Resources] I am in support of this if it means that all the specialists are in Despite gastro inpatients being at CGH currently, gastro inpatients are still
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing one place. I do have concerns about the lack of parking facilities seen on GRH wards and do not get the care they need from the gastro team. at CGH - especially if patients are being asked to travel from Patients either need to be moved promptly so the care of the patient is not further afield to attend this site. [Access, Facilities] impacted, or have a service at both sites. [Quality] Only if lower GI surgery is co-located - rapid senior surgical review with alacrity ensures that decisions for surgery are correctly timed and that non-surgical interventions are not pursued too long; if all one has is a hammer then everything looks like a nail. [Interdependency] Got to move something to CGH to balance the shift to GRH. Aligns well to elective services generally centralising to CGH. [Interdependency] Links with upper /lower GI as well as colorectal and cancer based surgeries, this is a no brainer as it would all fit together and enable this centre of excellence aim. [Interdependency] Gastroenterology experience has been demonstrably improved by the recent pilot. Less violence and aggression on the ward, less non-gastro (general medicine) patients using specialised beds and better staff satisfaction from cohorting our clinical capacity onto a single site. [Quality, Staff experience] A centre of excellence would benefit both staff, services delivered and patient care. [Quality, Staff/Resources] Neutral and other correspondence examples
I support the proposals to change and think the information provided presents a strong case. However, throughout the consultation document I
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see little or no reference to: a) How staff are to be retained, trained, recruited and afforded. b) No reference to any improvements to process or service instigated as part of the response to Covid -19 which will be retained as Best Practice moving forward. c) Limited reference to the way that services will be re-modelled in line with international Best Practice. There is limited information given for example on the use of Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing telemedicine, telephone consultation and follow up, health education in primary care, transfer of services into community settings, conversations to higher day case rates, better streaming through outpatients (and ED). The proposals appear to deal with the issue of duplication of services across two sites and consequent rationalisation and whilst this is to be welcomed, of itself, it does little to illustrate how the models of care can or will change. Similarly there is no financial analysis (that I can see) with the documentation provided. In an increasingly stretched NHS, this must be a consideration for services to be long term sustainable.
I feel this service could be led from either hospital and the service continue I the hospital why change for change sake . Save money and develop leadership on either site and share good practice online
REACH survey Patients always benefit from a joined up approach to care and specialists on the same site makes for a less stressful experience
Other correspondence Retain Gastroenterology Services at CGH as this fits with the Centre of Excellence model
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4.5 Trauma and Orthopaedics (T&O) inpatient services
Preferred option to develop: to develop: Two permanent ‘centres of excellence’ for Trauma at Gloucestershire Royal Hospital and Orthopaedics at Cheltenham General Hospital.
76.02% of all survey respondents either strongly supported or supported the proposal 10.53% of survey respondents either strongly opposed or opposed the proposal 13.45% of survey respondents had no opinion Easy read had two questions: o Trauma: 70.51% support / 12.82% oppose / 16.67% no opinion o Orthopaedics: 73.08% support / 14.10 oppose / 12.82% no opinion
75.35% of staff respondents either strongly supported or supported the proposal 76.28% of respondents excluding staff either strongly supported or supported the proposal
Fit for the Future Survey
Two permanent ‘centres of excellence’ for Trauma at Gloucestershire Royal Hospital and Orthopaedics at Cheltenham General Hospital.
Response Response
Percent Total
1 Strongly support 44.44% 228
2 Support 31.58% 162
3 Oppose 7.41% 38
4 Strongly oppose 3.12% 16
5 No opinion 13.45% 69
answered 513
skipped 111
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Trauma and Orthopaedics (T&O) inpatient services
The Easy Read Survey separated out the Trauma and Orthopaedic proposal into two questions:
Fit for the Future Survey Easy Read - Trauma
What do you think about us carrying on doing Trauma Surgery at Gloucestershire Royal Hospital after the pilot? Trauma Surgery is where people need operations after they have been injured in an accident.
Response Response
Percent Total
1 Good idea 70.51% 55
2 Bad idea 12.82% 10
3 Not sure 16.67% 13
answered 78
skipped 11
Fit for the Future Survey Easy Read – Planned Orthopaedics
What do you think about us carrying on doing Planned Orthopaedics at Cheltenham General Hospital after the pilot? Planned Orthopaedics are operations for things like hip replacements and knee surgery.
Response Response
Percent Total
1 Good idea 73.08% 57
2 Bad idea 14.10% 11
3 Not sure 12.82% 10
answered 78
skipped 11
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Qualitative Themes: Trauma and Orthopaedics (T&O) inpatient services
The following quotes from survey responses are from survey responses either supporting or opposing the proposal. The quotes included below Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing are illustrative of key themes in the feedback received regarding Trauma and Orthopaedics (T&O) inpatient services. Themes in the responses to the proposal relating to Trauma and Orthopaedics (T&O) inpatient services (A-Z): Access; Capacity; Efficiency; Facilities; Interdependency; Patient Experience; Pilot; Quality; Resources; Transport; Workforce
Trauma and Orthopaedics (T&O) inpatient services Preferred option to develop: Two permanent ‘centres of excellence’ for Trauma at Gloucestershire Royal Hospital and Orthopaedics at Cheltenham General Hospital. 76.02% of survey respondents either strongly supported or supported the proposal 10.53% of survey respondents either strongly opposed or opposed the proposal 13.45% of survey respondents had no opinion Easy read had two questions: o Trauma: 70.51% support / 12.82% oppose / 16.67% no opinion o Orthopaedics: 73.08% support / 14.10 oppose / 12.82% no opinion
Supporting the proposal Opposing the proposal Separating trauma and planned surgery proven model, Trauma needs unambiguous and fast treatment. I've no idea where/when I elsewhere, in terms of bed base, theatre capacity and managing can go to CGH so I'd call an ambulance rather than go by car. What a stupid infection rates. [Efficiency, Quality] waste of resources. [Patient Experience]
This is something that I believe is already pretty much I am concerned that having these two sited at different hospitals will result established with GRH being the trauma site and CGH being the in increased patient transfers due to the overlap of specialities. elective site. [Efficiency] [Access/Transport]
This principle is sound - to concentrate emergencies on one site Both hospitals have the population to support a centre of excellence- this is
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and orthopaedics on the other and it will help the ambulance just stealing Cheltenham hospital services away which has been happening service to direct patients to the appropriate site. [Efficiency] by stealth over recent years! [Access]
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing This scenario has been in place for some time and seems to work The pilot study at GRH regarding Trauma has not been publicly scrutinised. I well. Keeping elective patients away from acute admissions is gather it has not been successful due to pressure on beds and operating vital to minimise the risk of prosthetic joint infections.[Efficiency, time, consequently causing delays to surgery. It would not be sensible or Quality] responsible to continue this service at GRH. Orthopaedics at CGH on the other-hand has performed better. [Pilot, Capacity, Patient Experience]
Ok, need to give county spread. But Cheltenham not so easily From things I have heard about Trauma & Orthopaedics I am not convinced accessible and very difficult for family and visitors without a the T&O Pilot study has gone as well as the Hospital Trust has claimed. I car.... Cheltenham has a very limited evening bus service e.g. should like to see the full report of the Trial, before forming a judgement on from Stroud. [Access, Transport] this. I am not opposed to most elective orthopaedic surgery being done on one site and most trauma orthopaedics being done on the other, to minimise disruption to elective orthopaedic procedures, but Trauma Orthopaedics is fundamental to a fully functioning A&E Department, not least because it is not always obvious until x-rayed whether an injury is a broken bone or a soft-tissue injury. At least some trauma orthopaedic capacity should be retained on both sites. [Pilot, Quality]
If elective T&O operations are low risk then basing them on a Trauma and orthopaedics should stay together at GRH. [Interdependency] site away from emergencies makes sense as there will be a reduced chance of cancellation. Trauma is best location near the main A&E. [Capacity, Patient Experience]
As someone who is on the waiting list for a knee replacement No there should be one centre to concentrate all resources in one place,
and living in Cheltenham being able to keep a permanent 'centre unless one is for emergencies and one for electives. Two sites would dilute
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of excellence' at Cheltenham General would be good. [Patient this. [Efficiency] Experience, Access]
Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing Separating out emergency trauma and elective orthopaedics Trauma and orthopaedic need to go together. It would be VERY confusing to makes sense as it again puts the planned care in CGH which will split them. You've GOT to start treating this as one hospital over 2 sites; not be a calmer hospital and more suitable for that type of services, 2 different hospitals. EVRRYTHING trauma and orthopaedic at Gloucester. and the emergency services can have their centre of excellence [Efficiency] at GRH. Again, having the centres of excellence is a sensible way forward, and the pilot seems to have worked well. [Facilities, Quality]
Much like with previous service responses I believe that by If it is a trauma case, it is quite possibly an ambulance admission and GRH keeping Trauma linked with Orthopaedics will inevitably lead to cannot cope now. All ambulances go to GRH and then orthopaedics would Orthopaedics losing out because acute patients (trauma) has to have to be transferred to CGH, increased cost, risk, time and staff. [Capacity, take priority for beds, theatre space and staffing requirements. Resources/Workforce] This allows the massive Orthopaedics service to properly deliver aside from the constraints put on them through sharing bed and staff capacity with Trauma. [Quality, Capacity]
Neutral and other correspondence examples
Don't know why we need two centres. Probably better to have everyone on one site rather than spreading resources more thinly across two sites.
Because the two are so closely linked, why not have one Centre of Excellence in one place?
REACH survey The Trust must see the results of the Pilot Study first, before making any further decisions on this. It would be reckless to proceed before any
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further facts, information and recommendations have been gleaned and shared with the public. Patient care and health could be compromised and it would be negligent for the Trust to allow GRH to continue when it is currently not coping with demand. Quality of care over quantity of patients seen is of paramount importance. Governing Body Part 1 to be held at 2pm on 28 February 2021 via MS Teams-28/01/21 MS via 2021 28 February on at 2pm held to be 1 Part Body Governing
No if the pilot study has shown delays and pressure on beds then I think it would be very unwise to make Gloucester the place for Trauma services. If they do, then all orthopaedic trauma will end up there, (road traffic accidents for example). This means Cheltenham A&E will no longer be used for this purpose, essentially downgrading the A&E department at Cheltenham and making it a minor injuries unit. Again what sort of A&E will Cheltenham have?
Other correspondence We would hope that the GHNHSFT will publish comparative outcome data regarding the management of fractured neck of femur, lower limb and ankle fractures, and upper limb fractures for further scrutiny. Data for these key performance groups of trauma patients should be made available for both hospitals prior to the institution of the T&O Pilot Scheme, as well as outcome data during the pilot period. The success or otherwise of this Pilot Scheme should be judged on objective outcome data.
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4.6 Impact of our proposals on you and your family
The following quotes from survey responses illustrate the impacts (positive and negative) identified by respondents to the survey: Access; Environmental; Facilities/Car Parking, Outpatients, Patient Experience; Quality; and Safety.
The predominant impact identified from respondents from all areas of the county is Access to centralised services; whether at Cheltenham General Hospital or Gloucestershire Royal Hospital. Therefore, a significant number of examples of this impact have been selected below. Frequently respondents have linked Access with either expected improvement in quality of services or deterioration in quality of services. Several respondents highlight Environmental aspects of increased travel.
I do not believe they would impact negatively, the distance between the two centres is not very far, if it was an emergency the patient would be blue lighted anyway. I would rather get the best possible care than decisions being made on geography. If as a plus this means that patients may not need to be sent out of county this is huge benefit. [Access, Quality]
My wife and I are both in our 80s and moved from a rural location in 2019 as we anticipate a point at which we will not own a car. We deliberately bought a property within walking distance of CGH. We have already found it necessary to travel to Gloucester for X-ray and my wife was admitted for emergency treatment late on a Saturday evening. I had to return home to collect her essential medication and was able to do so in the car. This would have been particularly difficult without our own transport. [Access]
Any proposal that fails to deliver the full restoration of 24/7 type-1 consultant-led A&E services at CGH, will make it considerably more difficult to access emergency health care for me and my family. [Access]
Removal of services from Cheltenham would make it very difficult for people of North Cotswolds who depend very strongly on Cheltenham. [Access]
Minimal impact currently - may involve slightly longer travel dependent on outcome. Applies to services that would move to GRH. [Access] 13.2
As someone of working age with access to independent transport, I think this is a positive move for me. However, I am concerned about the social practical impacts for people who are dependent on public transport, elderly, need support to travel, more financially disadvantaged. [Access]
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I live in the Forest of dean so any move to Cheltenham will put 30 minutes extra on my journey. Maybe longer when you consider how difficult it is to park in Cheltenham. [Access]
Difficulty in getting to Cheltenham general hospital, public transport links poor or non- existent. [Access]
We live on the border in Herefordshire but our nearest GP surgery is in Gloucestershire where we access services. Having to travel to Cheltenham is too far. [Access]
I live in Moreton-in-Marsh and I am not able to drive. Gloucester is a foreign country! Oxford or Worcester is easier to reach. Any suggestion of concentrating services at GRH is therefore bad news. Only super specialist services should be located here. [Access]
Any medical treatment should be available at a local hospital. It is wrong to expect patients who are obviously ill to travel to long distances for treatment. Ecologically it is also better for a few medical staff to move between hospitals than for large numbers of patients to travel. [Access, Environmental]
If the services are not at both units this would mean further travel and time. It also means for Carers there days would be more disrupted getting patients to appointments in larger units. [Access]
I have multiple disabilities and cannot drive or travel on public transport. If I ever need any of the services covered in this proposal, I want them to be as close as possible to my home. It is easier for elderly, disabled, and very sick people to travel to their nearest hospital. An unfamiliar environment may be distressing for them, and it may be more difficult for their families to visit if they are further away. I will not be the only person in this category who is not able to either drive themselves or travel on public transport. Therefore, all procedures should be available in all hospitals, not in one centre. This feedback relates to all the services. [Access]
My view is that centres of excellence would be a positive proposal. Negative could be transport/parking etc. issues in either getting to hospital, or for visitors. A free green shuttle between the sites would help with this. But really transport issues are far down the line when compared to top class treatment. [Access, Transport, Environment] 13.2
Both hospitals pretty much equidistant for us and are over thirty mins away, so no change for us. [Access]
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Obviously because I live in the forest of Dean it would be better for my family to have all resources staff and centres of excellence at Gloucester but Cheltenham needs to have its own centres of excellence. [Access]
As a Gloucester based family it is always easier for us to go to GRH. However, I would prefer to travel a bit further to a centre of excellence. [Access, Quality]
There could be more travel for patients depending on the proposals, but clearly the aim is for people to have world class care and I personally would be prepared to travel a bit more and not be so territorial. It's your health that matters at the end of the day. Also, some of the proposals like IGIS should mean fewer people having to travel out of county which is a good thing. [Access, Quality]
As a resident of Cheltenham I am happy to travel if it means better care. I just want the right people in the right place to look after my family if they are unwell. [Access, Quality]
Car parking is an issue at CGH, assurances need to be made that relatives are able to park, to be able to transport and visit their relatives. The estate has to be able to support the changes to the centres of excellence along with staffing and support services. [Facilities/Car Parking]
I imagine most opposition to the proposals will come from those who live significantly closer to one hospital or the other. We are fortunate in living more or less halfway between the two. Despite it being easier, therefore, for me to agree to the proposals, I do feel strongly that rationalisation of provision is important. [Access, Efficiency]
As long as the clinic appointments are in the same place I think it will have very little impact on my family. [Outpatients]
I am concerned that scarce resource (pathology, radiology, social work etc.) is diverted to GRH leaving a second rate services that would not be able to safely support any centre of excellence (including oncology) based in CGH. [Quality/Safety]
A possible positive impact would be an increased likelihood of a successful outcome of any treatment in the future. [Quality] 13.2
Because we live in the very south of the county to a certain extent these changes will have very little impact on us as we are pretty much as far away from one hospital as the other. The time taken to get to either of them is about the same, and as there is no public transport to either hospital, it doesn't really matter for any of the services at either hospital. However, I know that having centres of excellence can generally improve patient outcomes, which is
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why I support the developments of the centres of excellence. At the moment some trauma and emergencies from our area are dealt with at Southmead, so if GRH and CGH can become superior centres of excellence, then perhaps we would be more likely to be treated in county. I would rather battle the traffic into Cheltenham or Gloucester than Bristol. [Access]
Creating a major elective hub at CGH is likely to be beneficial to my family. This would allow good access to intensive care if needed and reduce the risk of hospital acquired infection. [Quality]
My family and I could be affected positively by services being centralised because we would get the treatment we need in time by highly motivated trained staff. [Quality]
All proposals would have a positive impact on me and my family. I don't care where I or my loved ones are treated. If any one of us had an extremely unusual condition requiring us to travel to London for treatment, we would do it. It therefore makes no difference to me whether I have to travel to Cheltenham or to Gloucester for treatment, as long as the service is good, well-staffed with enough of the right staff and capacity available is all I care about. [Quality, Access]
4.7 Limiting negative impact
The following quotes from survey responses illustrate suggestions for limiting negative impacts identified by respondents to the survey [Access; Communications, Integration; Reduce patient transfers; Single Site, Transport, Travel Claims; and Workforce.]
Survey respondents shared the following mitigations to limit potential negative impacts of centralisation of specialist hospital services.
Retain services on both sites Improve Patient Communications Improve integration between hospitals, community services and GP practices Reduce the number of patient transfers between Acute hospitals Build a new Acute Hospital on a Single Site 13.2 Improve public transport Speed up payment of eligible Travel Claims Encourage more staff to work in Gloucestershire
As far as possible try to maintain urgent/emergency/acute facilities at both sites while splitting care not in those categories into centres of excellence across the two sites. [Access]
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I cannot understand why it seems the Trust struggles with employing adequate staff for both hospitals. Gloucestershire is a beautiful county, more and more people are leaving cities and moving into the countryside, like the Cotswolds and Cheltenham is the home of the 'festivals' after all! So providing more staffing and investing in equipment etc should be a priority for both hospitals. Why do staff have to cover both sites? The two hospitals are separate sites and should continue to provide equal facilities because Gloucestershire is such a large growing county. [Workforce]
Work with the transport services. [Access, Transport]
It is important that free public transport is available for patients between the two hospitals, so that (for example) people living in Cheltenham are not financially disadvantaged by having to travel to GRH, if they do not have a car. [Access, Transport]
Make all services available in all hospitals. If this is not possible, then there should be excellent hospital or volunteer transport which is suitable for individual patients with a variety of disabilities including severe allergies (I cannot travel in standard hospital transport or on public transport because of allergies to perfumed products from laundry detergent to standard toiletries.) [Access]
24 transport links (99 bus useful but only mon-fri) between CGH and GRH. Cheaper parking if patient needs transfer from/to CGH/GRH. [Access, Transport]
Easier travel; more car parking spaces and lower charges for parking. Move to a paperless system so there is no need to transfer paper notes and images between sites - practical experience at both hospitals show lost notes are very common. [Access, Transport, Car Parking]
You really need to have a "Southmead" in the Golden Valley area. And you need to consider better bus services to both sites for general public to reduce car parking requirements and problems. [Single site, Transport]
Finding ways to minimise the need to transfer patients between sites is important. Communication about any changes that are made and why they are necessary always helps. 13.2 [Reduce patient transfers, Communications]
Greater visibility and support given to people needing to claim travel expenses for hospital visits. Citizens Advice Stroud ran a campaign about this 3-4 years ago, surveying the hospitals and surgeries to see how visible the information was and how easy to claim. The
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procedure for making a claim and receiving payment was poor. Stressed relatives need immediate assistance. They should not have to wait a month to be reimbursed. [Travel Claims]
Get it Right First Time. Direct to FAS/ COTE bed. Another specialist COTE ward at CGH (although difficult to recruit to this area) Discussion with community partners: keep Community Hospital and Bed Based Rehab beds for patients needing these services to speed transfers out of acute hospital. Blocking beds in the community blocks up our ' back door' and our beds perpetuating the problem of flow. [Integration]
Better 'advertising' of which conditions and situations are for which hospital so we can make decisions without convoluted calls to 111. [Communications]
Try leadership and staff support for both units from one hospital. Sharing good practice teams can meet online. [Workforce]
4.8 Anything else you want to tell us
The following quotes from survey responses illustrate other comments made by respondents to the survey:
Bring back Cheltenham A&E full-time and with full services as soon as Covid restrictions are lifted.
My hope would be that by making these changes the local service will be made better and the cancelling of planned procedures is significantly reduced.
Just think more about travel access, parking facilities and best of all getting appointments and blood tests done promptly. The Cotswolds is treated as a backwater by Glos NHS
More free car parking at GRH and CGH.
If would help if other bodies such as Glos Highways and bus companies could be persuaded to consider better road access and enhanced public transport facilities to reduce difficulties 13.2 in trying to access two sites.
I would be interested to know what consideration One Gloucestershire have given to inclusion in terms of practical access to the hospital sites e.g. public transport providers, charities with volunteer drivers, support groups in disadvantaged areas.
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Given the health inequalities which have been demonstrated through the Covid-19 situation, it is vital to me that these considerations are given a platform in any changes, else we risk worsening inequalities already present. As well as the patient, this can impact visitors, whose support can positively bolster outcomes for a patient. Also, there is no mention of the impact on ambulance services, but presumably there will be an impact in terms of transfers needed (not just when ambulance first called to patient, but also transfers between GRH and CGH). I am wondering how this has been assessed? Thank you for appreciating the importance of having an A & E service in Cheltenham to local people, I am really pleased this is reflected in the plan.
Build a new County Hospital between Gloucester and Cheltenham, or focus development on the Gloucester site. Improve access (sheltered pedestrian links) to Gloucester rail and bus stations.
The shuttle bus between CGH and GRH is a great asset in relation to access to services. A commitment to its future would be good to hear. It would also be good to hear that discussions are being held to see whether the bus route could include a stop at Park and Ride at Cheltenham Racecourse. Decision makers should consider evaluation of services changes if implemented and the involvement of patients, carers and VCS in the evaluation.
Keep up the good work. Will be interested in the result of survey. Any plans for head injuries, chest surgery - including cardiac or neurosurgery, so these still go to Bristol of John Radcliffe, Oxford. Guess if you live west of the M5 you want all in GRH, east of the M5 CGH. There are of course major incidents to remember where anything and everything can turn up.
I understand and agree with your reasons for wanting to change things in these two big hospitals, but I would urge you to also consider our more rural hospitals (Cirencester, Stroud etc.) when it comes to where funds go. I would hate these to be underfunded at the expense of these changes.
The public’s primary concern about the reconfiguration of specialist services within the hospital relate to the convenience and accessibility of services and the long term sustainability of a Type 1 A&E Department in Cheltenham. Of some of these proposals are implemented it is difficult to see how a full Type 1 A&E Department would be sustainable in the long term. This is despite the reassurances the Hospital Trust has repeatedly been given. 13.2 It is these proposals which have undermined staff and public confidence in the Hospital Trust's sincerity over the re-opening of Cheltenham A&E and its long term future.
If you centralise more long queue and parks, waste cancelled appointments staff on sick holidays etc. As more money was used in covid 19. We have to think weekly and keep NHS
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going for years to come. Electric chargers at hospital while wait for o/patient and visitors. Cars in come for hospital?
Refreshing to see such an in depth review and consultation. How about integration of Social Services and the NHS next?
Whatever decision is made, the correct and additional staff numbers must be allocated. You cannot simply move the patient workload (currently split over two sites with two teams) to one site with only that sites pre-existing team numbers. This will be a recipe for failure / disquiet. Working in a small speciality which centralised 10 or so years ago the benefits are huge for us.
Improving continuity of care, reducing outliers and improving communication with families might be improved if a balance in activity across the hospitals is achieved.
These are excellent consultation proposals but miss one very important heading - THE CUSTOMER CARE EXPERIENCE. Visits to both major hospitals are still very poor experiences. Everyone does their best with awful facilities and it's time we moved from a 1958 experience to 2020.
I would like to see a very positive statement, and concrete proposals for the better care of patients presenting with mental health problems in ED. This has been a long ongoing concern, how will Fit for the Future ensure that mental health is given proper consideration?
I worry about the link and relationship between these proposals and GP services. GP services need to be as much a part of this as the hospitals and the hospitals cannot do this in isolation of community services. I can see part of the proposal is to enable more joined up working but this has to work in practice with collaboration and cooperation across the services. While I have experienced fantastic GP services in Gloucestershire (up to about 10 years ago). Unfortunately I have also experienced some poor GP service provision in Gloucestershire, which has deteriorated over the last 8 to 10 years. My biggest concern is that if the GP services are not joined up with these proposals, this will not be able to succeed.
I have been watching this play out for years and too much time and negative energy has been spent which has hampered the development of all specialties in both hospitals. I am 13.2 utterly fed up with it.
Inappropriate and dangerous hospital discharges happen regularly, particularly at GRH. I hope these changes will help reduce these. Mental health support is very poor, particularly in GRH, I hope the cost and staff savings can be used to provide better mental health support for patients with mental ill health.
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I used to work for the department of health. The fashion for building new hospitals would alternate between big is beautiful and small is beautiful on a 10 year cycle. The result was that all current buildings was out of step with prevailing thinking. Health trusts need to resolve this conundrum and ensure a successful balance between specialist and locally delivered hospital based options.
Just ensure that the investment needed to provide these changes properly and not half hearted is there for all services involved including those that are sometimes overlooked. There is no point picking a service up and moving it to one side of the county or other if you don't use this opportunity to actually improve it.
A future proof plan for reduced waiting times, reduced hospital stay, access to cutting edge skills and equipment along with optimal training of junior staff and attracting the best must be a positive move.
Invest in your nursing staff as you do with every other professional group. Pay them more and develop their skills. This is the only way you will be seriously considered as addressing the recruitment and retention crisis.
I find taking part in the survey stimulating and support the developments.
Do not ignore the publics opinion we have a right to choose where we have our care.
13.2
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5. Other correspondence/written responses
9 written responses were received during the consultation (A-Z).
Cheltenham Borough Council [Access, Capacity, Interdependency + commitment to Cheltenham General Hospital A&E] Cllr Martin Horwood, Liberal Democrat, Cheltenham Borough Council [Capacity, Access, Pilot + timing of consultation] Leckhampton with Warden Hill Parish Council [Capacity, Access, Pilot + timing of consultation] REACH: Restore Emergency At Cheltenham General Hospital campaign (including REACH survey interim report) [Capacity, Access, Interdependency, Facilities, Quality, Pilot + commitment to Cheltenham General Hospital A&E] – Summary of REACH Survey responses below. Tewkesbury Borough Council [Access + commitment to Cheltenham General Hospital A&E] 4 x members of the public [#1: Quality, Resources, Workforce, Facilities, Staff Experience, Pilot. #2: Workforce. #3: Quality, Patient Experience. #4: Efficiency, Resources, Capacity, Workforce]
10 email responses were received from members of the during the consultation from members of the public
[#1. Efficiency, Resources. #2: Access, Resources. #3: Patient Experience, Access, Resources, Facilities, Integration (use North Cotswolds Community Hospital). #4: Integration (use North Cotswolds Community Hospital), Access. #5: Access, Integration (use North Cotswolds Community Hospital). #6: Access. #7: Access + commitment to Cheltenham General Hospital A&E Department. #8: Access, Patient Experience. #9: Interest in Stroke services. #10: Copy of Member of the Public Letter 4: Efficiency, Resources, Capacity, Workforce]
13.2
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5.1 REACH Survey – summary interim results The REACH Report on Interim Results (17 December) has been shared with the Fit for the Future consultation team and can be found in full in the online appendices.
The REACH survey asked different questions to those in the Fit for the Future Survey and Fit for the Future Easy Read Survey.
The REACH survey number of responses or demographics of respondents have not been shared with the Fit for the Future consultation team at the time of writing.
Summary results (EXTRACTS from the REACH Interim Report] regarding each specialist services are proposals are as follows:
Acute Medical Take: NHS Preferred option to develop: A ‘centre of excellence’ for Acute Medicine (Acute Medical Take) at Gloucestershire Royal Hospital. REACH survey question: Do you agree with the Trust’s preferred option of centralising acute emergency medical patients on to the GRH site? EXTRACT: The public response has been overwhelming, indicating that the people do not support centralisation of the acute medical take or emergency admissions at GRH.
Emergency General Surgery: NHS Preferred option to develop: A ‘centre of excellence’ for Emergency General Surgery at Gloucestershire Royal Hospital. REACH survey question: Do you agree with the Trust’s preferred option of centralising acute emergency general surgical patients on to the GRH site? EXTRACT: Public opinion is again not in favour of centralising emergency general surgery onto the GRH site. Only a small minority support One Gloucestershire’s preferred option.
Planned Lower GI (colorectal) general surgery: NHS Preferred option to develop: A ‘centre of excellence’ for Planned Lower GI (colorectal) general surgery at Cheltenham General Hospital (CGH) or Gloucestershire Royal Hospital (GRH). REACH survey question: Do you agree with the Trust’s preferred option of centralising planned lower gastrointestinal/colorectal patients onto a single hospital site? EXTRACT: Public opinion on this issue was split. Notably a significant minority of people were neutral on this topic, as they believed that this should be available at both sites, or that answering this depended on the outcome of the emergency surgery debate. It would appear 13.2 that the public would ideally prefer to have services as close as possible to home, whether this might be for emergency or elective care. Supporters of this proposal, however, indicated that this should be centralised in Cheltenham as part of the Cancer Centre.
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Location of Planned Lower GI (colorectal) general surgery: NHS No preferred option. REACH survey question: If you do agree that it would be sensible to centralise planned lower gastrointestinal/colorectal patients onto a single hospital site, which hospital would best deliver this service? EXTRACT: Supporters of centralising colorectal planned patients onto one site overwhelmingly indicated that Cheltenham should be the preferred site for such a proposal. Many respondents cited the importance of co-locating colorectal surgery with the Cancer Centre and patients with other cancer requiring colorectal expertise e.g .gynaecological and urological cancer patients. Some patients were neutral on this question, but this may reflect the respondents to the previous related question, who were not persuaded about centralisation.
Planned day case Upper and Lower GI (colorectal) surgery: NHS preferred option to develop: A ‘centre of excellence’ for planned day case Upper and Lower GI (colorectal) surgery at Cheltenham General Hospital. REACH survey question: Do you agree with the Trust’s preferred option of centralising planned day case upper and lower gastrointestinal patients onto the CGH site, as opposed to continuing day surgery in community hospitals and the two main hospitals? EXTRACT: Public opinion clearly opposes the centralisation of daycase surgery at CGH. The public wants to have daycase surgery performed as close to home as possible, with the community hospitals. This would seem perfectly reasonable, as the delivery of daycase surgery in community as well as acute hospitals is entirely appropriate patients.
Image Guided Interventional Surgery (IGIS): NHS preferred option to develop: A 24/7 Image Guided Interventional Surgery (IGIS) ‘Hub’ at Gloucestershire Royal Hospital and a ‘Spoke' at Cheltenham General Hospital. REACH survey question: Where do you believe that the main interventional radiology centre or “hub” should be located in? EXTRACT: A clear majority of the public replies indicate that the main centre or hub for interventional radiology should be at Cheltenham. The respondents indicating “no opinion” generally said that this service should be provided at both hospitals. The Proposal from One Gloucestershire is for a “hub and spoke” model. Public opinion indicates that the main centre or “hub” should be at Cheltenham with a smaller service or “spoke” at Gloucester. 13.2 Vascular Surgery: NHS preferred option to develop a ‘centre of excellence’ for Vascular Surgery at Gloucestershire Royal Hospital. REACH survey question: Where do you believe that the main vascular interventional radiology/surgery centre should be located in?
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EXTRACT: The overwhelming public response is that the interventional vascular centre should remain at Cheltenham, maximising the use of the state of the art hybrid interventional operating theatre at CGH.
INTERVENTIONAL CARDIOLOGY [question not included in the Fit for the Future Survey and Fit for the Future Easy Read Survey] REACH survey question: Where do you believe that the main cardiac interventional radiology/surgery centre should be located in? EXTRACT: The public response was evenly split between having interventional cardiology at both sites or at Cheltenham alone.
INPATIENT VASCULAR SURGERY [question not included in the Fit for the Future Survey and Fit for the Future Easy Read Survey] REACH survey question: Where do you believe that the main vascular inpatient surgery centre should be located in? EXTRACT: The overwhelming public response is that inpatient vascular surgery should remain at Cheltenham, so that the state of the art hybrid vascular theatre can be used properly. The public do not believe that spending more money to replicate this facility at Gloucester represents value for taxpayers’ money.
Gastroenterology inpatient services: NHS preferred option to maintain a permanent ‘centre of excellence’ for Gastroenterology inpatient services at Cheltenham General Hospital. REACH survey question: Where do you believe that the gastroenterology inpatient service should be located in? EXTRACT: The vast majority of respondents indicated that the single site gastroenterology inpatient site should be located in Cheltenham. Many cited that this is sensible, as it would be sited alongside the cancer centre in Cheltenham. Those who expressed no opinion indicated their preference for this service to continue on both sites.
Trauma and Orthopaedic inpatient services: NHS preferred option to maintain two permanent ‘centres of excellence’ for Trauma at Gloucestershire Royal Hospital and Orthopaedics at Cheltenham General Hospital. REACH survey question: Do you believe that One Gloucestershire should be considering 13.2 any proposals until the results of the “Pilot Study” are made public for proper scrutiny? EXTRACT: There was overwhelming public opinion that the results of the “Pilot Study” on Trauma and Orthopaedics should be presented for scrutiny prior to considering any proposals for a permanent reorganisation. The public believe that One Gloucestershire should be transparent and share the data about trauma surgery outcomes for proper scrutiny.
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REACH survey question: Last but not least do you agree that the “Pilot Study” arrangement with Trauma based in Gloucester and planned orthopaedic surgery based in Cheltenham should continue as a permanent reorganisation, without the formal results of the "Pilot Study" being revealed? EXTRACT: The public believe that the proposal to make a permanent reconfiguration along the lines of the “Pilot Study” should not be enacted until the results of the “Pilot” have been fully evaluated. Fewer than 5% of the respondents believe that it would be appropriate to proceed on such a basis.
5.2 Other comments received during the consultation (Not directly related to the Fit for the Future consultation proposals)
During the consultation, members of the consultation team spoke to participants about matters unrelated to the Fit for the Future proposals. Other subjects included the national and local response to the Coronavirus pandemic, including practical questions about Covid- 19 testing and vaccination; the timing of the consultation taking place during a pandemic; feedback about services such as primary care (GP) services and mental health services.
The final subject to report was the significant number of messages of thanks to health and care staff and other frontline workers for their efforts to maintain services during the pandemic.
13.2
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6. Addressing themes from the Consultation
This Interim Output of Consultation Report is one of a number of key documents that decision makers utilise (and which are made available to the public), when assessing service change proposals. To support ‘conscientious consideration’13 decision makers should be able to provide evidence that they have taken consultation responses into account. As part of this process, the Decision Making Business Case (another of the key documents utilised by decision makers), will include significant content from the consultation. In addition to summarising the consultation process it will also include: A summary of consultation findings Analysis of consultation responses including any alternative suggestions to the proposals New evidence from the consultation and the impact of this on the proposals An updated Integrated Impact Assessment that includes feedback from the consultation This information is a crucial part of determining the final proposals that are included in the Decision Making Business Case (DMBC) for consideration by decision makers. Further work will be completed to ensure decision makers are able to take a proportional view based on the quantitative and qualitative responses. Sections 3 and 4.7 have already identified key themes and mitigations to limit potential negative impacts that will be need to be addressed by the DMBC. The table below lists some of the specific topics, identified from all sources of consultation responses that will need to be considered and responded to as part of the post-consultation, pre-decision making process. As with all consultations there are a range of issues identified commensurate with the differing views of those responding to the consultation.
Theme Topic Access Establish Centres of Excellence on both sites (GRH & CGH) Improve communication regarding location of services Ambulance response times and capacity Car parking Public transport including Park & Ride and Inter-site” 99” bus service Travel expenses claim process Practical travel support to access services for those disadvantaged groups and impact on health inequalities 13.2 Additional services provided in-county to avoid out-of-county travel
13 One of the Gunning Principles that have formed a strong legal foundation from which the legitimacy of public consultations is often assessed.
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Capacity GRH capacity including beds and Emergency Department Making the most of the CGH site Impact of population growth on proposals Impact of COVID-19 on separation of emergency and elective surgical services Use of virtual technologies to support services Facilities New hospital Use of the hybrid theatre at CGH Use of community hospitals to support services Integration Increased co-operation with other regional hospitals Partnership with community and primary care and the voluntary sector Integration of Social Services and the NHS Care of patients presenting with mental health problems in Emergency Department Interdependencies Access to theatres Colorectal surgery and emergency general surgery co-located Separation of elective and emergency vascular surgery Co-location of colorectal surgery with gynaecology and urology at CGH Interventional radiology hub at CGH and spoke at GRH Centralise all IGIS at GRH, no requirement for a spoke at CGH. Pilot Publication of Trauma and Orthopaedic pilot evaluation information Quality Training hospital More information on infection control Plans to improve services once re-located Medical cover at CGH
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7. Questions and Answers
Throughout the consultation a range of questions have been received from a variety of sources e.g. online discussion groups, Information Bus Tour, survey free text responses. The following questions (and responses) are representative of frequently asked questions.
Question Response Acute Medicine (Acute Medical Take) How are you going to ensure GRH will be FIT FOR THE FUTURE is a long term strategic able to cope with the increase in patients? plan, which would take a number of years to implement. We are also investing in new facilities at both hospitals which will increase the number of patients we can look after. As part of the programme we are reviewing bed numbers across both sites to ensure that they align with the proposed change in services. If approved additional acute medicine beds would be provided at GRH. If you move Acute Medicine, surely you will We have made a public commitment to end up closing the A&E department? maintain the A&E department at CGH. The department will continue to provide Consultant Led A&E services 8 a.m. to 8 p.m. and a Nurse Led service from 8 p.m. to 8 a.m. This model of care has been in place at Cheltenham A&E since 2013. Under the FIT FOR THE FUTURE proposals, the same day emergency care service at CGH (which is provided by acute medicine and is consultant led) would extend from 8am to 6pm, Mon to Fri to 8am to 8pm Mon to Fri. Are you closing the Acute Care Unit (ACU) in Under the FIT FOR THE FUTURE proposals Cheltenham? this service would move from CGH and form part of an expanded Acute Medical Unit at GRH. 13.2 Presume staffing a single acute centre is Yes this is correct and a key driver for the easier than two making the care it can change. Moving the acute medical take to provide more consistent and ‘guaranteed’. Is one site would mean we have greater this the case? flexibility to cover staff rotas and provide a sustainable service. Aspiration to excellence is essential but not Our proposals are focused on creating
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if this is considered zero sum - i.e. we can Centres of Excellence at both hospital sites; aspire to be a centre of excellence in A and for planned care and cancer at CGH and for therefore B will not be excellent. How are emergency care, paediatrics and obstetrics you proposing to ensure this does not at GRH. Through the centralisation of happen? specialist services we would be able to utilise our resources (staff, buildings and equipment) in a more effective, efficient and sustainable way. There are currently services which are The FIT FOR THE FUTURE proposals aim to already considered excellent: does the Trust build on our services which are already know what these are and do the various considered excellent, for example cancer plans consider that aspiring to excellence in care at CGH and paediatrics and obstetrics at one domain might strip an already GRH, by using the same approach of considered excellent service of its status? centralisation of highly specialist services which allows us to utilise our resources (staff, buildings and equipment) in a more effective, efficient and sustainable way. There are no plans to change those services but rather learn from their experience to ensure that we have excellent services for the population we serve. We know that to give patients a good FIT FOR THE FUTURE focuses specifically on experience at the ‘front door’ we have to specialist services provided by the GHFT have an efficient ‘back door’. How are you which includes the admission and discharge going to support the hospitals ‘back door’ as of affected patients. However, the Trust this is as important as the ‘front door’? continues to work in collaboration with our local integrated care system to improve end to end care pathways across a wide range of services; this work is ongoing and complementary to the FIT FOR THE FUTURE programme. We know that moving older patients and We are fully aware of this risk and do our particularly patients with dementia multiple utmost to minimise any unnecessary ward times is not good for their recovery. How can moves in patients with delirium and we make this better for this cohort of dementia unless the clinical situation or 13.2 patients? operational pressures make this imperative Our Staff are trained in supporting the care of patients living with dementia and aim to work in partnership with carers and relatives. We use a butterfly symbol to make all members of the team aware that a
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patient needs extra support. The butterfly symbol may be on the patient’s medical notes and/or on their hospital identity wristband. We also support ‘John’s campaign. What plans do you have to ensure patients As part of FIT FOR THE FUTURE programme are not moved multiple times between sites, we are identifying the number of beds or indeed, wards at each site? required on both sites in order to support the proposed changes. We are also developing protocols to ensure that the best care is provided on both sites and that patients are not moved unnecessarily. In addition our Cinapsis system is helping GPs to have conversations with Consultants to determine if a patient needs to be seen in A&E, or admitted and if so which hospital to refer to. Currently, the acute medicine facilities are Separate to FIT FOR THE FUTURE the Trust woeful. What investment are you putting in has a capital development plan to improve to improve the acute medicine facilities? the space and layout of the Same Day Emergency Care and Acute Medical Unit facilities at GRH. What are you offering Cheltenham to ensure Our proposals are focused on creating it doesn’t suffer as a town because you have Centres of Excellence at both hospital sites; made Gloucester your focus? for planned care and cancer at CGH and for emergency care, paediatrics and obstetrics at GRH. Through the centralisation of specialist services we would be able to utilise our resources (staff, buildings and equipment) in a more effective, efficient and sustainable way.
Separate to FIT FOR THE FUTURE the Trust has a capital development plan to provide two new theatres and a day surgery suite at 13.2 CGH.
FIT FOR THE FUTURE proposes no change to the availability of outpatient services at CGH and we have made a public commitment to maintain the A&E department at CGH. The
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department will continue to provide Consultant Led services 8 a.m. to 8 p.m. and a Nurse Led service from 8 p.m. to 8 a.m. This model of care has been in place at Cheltenham A&E since 2013. Under the FIT FOR THE FUTURE proposals, the same day emergency care service at CGH (which is provided by acute medicine and is consultant led) would extend from 8am to 6pm, Mon to Fri to 8am to 8pm Mon to Fri.
It is anticipated that FIT FOR THE FUTURE proposed changes would impact approx. 20- 30 people a day i.e. these patients would need to travel to or be taken to GRH for their acute care. Will the centralisation of the Acute Medicine Similar to centralising acute medicine onto take improve access to mental health one site, the mental health team supporting services? acute medical patients would be able to concentrate their team that supports these patients onto one site giving them greater flexibility to deliver these services.
Are you going to increase the bed capacity at FIT FOR THE FUTURE is a long term strategic Gloucester so that it can cope? plan, which will take a number of years to implement as it will require changes to estate (including ward and theatre capacity), workforce and equipment.
As part of the programme we are reviewing bed numbers across both sites to ensure that they align with the proposed change in services. How are you involving support services e.g. Support services requirements have been Pathology and Pharmacy in the planning? factored into the design of our proposals and 13.2 were included in the process of developing and appraising the FIT FOR THE FUTURE solutions. Dropping off close to entrances is difficult, As part of the capital development particularly A&E and finding a parking space programme at GRH, access to the A&E is difficult at GRH. What are your plans, if department will be improved. Whilst there
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any, to improve and increase the access and are currently no plans to increase parking parking facilities at GRH? spaces we regularly review the provision of public transport to help improve access to our hospitals. Why has Cardiology not been considered in Interventional Cardiology is included in this any of these plans? consultation (as part of the Image Guided Interventional Surgery (IGIS) service. Non interventional cardiology could be included in any future phase of FIT FOR THE FUTURE. There are far too many elderly patients as As part of FIT FOR THE FUTURE programme outliers across the hospital; another care of we are modelling the number of beds the elderly ward would be beneficial. Are required on both sites to support the you considering the use of beds at CGH? proposed changes. This modelling focuses on activity by specialty rather than existing bed numbers. The aim will be to avoid patients having to be admitted as ‘outliers’ to the wards of other specialties. Gastroenterology inpatient services Has the recent pilot trialling this been Yes very. The service has been able to successful? provide a better patient experience as patients are treated by the right specialists at the right time. Clinicians have been able to concentrate on sub-specialty work and have increased the number of endoscopy sessions and clinics. The pilot has worked well for junior doctor who have been able to undertake the specialist training required and improves staff retention and recruitment. What are the results / outcomes of the As above recent pilot trailing this? Despite gastro inpatients being at CGH Although the Gastro ward is based at CGH, currently, gastro inpatients are still seen on there is an on call consultant and registrar at GRH wards and do not get the care they GRH to give timely opinion to patients need from the gastro team. Will you move coming into ED at GRH and also patients 13.2 patients to CGH to get the specialist care who require assessment and short term they need and care is not impacted? treatment can be seen at GRH. However if a longer stay for a more complex condition is required the patent will be transferred to the specialist ward at CGH. Will there be some gastroenterology As above
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presence at GRH also? Would it not be better suited at GRH where As explained above there are clinicians at other acute medical care is taking place? both sites, the transfer to CGH is only for those who need specific and complex gastrointestinal specialty care. Do both hospitals not need a centre of Gloucestershire Hospitals is a very large excellence due to the size of the population Trust but the number of patients who and the location of the services? Will CGH be require treatment as an in-patient in able to cope with demand for this service? gastroenterology is relatively small and co- locating the In-patient team on one site enables the provision of the best service. Will colorectal surgery is also be located at There are two options for colorectal surgery, CGH? Without this it will leave one at CGH and one at GRH. In either option Gastroenterology exposed. there would be a daily senior gastroenterology clinical team at both sites and so liaison with the colorectal team would continue whichever site colorectal is based. Will you consider having continuing support Endoscopy and outpatient clinics, where for Gastroenterology services at Cirencester most treatment is carried out will remain hospital? unchanged and continue to be provided at community hospitals. Will Emergency Gastroenterology patients The ED at CGH is closed temporarily as a be admitted to ED at CGH once it’s result of the COVID epidemic and the plan is reopened? Otherwise you don’t have a to restore the previous service. The plan is 'centre of excellence. You will have patients for patients to be able to access the service on both sites. at both sites. Will Pathology be taken into account with It is essential when services are re-organised these decisions? - especially Blood that all support services are included as no Transfusion service can run without input from colleagues. Before making the changes task and finish groups are implemented to involve all services that will be affected so that we have the assurance that they are able to provide the support. The pilot has 13.2 run for 2 years and the service is running well. Will this be a Proper centre of excellence? If The Specialist ward at CGH will be a centre you want to have a centre of excellence of excellence for patients with complex EVERYTHING to do with that area of conditions and the team will be co-located medicine needs to be there, no half to provide this. However it is important that
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measures. those who require out-patient or short stay assessment and treatment have access to treatment nearer to home at CGH, GRH and Community Hospitals. Describe centre of excellence as this term is When specialist care is needed our aim is to being overused in the survey? increasingly deliver this through ‘Centres of Excellence’, centralised services where we can consolidate skills and equipment to provide the very best care. Sometimes these centres may be outside Gloucestershire, but where possible as an Integrated Care System we think it would benefit patients to develop our specialist services so we can provide specialist care in our county. Will this service be easily accessible? Yes patients would be assessed at both CGH and GRH EDs and out-patient clinics and endoscopy clinics would be maintained at all sites including community hospitals. Is this not already in place? The pilot was started 2 years ago but consultation is being sought to make this move permanent. General Surgery (emergency general surgery, planned Lower Gastrointestinal [GI] / colorectal surgery and day case Upper and Lower GI surgery) How would you support those that need The proposal is for all emergency surgery to emergency surgery at CGH? be located at GRH. If an ambulance is called the paramedics would review and would take the patient directly to GRH. If patients ‘walk in’ to CGH ED and need to be reviewed or referred to the surgical team there are existing Standard Operating Processes in place depending on how poorly the patient is. Are patients that require emergency general As above. surgery fit to travel between sites? 13.2 Why can there not be this service offered at There are a number of very high risks CGH too? involved with continuing to provide emergency general surgical services at both sites, they are: There are not enough junior (trainee) doctors to cover rotas on both sites
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and there is negative feedback from trainees about their workload. In a 7 month period in 2019 15% of shifts (390) for emergency surgery were not covered. Gaps in rotas have increased by 46% in three years. At times senior doctors are in theatre an unavailable to review you if you are waiting for specialist assessment in the ED or surgical assessment unit. This leads to delays. All these issues would be resolved by moving to one site. Will the bed capacity at GRH be able to cope Bed capacity is being modelled; services with this? How will you ensure surgical would not be moved permanently before patients are not outliers on other wards? bed capacity is established. Will GRH A&E be able to cope with the The service has moved as part of the COVID increase in emergencies? changes and already we have seen the ED process improve with higher percentage of patients seen quickly. This is because there is a dedicated senior team of clinicians that are not rostered to be in theatre and can give a specialist opinion. There is also a surgical assessment unit to provide timely assessment and treatment, which means patients often don’t need to be admitted to a bed. Will there still be surgical cover at CGH even There will still be surgery carried out at CGH, after centralisation? urology, gynae-oncology, elective orthopaedics, breast surgery and day surgery. Elective colorectal surgery is being discussed as part of the programme with options for centralisation at either CGH or GRH. There will still be an out of hours theatre team on call at CGH, to provide care 13.2 for patients who need to return to theatre with complications.
There are Standard Operating Processes in place to ensure a patient is reviewed by or referred to the surgical team depending on
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how poorly the patient is. By making this change will you be able to Yes, particularly for those who are planned protect planned surgery and reduce the to have day case surgery as in times of very number of cancellations especially those high demand sometimes it is necessary to cancelled on the day? use beds in the day surgery ward at GRH for in-patients. By moving this work to CGH where a new designated day surgery ward and two new theatres are to be built, this should reduce cancellations and improve patient experience. How many will this change affect per year – In the year Feb 2019 to Jan 2020, 5,782 i.e. how much emergency general surgery is people underwent emergency general performed each year? surgery. Of these 1,753 were carried out at CGH. An impact assessment has been undertaken to assess the travel impact, it shows: For 74 patients who had emergency surgery at CGH the transfer to GRH would be positive For 1,342 patients who had emergency surgery at CGH the transfer to GRH would be neutral For 337 patients who had emergency surgery at CGH the transfer to GRH would be negative How are you going to increase the bed FIT FOR THE FUTURE is a long term strategic availability at GRH to manage this? plan, which would take a number of years to implement. We are also investing in new facilities at both hospitals which will increase the number of patients we can look after. As part of the programme we are reviewing bed numbers across both sites to ensure that they align with the proposed change in services. How are you going to ensure CGH theatre Many staff work on both sites already and 13.2 staff maintain their skills in emergency often this is done to gain experience in surgery? different fields. When the final decisions are made all affected staff would be involved in discussion to assess the best area for them to work with regard to their personal situation and training and experience.
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How will you minimise the number of times For people undergoing elective (planned) patients are moved between each hospital surgery, the site would be specified. For or between wards at each hospital? those who are emergency admissions; if they arrive by ambulance they would be taken to GRH directly. The patients that may need to travel are those who ‘walk in’ to ED at CGH and after assessment are found to require hospital admission. These patients will be transferred to GRH. Will there be enough parking at GRH for the There is more car parking available on the increase in people going there? GRH site as the Trust gained permission to build a multi storey car park. On the GRH site there are a total of 11 car parks providing 1,854 car parking spaces, of which 532 are public, 1208 staff and 87 spaces available for blue badge holders (DDA). On the CGH site there are a total of 11 car parks providing 741 car parking spaces, of which 192 public, 437 staff and 40 Oncology patient car parking spaces with 56 spaces for blue badge holders. What are the financial implications of this There are no changes anticipated to income move? or workforce and so the financial impact is neutral How are you going to measure if this change There are a wide range of quality, outcome, has been successful in improving patient and patient and staff performance measures that staff experiences and outcomes? are monitored to assess the impact of any changes. In addition there are currently 5 items on the GHFT Risk Register with regard to emergency general surgery which would be monitored; they are: A risk of unsafe surgical staffing caused by a combination of insufficient trainees and excessive work patterns. 13.2 A risk of patient safety caused by insufficient senior surgical cover resulting in delayed senior assessment and treatment. A risk to safe service provision caused by an inability to provide an
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appropriate training environment leading to poor trainee feedback which could result in a reduction in trainees and therefore adversely impacting on the workforce. A risk of sub-optimal care for patients with gall-bladder disease and other sub-specialty conditions caused by a lack of ability to create a sub- specialty rota which could result in inequitable care and different clinical outcomes. A risk of sub-optimal care caused by the limited day time access to emergency theatres resulting in an increased length of stay and poor patient experience. Why can’t you build a new hospital in the Over a billion pounds would be required and middle? although Gloucestershire County Council does have this as a goal for the future, it would take 12-15 years to deliver. It in meantime we need to provide the best care with the resources that we currently have. Will you consider the support services when This is a really important point, no service you make this change for example can move without the support of other Pathology? services. During the months before the start of the pilot weekly task and finish meetings were held with all associated services, pathology, pharmacy, therapy, theatre, nursing, radiology and the emergency department to ensure that SOPs were in place and rotas etc. had been amended to reflect the changes. How will you ensure resilience when you This would not change, sadly these have an outbreak of Norovirus or Covid and outbreaks can and do occur at either site. 13.2 have to shut wards? There is a dedicated infection control team who advise on a daily basis with the optimal way to segregate and treat patients who have or are exposed to these infections. Have you been working with the ambulance Yes, we have been working closely with the service when looking at these changes? ambulance trust to ensure that all options
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are deliverable. What will there be about CGH to attract There are no proposals to remove surgery anybody to work there, if surgery is removed from CGH altogether. Surgery for urology, from Cheltenham altogether? gynae-oncology, elective orthopaedics, breast surgery and day surgery will be based at CGH. Elective colorectal surgery is being discussed as part of the programme with options for centralisation at either CGH or GRH. Which hospital is safer, Gloucester or Both are safe, all service moves are carefully Cheltenham? considered and safety is of paramount importance. If the executive team and external agencies are not reassured that a proposal is safe, it would not be considered. Haven’t you already made the decision There is a preferred option for emergency about where you are going to locate surgery which is at GRH and for day surgery services? at CGH. These recommendations come after significant work to assess the best options by assessing the patient benefits of co-locating services. As there was not a preferred option for elective colorectal surgery, either CGH or GRH, both were included in the consultation; the feedback of which is carefully considered before decisions are made on any permanent changes.
Image Guided Interventional Surgery (IGIS) including Vascular Surgery Are you going to invest in the theatres at Yes. We would convert theatre capacity at GRH to provide an environment at least GRH to a ‘hybrid theatre’ facility to allow comparable to that already in Cheltenham? complex endovascular procedures to be undertaken. The existing hybrid facility at CGH would be converted to a standard theatre. How are you going to ensure there are FIT FOR THE FUTURE is a long term strategic enough beds at GRH to manage the extra plan, which would take a number of years to 13.2 demand? implement. We are investing in new facilities at both hospitals which will increase the number of patients we can look after; for example 41 additional beds at GRH as well as improved day case theatre facilities at CGH. Are you planning to invest in the ward space Absolutely. It would be important to ensure
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for this patient group if this change goes services are allocated a sufficient number of ahead? beds to manage their patient throughput, and that these beds are within an appropriate environment which supports the delivery of excellent care. Why did you invest in a hybrid theatre in In 2007 the decision was taken to centralise Cheltenham to then decide to move the Vascular Surgery. At that time an options service? appraisal was undertaken to consider the benefits of centralisation at either CGH or GRH. CGH was selected as the preferred location. The proposal we are now consulting on to relocate the Vascular arterial centre (regional hub) to GRH is in consideration of the current and proposed configuration of services. Critical to this is the relationship with general surgery, the benefits of centralising emergency general surgery at GRH, and the requirement for general surgery staff to form part of the on- call surgical rotas for Vascular Surgery. The Hybrid facility in CGH was installed in 2013, and the technical equipment within it is now reaching its planned end of life. Will the proposed change mean that The proposals are to relocate the vascular planned vascular surgery is less likely to be arterial centre and inpatient bed base to cancelled? GRH. This would mean that complex endovascular surgery and vascular surgery patients requiring an overnight stay in hospital would take place in the safest environment, with other emergency services available to assist at the same location 24/7 should complications arise. Approximately one third of surgical interventions undertaken in vascular surgery are conducted as day cases. Elective day case 13.2 procedures would be undertaken at CGH in the new Day Surgery unit, allowing these vascular patients to benefit from the Centre of Excellence for Elective Care. Do these proposals cover all of vascular or These proposals would move all emergency are you going to split emergency and vascular work to GRH. Any vascular
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planned between the two hospitals? procedure requiring an overnight stay would also be undertaken at GRH, as well as complex surgery and endovascular surgery requiring the hybrid theatre facility. Approximately one third of our vascular procedures are undertaken as day cases and these would be conducted at the new Day Surgery unit at CGH. Why are you centralising vascular at GRH Interventional cardiology is part of the FIT and leaving cardiology at CGH? FOR THE FUTURE Phase 1 scope and it is proposed this is located at GRH with vascular surgery. The wider cardiology service is expected to form part of the FIT FOR THE FUTURE Phase 2. All configuration scenarios will be considered during this process and appraised in order to determine the preferred configuration. Trauma and Orthopaedics (T&O) inpatient services 1. Trauma and orthopaedic need to go The orthopaedic service has always been together. It would be VERY confusing to split divided into two categories, trauma and them. You've GOT to start treating this as elective (planned) surgery. Although there one hospital over 2 sites; not 2 different are some similarities the two work quite hospitals. EVERYTHING trauma and differently and have completely separate orthopaedic at Gloucester. How will this wards (even on the same site). The reason work across 2 sites with transferring patients for this is that for many orthopaedic and ambulance admissions? And operations, for example joint replacements 2. Because the two are so closely linked, why need ultra clean environments to prevent not have one Centre of Excellence in one infection, so the elective wards are ring- place? fenced for this group alone and patients 3. Why are these separated at two sites? Are have stringent tests for MRSA, MSSA and they not related, so should be together on COVID 19 before admission. one site? Separating facilities for emergency care (from planned care) would ensure that, if you have a life or limb threatening emergency, the right facilities and staff 13.2 would always be available to give you the best possible chance of survival and recovery. Conversely separating the elective (planned) surgery would mean a smaller chance of cancellation at short notice. It would also be impossible to have the
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whole service on one site as the infrastructure does not allow this. 8 laminar flow theatres would be required on one site. I think it makes sense to have trauma on one This is a very important point. The pilot was site but there needs to be adequate started at the end of 2017. The majority of orthopaedic cover for the other site. Will this the out of hours team will be working with happen? the unscheduled or Trauma site. However it is essential that the elective site is also fully covered. There is a separate doctor rota at the elective site together with a team of dedicated nurses, therapists, pharmacists, radiographers and extended scope practitioners. In the early days of the pilot we also started a daily ward round for elective patients as we felt there was a gap in service provision. Will sites be able to cope with capacity? Yes, the service is very large and was previously spread across the site so was able to refine the service within the existing footprint. Are both sites fit for purpose? Yes, but centralising the service onto separate sites is really just the beginning; it provides the foundation to build for the future. For example the service has continued to evolve with Enhanced Recovery after Surgery work and rationalisation of surgical equipment in elective surgery and the implementation of a Trauma Assessment & Treatment Unit within Trauma services Has the recent pilot trialling this been Yes, many things have improved for successful? example: Trauma: Now there is a review of every trauma patient 24/7. There is always a senior orthopaedic 13.2 surgeon available to respond to patients in ED. The feedback from junior doctors regarding training is much improved Elective: There are significantly fewer
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cancellations There are increased volumes of hip and knee surgery ( until theatre refurb in 2019 and COVID in 2020) Changes have facilitated improvements in ERAS. However the service continues to evolve and improve with the provision of Trauma Assessment & Treatment Unit and responding to the needs of the patients and staff. Will Pathology to be taken into account with This is a really important point, no service these decisions - especially Blood can move without the support of other Transfusion? services. During the months before the start of the pilot weekly task and finish meetings were held with all associated services, pathology, pharmacy, therapy, theatre, nursing, radiology and the emergency department to ensure that SOPs were in place and rotas etc. had been amended to reflect the changes. Only makes sense if full A&E restored at Cheltenham? There is a national trauma network in place. For Gloucestershire the Trauma Centre is in Bristol but Gloucestershire Royal Hospital (GRH) is designated a Trauma unit. Therefore the only patients attending Cheltenham General Hospital (CGH) for a trauma injury will be those who ‘walk in’ or those that the ambulance teams have assessed can be managed at CGH. There are well established operational policies in place to manage any patients that need to be transferred from CGH to GRH for admission. 13.2
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8. Evaluation
8.1 Considerations and learning points for future engagement and communication activities
Our approach to evaluating the effectiveness of our consultation activities locally is to apply a well-known quality improvement methodology, using an iterative process: Plan, Do, Study, Act (PDSA cycle) https://improvement.nhs.uk/documents/2142/plan-do-study-act.pdf
We have applied the following evaluation framework. Engagement (and Consultation), Experience and Inclusion Evaluation Framework developed by The Science and Technologies Facilities Council has developed a useful engagement evaluation framework, https://stfc.ukri.org/files/corporate-publications/public- engagement-evaluation-framework/ We have adapted this to support the STUDY element in our Engagement, Experience and Inclusion PDSA Cycle
Dimension Definition Response
Inputs Engagement A comprehensive Fit for the Future communications and (and consultation plan was developed to support the consultation Consultation), activity. This plan, assured by NHS England/Improvement experience and and independently by The Consultation Institute, set out the inclusion inputs approach to communications and consultation. In response include the to pandemic restrictions, the plan was developed to support time, skills and a ‘socially distanced’ consultation. This included the money that are development of more online methods such as the new Get invested into Involved in Gloucestershire online participation platform; delivering independently chaired Gloucestershire Media engagement @GlosLiveOnline discussions and Gloucestershire Hospitals activities. NHS Foundation Trust Facebook Live produced clinical discussions. The plan was evaluated using an Engagement and Equality Impact Assessment https://www.onegloucestershire.net/wp- content/uploads/2020/10/Equality-and-Engagement- Impact-Assessment-FINAL-1.pdf 13.2 Outputs Engagement Over 75 engagement events were held. The majority of (and events were held on line. The Information Bus Tour were consultation), socially distanced face to face events. experience and inclusion Approximately 5000 information booklets were produced outputs are the and distributed in local communities. activities we 149
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undertake and the resources A door to door drop of 297,000 delivered information to that we create. households in Gloucestershire. This resulted in over 1,700 requests for information. This was a key method for ensuring that people not able to access materials on-line were able to engage with the consultation.
Feedback received did include comments on the Fit for the Future communications and consultation process itself. Feedback received was a mixture of positive and negative comments. An example of learning from feedback of this kind from the earlier Fit for the Future engagement was the suggestion to use of QR codes on future publications to allow people to link quickly to website materials. A QR code was added to the Fit for the Future consultation materials.
Reach Reach has two Total face-to-face contacts was more than 1000 (public) and main elements: more than 350 staff. More than 700 Fit for the Future The number of surveys completed. There were 22 Facebook posts with a people reach of over 90,000. 38 tweets generated over 30,000 engaged, this impressions and over 750 engagements. includes attendance at We do not routinely collect demographic information about events, individuals participating in events/drop-ins etc. completion of Demographic information was collected through our survey, surveys, social but these questions were optional and consequently were media not always completed. However, the demography of the interaction etc. county is considered during consultation planning and events/meetings targeted to reach a wide range of The types or communities of interest and those groups identified though diversity of the independent Integrated Impact Assessment. people engaged. Outcomes Outcomes are The consultation has been independently Quality Assured by the way that The Consultation Institute. A Consultation Institute Advisor audiences worked with the Fit for the Future programme, acting as a respond to the critical friend; each stage of the consultation planning and engagement, activity was formally signed-off by a Consultation Institute experience and Assessor, ensuring a totally independent element in the 13.2 inclusion consultation process. The six stages, or gateways, of the activity – Quality Assurance process are: completed Scope and Governance event The Project Plan evaluation Consultation Document Review forms, Mid-Point Review*
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independent Closing Review observation Final Report reports *The Mid-Point Review considered the efficacy of the consultation activities to date and those planned for the second half of the consultation period to identify any potential gaps in opportunities for participation. Prior to the Mid-Point review Covid-19 Lockdown#2 necessitated the postponement of some Information Bus Tour Dates, alternative locality online ‘Cuppa and Chats’ were arranged to provide opportunities for geographically based participants to discuss the consultation proposals. The Information Bus Tour recommenced after the end of Lockdown#2
Processes Processes are See above The Consultation Institute Quality Assurance the way we process. work to plan, develop and Inclusion Gloucestershire: Assisted with the development of deliver our Easy Read materials. engagement, experience and inclusion Gloucestershire County Council’s Digital Innovation Fund activities. They Forum: Informed early planning for online activities and include our assisted with awareness-raising of the consultation to approaches to potentially digitally excluded groups. quality assurance and Friends from the Friendship Café in Gloucester City: following good Supported awareness raising and survey completion within practice. diverse communities.
Healthwatch Gloucestershire (HWG): HWG Readers Panel reviewed an early draft of the full consultation booklet and made suggestions for changes, which were incorporated into the final version. A HWG representative will be a member of the independent Oversight Panel for the second Fit for the Future Citizens’ Jury.
Aneurin Bevan Health Board (ABHB): ABHB facilitated the 13.2 translation of the summary consultation booklet into Welsh, and facilitated an Information Bus visit to Chepstow Hospital in Monmouthshire to enable residents living close to the Wales England Border, who might access services in Gloucestershire the opportunity to find out more about the consultation.
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Know Your Patch (KYP) Coordinators: KYPs allowed us space on agendas to share information at online meetings during October and November 2020 to promote the consultation.
District/Borough Councils and Retail partners: Supported the ‘socially distanced’ visits of the Information Bus (outside of Lockdown 2) to locations with maximum footfall across the county. District and Borough Councils also hosted members’ seminars to discuss the Fit for the Future consultation.
Local media: Gloucestershire Live, BBC Radio Gloucestershire and GFM Radio
Others: Many other groups and individuals have helped to raise awareness of the consultation such as Trust Governors, staff-side representatives, hospital volunteers and community and voluntary sector organisations such as homelessness support charities.
8.2 ACT (following Fit for the Future engagement) The following actions were undertaken following feedback received during the FIT FOR THE FUTURE engagement to support future communications and engagement associated with FIT FOR THE FUTURE Programme: Inclusion Gloucestershire participants identified the following areas for us to consider to improve engagement further (extract from Inclusion Gloucestershire Engagement Report): Less information, less jargon and easy read copies of all information. From our experience, people who represent the seldom heard groups tend to need more time and preparation to support them to engage. It would have been helpful to have had at least two weeks research time prior to each area workshops. Workshops to be held later in the morning to enable people who use public transport to use their bus passes. Workshops to be held in the actual areas and at times that people can attend. For example: Tewkesbury was held in Highnam for 09.00am, Stroud and Berkley Vale held in Nailsworth for 09.00am and North Cotswolds was held in Cirencester for 09.00am. Some people from the BME communities were not able to engage in the workshops 13.2 due to a language barrier. Going forward it might be more beneficial to liaise with community leaders to hold specific workshops within the BME communities with community support for interpreters. We know that there are many barriers for people from the BME communities accessing health care. For many, they don’t know how to ask for the health care that they need or struggle to understand treatment options.
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For One Gloucestershire to go out to community groups such as the Inclusion Hubs for those who need to go at a slower pace and for a wider group of people to be included in the process.
8.3 ACT (following Fit for the Future consultation) The following actions will be undertaken following feedback received during the Fit for the Future consultation to support future communications and engagement:
The consultation targeted the visually impaired people through representatives from the Sight Loss Council, the Macular Society and RNIB. The following suggestions were shared with the consultation team in order for them to reach more people with Visual Impairment: o Place adverts in Talking newspapers o Use BBC local radio o Focus on promotion of telephone line and ability to order large print copies of the booklet o Focus on voice based/telephone based contact as most of people with visual impairment don’t use desktops/laptops and rely on mobile phones.
The consultation targeted the homeless people; the consultation team now has established good links with homelessness charities in Gloucestershire, these networks should be maintained and development further through links with the Gloucestershire Hospitals NHS Foundation Trust Homeless Specialist Nurse.
The consultation targeted travelling communities; the consultation team now has established good links with the County Council Traveller Welfare Officer. Plans to improve communications for travelling communities about local NHS services are planned for 2021.
The consultation used more online participation methods than ever before. These proved to be very popular with groups who may not have engaged with consultations before and facilitated easier access to more people who may not have previously been willing or able to attend face to face events. The One Gloucestershire Communications and Engagement Sub Group will review the current online methods available and consider opportunities for maximising their use for future engagement and consultation activities; in particular use of a range of online platforms will be explored to maximise choice and access.
13.2
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9. Copies of this report
This report is available on the One Gloucestershire website at: https://www.onegloucestershire.net/yoursay/ and on the online participation platform Get Involved in Gloucestershire https://getinvolved.glos.nhs.uk
Print copies of the report can be obtained from the NHS Gloucestershire Clinical Commissioning Group Engagement and Experience Team by calling: Freephone 0800 0151 548 or email: [email protected]
13.2
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13.2
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Gloucestershire Clinical Commissioning Group
Audit & Risk Committee
Minutes of the meeting held at 9:30am on 15th September 2020
Via MS Teams Members Present: Colin Greaves CG Lay Member, Governance (Chair) Dr Hein Le Roux HLR Deputy Clinical Chair Peter Marriner PM Lay Member, Business Alan Elkin AE Lay Member, Patient and Public Experience In Attendance: Gerald Nyamhondoro GN Governance Officer (taking minutes) (Agenda Item 13) Cath Leech CL Chief Finance Officer (Agenda Items 8, 10, 11 & 18) Alex Walling AW Engagement Lead, Grant Thornton LLP (Agenda Item 6) Justine Turner JT Internal Audit Manager, BDO LLP (Agenda Item 5) Paul Kerrod PK Deputy Head, Counter Fraud Service (Agenda Item 7) Adam Spires AS Internal Audit Manager, BDO LLP (Agenda Item 5) Haydn Jones HJ Associate Director, Business Intelligence (Agenda Items 12 & 14) Penny Fowler PF Commissioning Manager (Agenda Item 9) Mark Walkingshaw MW Deputy Accountable Officer & Director of (Agenda Item 9) Commissioning Emily Beardshall EBs Deputy ICS Programme Director (Agenda Item 15) 14
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1. Apologies
1.1 Apologies were received from Dr Will Haynes and Jo Davies.
1.2 The meeting was confirmed to be quorate.
2. Declarations of Interests
2.1 The Chair presented the formal Register of Interests of members of the Audit & Risk Committee. HLR declared a general interest of GPs in Primary HealthCare services. The committee considered the declaration and concluded that the participation of HLR with full rights of members was not prejudicial to the proceedings, or to the Gloucestershire Clinical Commissioning Group (thereafter “the CCG”), or in any other conceivable way.
The Chair announced that due to pressure on the part of presenters from other competing commitments the meeting would not follow the order set out on the agenda but would prioritise agenda items in response to the availability and time constraints on affected presenters.
3. Minutes of the Previous Audit & Risk Committee Meeting
3.1 Minutes of the meeting held on Tuesday 14th July 2020 were approved as an accurate record of the meeting, subject to the following amendment: The second sentence of paragraph 4.5 should read as follows: “CG asked Christina Gradowski (CGi) and Lauren Peachey (LP) to progress the drafting of the proposed constitutional reforms”.
4. Matters Arising
4.1 26.09.19, Agenda Item 5.2.10 Safeguarding. CG explained that the 14
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primary responsibility of Safeguarding within GP Practices lay with GP Practices and the CCG needed reassurance from the Practices. CG further stated that there was a need to review and improve Safeguarding education, training and monitoring mechanisms. CGi discussed how to capture training statistics with JB, specifically level 2&3 Safeguarding training. Members requested that JB investigate how to capture the numbers expected for level 2 & level 3 multi-disciplinary training. Item remains open.
4.2 17.12.19, Agenda Item 18.1 Any Other Business. CG stated that the postponement of the review of the committee’s terms of reference was a result of delays in the pending constitutional reforms. CG asked Christina Gradowski (CGi) and Lauren Peachey (PL) to progress the drafting of the proposed constitutional reforms. Pressures from Covid-19 pandemic had resulted in constitutional reform slippage. The committee would review this item on 8th December 2020. Item remains open.
4.3 17.12.19, Agenda Item 4.1.1 Continuing HealthCare. Fast Track. 17.12.19, Agenda Item 4.2.1 Continuing HealthCare. Standard 28-Day Target. 10.03.20, Agenda Item 5.4.6 Personal Health Budget (PHB). 10.03.20, Agenda Item 5.6.2 Follow-up of Audit Recommendation on Continuing HealthCare. Outstanding Reviews. 10.03.20, Agenda Item 5.6.2 Follow-up of Audit Recommendation on Continuing HealthCare.
The committee discussed the Matters Arising relating to Continuing Health Care (CHC) and Personal Health Budget (PHB) and the impact of the Covid-19 response on the service. It was proposed by the Chief Finance Officer that the CHC team present to a Governing Body Development Session on the CHC recovery programme, including the Hospital Discharge Schemes following the Covid-19 response as this should pick up a number of the areas covered and this would also ensure that there was sufficient time allocated to the subject. This was 14 agreed along with an update from KF and DS at the Audit & Risk
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Committee on the 8th December.
4.4 10.03.20, Agenda Item 5.6.2, Follow-up of Audit Recommendation on Safeguarding Children. To ensure that there was at least 95% compliance with mandatory training Level 1, the committee requested that Marion Andrews-Evans and her team provide: information on the current position regarding the Practices’ response to Self-Assessment, including reassurance on Safeguarding by Primary Care; current statistics on Safeguarding training.
ABs and JB were requested to present an update to the Committee on 8th December 2020. Item remains open.
4.5 26.09.19, Agenda Item 5.2.10 & 14.07.20, Agenda Items 4.1.1 – 5.6.2, Personal Health Budget, Continuing HealthCare and Safeguarding. CL clarified that the matters mentioned in paragraphs 4.4 and 4.6 – 4.10 of the meeting held on 14th July 2020 would be covered during Business Sessions to be held prior to the 8th December review. Item remains open.
4.6 10.03.20, Agenda Item 5.6.2, Follow-up of Audit Recommendation on Risk Maturity. Identifying Key Performance Indicators (KPIs) as a tool for measuring the effectiveness of risk management activity at the CCG. Members would review this item on 15th September 2020. Closed.
4.7 10.03.20, Agenda Item 8.3, Risk Management. The committee requested that a Risk Change report and a risk Heat Map be run. The committee would review this item on 15th September 2020. Closed.
4.8 10.03.20, Agenda Item 8.3, Risk Management. The committee requested that arrangements be made for directorates to come before the committee to present their risks and mitigations. The committee would review this item on 15th September 2020. Closed. 14
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4.9 14.07.20, Agenda Item 6.3.1, Counter Fraud Progress Report. The outcome of the staff survey jointly conducted by Counter Fraud and two other CCGs in the South West would be presented to the committee on 15th September 2020. Closed.
4.10 14.07.20, Agenda Item 6.4.5, AE raised a query as to why Standard 1.8 was showing ‘amber’ risk. CL explained that the contracts team were still assessing and mitigating relevant risks. The committee requested an update on progress. Closed.
4.11 14.07.20, Agenda Item 7.4, Risk Management. CGi reassured that the Governance team was committed to supporting directorates and Risk Leads to recover from the slippage through offering further training to Risk Leads. Closed.
4.12 14.07.20, Agenda Item 17.4.1, Audit Follow-Up. JT gave a verbal update on the follow-up report and explained that BDO LLP had started its audit work. JT added that the auditors had finished the fieldwork on individual projects and they were in the process of drafting the report which would be made available at the next committee meeting. JT gave a general outline of the preliminary Audit Plan. Item remains open.
The Chair directed that the meeting proceed to Agenda Item 7.
7. Counter Fraud
7.1 Progress Report
7.1.1 PK presented the report and stated that there was a need to increase awareness of fraud and bribery. The CCG was therefore required to demonstrate that there was an on-going programme of work to raise awareness premised on comprehensive policies, policy reviews and proactive engagement with external organisations. PK outlined the 14
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progress made on work carried out since July 2020. Members discussed the contents of the Progress report.
7.2 Counter Fraud Functional Standard
7.2.1 PK explained that the Counter Fraud Centre of Expertise formally published the Counter Fraud Functional Standard in June 2020.
7.2.2 PK reassured that in terms of implementation, Counter Fraud Authority (CFA) intended to introduce the Functional Standard through consultation with stakeholders to ensure that the stakeholders would add input regarding how the Standard was implemented at local level.
7.2.3 PK added that in terms of administration and governance of the process there was no intention to change the current online process of submission, and the authorisation process would continue to require reviews by the Audit & Risk Committee Chair and final approval by the Chief Finance Officer. Members discussed the report.
7.3 RESOLUTION: The Audit & Risk Committee noted the contents of the Counter Fraud report.
Paul Kerrod exited the meeting at 10:05am.
The Chair re-directed the meeting to proceed to Agenda Item 5.
5. Internal Audit Report
5.1 Progress Report
5.1.1 AS presented and explained that the report was intended to inform the Audit & Risk Committee of progress made against the Internal Audit Plan. AS also gave an update on emerging issues relevant to HealthCare. 14
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5.1.2 AS stated that HM Revenue & Customs (HMRC) published details in relation to home working, including expenses that could be paid tax-free. AS added that BDO LLP could help with advice on payments that could be subjected to tax and those which could be paid tax-free.
5.1.3 AS stated that the NHS aimed to build on the creativity and drive shown by the NHS personnel in their response to the Covid-19 pandemic. AS described the increased focus on fostering a culture of inclusion and belonging which now existed in the health service sector.
5.1.4 AS explained that BDO LLP would be, starting from 16th September 2020, hosting the first of a series of on-line ‘Employment Tax Club’ meetings which focused on challenges faced by the public sector.
5.2 Individual Funding Requests (IFR)
5.2.1 JT presented the report and stated that IFR related to clinical interventions which the CCG did not commission on routine basis. JT explained that IFR treatments needed to be approved by the Triage Panel and the IFR Panel.
5.2.2 JT described areas of good practise which included comprehensive IFR, Criteria Based Access (CBA), Prior Approval (PA) policies and Standard Operating Procedures (SOPs).
5.2.3 JT stated that the auditors however noted that out of the 83 policies and treatment criteria listed on the Effective Clinical Commissioning Policies (ECCP) Master List, 12 were either not updated in a timely manner or were not attached on the CCG’s website properly. The auditors gave substantial assurance on design control and moderate assurance on operational effectiveness.
5.3 Blockchain Survey Report 14
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5.3.1 AS presented the report and explained that BDO LLP participated on a global survey on utilisation of blockchain technology. AS described blockchain as a computer technology tool which was in its early stages of development.
5.3.2 AS emphasised that blockchain was an enabler of an entirely new level of information exchange within and across industries. AS outlined the connections between cloud and artificial intelligence and explained blockchain’s potential in helping organisations create and realise new value for solutions beyond those offered by current technologies.
5.3.3 AS reiterated that the level of blockchain utilisation was still low across all sectors but there was a growing awareness of blockchain technology. AS added that it appeared blockchain would be an increasingly valuable tool in the long term.
5.3.4 AS summarised impediments to blockchain technology as follows: lack of blockchain regulation; lack of political will to adopt the technology; high implementation costs.
5.4 Internal Audit Follow-Up of Recommendations
5.4.1 JT updated members on the follow-up of recommendations and described the progress made. Members requested that JT and AS provide further update on 8th December 2020.
5.4.2 JT stated that the required amendment to the constitution was overdue. CG concurred and explained that CGi had been delegated other priority tasks. Members expressed their wish to have the constitutional issues attended to and have the amended constitution signed off by NHS England by the end of 2020. Action: Mary Hutton (MH) and Christina Gradowski (CGi). 14
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5.5 RESOLUTION: The Audit & Risk Committee noted:
The contents of the Progress report. The contents of the Individual Funding Requests report. The contents of the Blockchain Survey report. The contents of the Audit Follow-up of Recommendations report.
6. External Audit Report
6.1 Progress Report
6.1.1 AW presented the report and stated that Grant Thornton LLP had begun planning the 2020/21 audit and were discussing with management on the best approach to the financial and value for money audits. AW added that the auditors were reviewing Governing Body papers and the latest financial and operational performance reports. The auditors were also considering relevant reports from regulators.
6.1.2 AW explained that Grant Thornton LLP expected to issue their Audit Plan summarising the approach to key risks in January 2021. AW stated that the timelines for Interim Audit Findings, Audit Findings (ISA 260) report and Auditors report and Annual Audit Letter were still to be agreed.
6.2 Sector Update
6.2.1 AW discussed the sector update and emphasised that HealthCare was a rapidly changing sector. AW further stated that providers and commissioners faced the challenge of rising public expectations, an ageing population and advances in medical technology.
6.2.2 AW highlighted areas from the sector update including that the establishment of Primary Care Networks (PCNs) was one of the most 14
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important reforms to Primary Care in England in recent years and that PCNs created an important opportunity to develop more comprehensive approaches to primary mental healthcare.
6.2.3 AW further identified some of the gaps in the provision of health services as follows:
the provision of Mental Health support in Primary Care did not meet the full range of the needs of children, adolescents or older people; the Covid-19 pandemic increased the workload in both Primary Care and Mental Health services; psychological therapy services developed through the Improving Access to Psychological Therapies (IAPT) programme provided valuable support to treatment for many people but did not present a complete solution to the range of challenges that exist in Primary Care; a significant number of people had their referral to specialist Mental Health services rejected and this often left GPs supporting people with needs the GPs were not fully equipped to manage.
6.2.4 CG commended the report especially its coverage of Primary Care and Mental Health issues. AE who chairs the Primary Care Commissioning Committee (PCCC) stated that the report was a valuable source of relevant information for the PCCC and he expressed an interest and commitment to taking the report to the PCCC. Action: Alan Elkin (AE), Helen Goodey (HG) and Kim Forey (KF).
6.3 RESOLUTION: The Audit & Risk Committee noted the contents of the External Audit and Sector Update report.
The Chair directed the meeting to proceed to Agenda Item 10.
10. Summaries of Procurement Decisions 14
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10.1 There were no summaries of procurement decisions
10.2 Procurement Purchase Orders (Covid-19 Related)
10.2.1 The report was presented and covered the temporary and auditable system designed to generate Emergency Purchase Orders without derogating from established purchasing policy. Two purchase orders relating to Covid-19 activity were presented.
10.3 RESOLUTION: The Audit & Risk Committee noted the contents of the Summaries of Procurement Decisions.
11. Waiver of Standing Orders
11.1 Procurement Waiver of Standing Orders (Business as Usual)
11.1.1 CL stated that there were 9 Business as Usual waivers of standing orders requested and approved. PM queried the high rentals at Big Yellow storage facilities. CL responded that the CCG was mindful of the need to reduce storage costs but the CCG required significant storage space and Big Storage had low charges relative to the space provided.
11.1.2 CG commented on waiver 412/08/2020 which related to G.DOC Ltd and he emphasised a need to adhere to due process when handling transactions or contracts. CG requested for demonstration of due diligence preceding the delivery of spirometry testing service by G.DOC Ltd to GHFT. Action: Cath Leech (CL).
11.1.3 CG raised a question relating to waiver 403/07/2020, Direct Access to 24-hour Electrocardiogram (ECG) for South Cotswolds Locality and Tewkesbury / Newent / Staunton Locality. CG asked that assurance of improvement in the quality of service from this service should be brought before the Quality & Governance Committee. Action: Peter Marriner 14
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(PM) and Alan Elkin (AE).
11.2 Procurement Waiver of Standing Orders (Covid-19 Related)
11.2.1 There were no waivers of standing orders relating to Covid-19 activity for the period starting from 4th July 2020 and ending on 4th September 2020.
11.3 Personal Protective Equipment (PPE) Donations to the CCG during the Covid-19 Pandemic
11.3.1 There were no donations of PPE made to the CCG since the previous Audit & Risk Committee report which was presented on 14th July 2020.
11.4 RESOLUTION: The Audit & Risk Committee noted the contents of the Registers of Waivers of Standing Orders.
The Chair directed the meeting to proceed to Agenda Item 16.
16. Losses and Special Payments Register
16.1 There was nothing to report on this item.
17. Debts Proposed Write-offs
17.1 There was nothing to report on this item.
18. Aged Debt Report
18.1 CL presented the Aged Debt report which provided a summary of the Aged Debt as at 2nd September 2020. CL stated that the outstanding debt as per the Sales Ledger was £1,589,920 of which £1,095,695 was NHS and £494,224 was non NHS. CL clarified that £491,000 of the Sales Ledger debt was not yet due for payment. CL gave a breakdown of the NHS debt and the non NHS debt. Members discussed the contents 14
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of the report.
18.2 RESOLUTION: The Audit & Risk Committee noted the position of debtor balances and the actions being taken to recover the debts.
Penny Fowler and Mark Walkingshaw joined the meeting at 11:00am.
The Chair re-directed the meeting to proceed to Agenda Items 8 and 9.
8. Gifts & Hospitality and Commercial Sponsorship & Rebates
8.1 There was nothing to report on this item.
9. Overarching Risk Report
9.1 CG presented the report and stated that there was now a new 4Risk system in place to provide timely updating, reporting and senior oversight of risks. CG added that 4Risk was easier to use but the disadvantage with this new system lay in that it did not separate confidential from non- confidential information on risk matters. CG emphasised that practical and legal consideration required separation of confidential from non- confidential risks. CG stated that he would work closely with the risk management team to address this issue. Action: Colin Greaves (CG), Christina Gradowski (CGi) and Lauren Peachy (LP).
9.2 CG presented the Corporate Risk Register (CCR), the Governing Body Assurance Framework and Key Performance Indicators (KPI) before the committee. Members reviewed the KPIs and were happy with the KPIs but expressed some reservations on Heat Mapping. PM stated that risk monitoring and performance could be aided by tightening oversight on Risk Leads and by demanding comprehensive explanations for any shortfalls in the directorates’ performance positions.
9.3. Members reviewed the new risks and they were happy with the inclusion 14
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of all risks except risk ID17. Members referred risk ID 17 which related to End of Life (EoL) budget overspent back for further review. Members reviewed the risks recommended for closure and they were happy to close the risks.
9.4 Risk Management Performance – Commissioning Directorate
9.4.1 PF who is a Risk Lead presented. PF stated that the Commissioning directorate (thereafter “the directorate”) currently had 7 risks which covered key areas of the work streams within that directorate. PF added that the directorate had more detailed operational registers which were sub-sets of the key work streams. PF stated that the directorate had linked its risks with other risks within the CCG.
9.4.2 PF described the highest directorate risks as risks CD3 and CD4. These risks referred to the non-delivery of the constitution standard for maximum wait of 4 hours within the emergency department; and the risk of failure to reduce demand and prevent unnecessary acute attendances and emergency admissions, respectively. Members commended the report and the quality of work produced by PF and the directorate.
9.5 RESOLUTION: The Audit & Risk Committee:
Noted the contents of Risk Management report. Noted the contents of Corporate Risk Register. Noted the contents of Governing Body Assurance Framework. Considered the risk KPIs and provided feedback. Approved the following new risks:
1. ID 20 relating to lack of Psychology resource in Community Services which deliver rehabilitation. 2. F&ID 10 which stated that Gloucestershire HSCN migration was behind schedule and could possibly not meet the deadline. 14
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3. F&ID 11 which was risk that Practices which migrated to HSCN could be at a greater risk of cyber-attack. 4. F&ID 12 which stated that the benefits of JUYI might not be fully realised. 5. F&ID 13 which stated that the breadth of clinical data available through TPP strategic reporting extract was limited. 6. ID18 which referred to lack of appropriate capacity within the Evening & Overnight District Nursing team across the county impacting on patient care. Referred back risk ID 17 on EoL budget overspent for further review. Approved closure of risks: 1. ID 13 relating to lack of GP support for visiting people at home. 2. F&ID 6 relating to Shared Record Project.
Penny Fowler and Mark Walkingshaw exited the meeting at 11:10am.
Emily Beardshall and Haydn Jones joined the meeting.
The Chair directed the meeting to proceed to Agenda Item 14.
14. STP / ICS Solutions Update
14.1 HJ gave a verbal presentation and explained that the ICS was concentrating on recovery. Due to the response to the Covid-19 pandemic the NHS had an interim financial framework for months 1-6 and efficiency plans had been suspended.
14.2 HJ stated that discussions had started with the Gloucestershire Directors of Finance to restart the efficiency programme for the whole system and that this would include a focus on building on changes implemented during the Covid-19 period. 14
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14.3 RESOLUTION: The Audit & Risk Committee noted the STP/ICS Solutions update.
The Chair re-directed the meeting to proceed to Agenda Item 12.
12. Covid-19 Response – Non NHS Supplier Arrangements
12.1 HJ presented the report and stated that there were significant changes to health services as part of the response to Covid-19. This resulted in a need for contractual variation between the CCG and providers.
12.2 HJ added that arrangements with non NHS Suppliers had been governed by Cabinet Office Procurement Policy Notes (PPNs) and supplementary NHSE&I guidance. Such arrangements were now being reviewed as health services moved towards recovery and restoration.
12.3 HJ stated that some suppliers required additional support due to pressures of operating under Covid-19 conditions. He added that the CCG was carrying out a review of arrangements with the providers impacted.
12.4 RESOLUTION: The Risk & Audit Committee noted the Covid-19 Response – Non NHS Supplier Arrangements report.
The Chair directed the meeting to proceed to Agenda Item 15.
15. Bronze Cell & Issues Report
15.1 EBs presented the report and summarised as follows:
all Bronze Cells had recorded and reviewed risks; risks were being reviewed weekly; risks were being scored on the standard 5x5 matrix; 14
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there were a total of 123 open risks with 13 scored at 16 and 1 scored at 20.
15.2 EBs explained that there were risks that were categorised as ICS risks and there was a need to focus on establishing clear ownership of such risks. EBs stated that reconciliation between risk registers of the partners and the Bronze Cell risk registers was in progress.
15.3 EBs added that corporate risk registers were being populated with Covid- 19 risks and there was a good match across organisations. It was requested that the Bronze Cell & Issues report be circulated to members. Action: Gerald Nyamhondoro (GN)
15.4 RESOLUTION: The Audit & Risk Committee noted the contents of the Bronze Cell & Issues Update.
The Chair re-directed the meeting to proceed to Agenda Item 13.
13. Declarations of Interest Report
13.1 GN presented the report and explained that all employees and members of the Governing Body were required to declare their interests. GN added that effective and transparent handling of conflicts of interest gave confidence to the public, patients and HealthCare providers.
13.2 GN stated that as of 31st August 2020:
all Governing Body members had declared their interests; 96% of staff in bands 8A and above had declared their interests; 98% of staff in bands 7 and below had declared their interests.
13.3 GN emphasised that the Governance team was committed to ensuring that the CCG’s conflict of interest policy was effective and everyone required to declare interests complied. GN explained that the 14
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Accountable Officer offered support to the Governance team in their effort to achieve this objective.
13.4 GN stated that the Governance team recommended that, if practicable, the Conflict of Interest Guardian should, on annual basis, meet with the Accountable officer to review compliance levels. Action: Christina Gradowski (CGi).
13.5 AE suggested that in addition to the KPIs presented the actual number of staff who had complied and those who had not complied be circulated to members. Action: Gerald Nyamhondoro (GN).
13.6 RESOLUTION: The Audit & Risk Committee noted the contents of the Declarations of Interest report.
The Chair directed that the meeting proceed to Agenda Item 19.
19. Audit & Risk Committee Self-Assessment Report
19.1 CG presented the report and stated that appraising the committee’s performance clarified individual roles and the collective responsibilities of members. CG further emphasised that better knowledge of what was expected could help members become more effective in discharging their duties.
19.2 CG presented the self- assessment tools to members for review and adoption. Members reviewed and discussed the tools.
19.3 RESOLUTION: The Audit & Risk Committee approved the Self- Assessment tools.
20. Any Other Business
20.1 There was no other business to conduct. 14
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The meeting was closed at 12:00 noon.
Date and time of the next meeting:
The next meeting would be held at 09:30am on Tuesday 8th December 2020 via MS Teams.
Minutes Approved by the Audit & Risk Committee:
Signed (Chair):______Date:______
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Primary Care Commissioning Committee
(Meeting held in public)
Minutes of the meeting held at 9:45 am on 22nd October 2020
Virtually via Microsoft Teams
Present: Alan Elkin (Chair) AE Lay Member, Patient and Public Engagement Colin Greaves CG Lay Member, Governance Cath Leech CL Chief Financial Officer Mark Walkingshaw MW Director or Commissioning Jo Davies JD Lay Member, Patient Engagement Marion Andrews- MAE Director of Nursing and Quality Evans In Attendance: Lauren Peachey LP Governance Manager (minutes) Jeanette Giles JG Head of Primary Care Contracting Jo White JW Programme Director, Primary Care Andrew Hughes AH Associate Director, Commissioning Stephen Rudd SR Head of Locality and Primary Care Development Christina Gradowski CGi Associate Director of Corporate Affairs
1. Apologies
1.1 Apologies were received from Julie Clatworthy, Dr Andy Seymour, and Mary Hutton
1.2 It was confirmed that the meeting was quorate.
1.3 The chair welcomed the members of the public who had joined the meeting. 15
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2. Declarations of Interest
2.1 There were no declarations of interest raised.
3. Minutes of the Previous Meetings
3.1 The minutes of the meeting held on the 27th August 2020 were approved as accurate.
4. Matters Arising
4.1 Item 6.14, 31/10/2019, Goal 5 of Primary Care Strategy: Digitally enabled: A demonstration of clinical systems for PCCC members to be arranged.
AE stated that a proposed date had been sent to members via email from LP. Action closed.
5. Lydney Practice
5.1 With regard to Lydney Practice, JW summarised there had been significant staffing changes within the last six months including two out of four partners retiring. JW said that the remaining two partners had tried to recruit additional partners but had not been successful. JW said that while the two remaining partners did not wish to hold the contract by themselves they were keen to stay working in the practice providing services to their patients. They had therefore explored suitable alternative options, the most attractive being bringing in GDoc to take on the GMS contract.
5.2 JW stated that GDoc were well known to the CCG. They hold two other medical services (APMS) contracts and have a proven financial history. Since the discussions had begun, a further salaried GP had joined the Lydney Practice. JW confirmed that the CCG had undertaken financial due diligence on GDoc as well as quality assurance. JW explained that GDoc were a membership organisation of the GP practices in Gloucestershire and they hold the contract for Gloucester Health Access Centre (GHAC) which was 15 Page 2 of 14 PCCC Part One Minutes 22nd October 2020
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situated in a deprived part of Gloucester.
5.3 JW reflected that GDoc seemed a good fit for the practice and emphasised that the partners were very keen on this option and it meant they would stay working in the practice. JW explained that GDoc were keen to support Lydney Practice as a GP Training Hub which was likely to improve the ability to recruit in the future. In addition to this, there was also an expected premises development in the Forest of Dean which would be supported by GDoc; this would ensure that provision of primary care medical services going forward were provided from fit-for-purpose premises.
5.4 JW continued to explain that the closest practice, Severnbank, had been made aware of the changes that were taking place and they were supportive, as were the local PCN leaders. The Patient Participation Group (PPG) and the League of Friends were also aware of this approach.
5.5 JW stated that there had been a novation of contract from Lydney to GDoc Ltd and a Contract Award Notice (CAN) had been issued. The CCG had been assured that GDoc would deliver a high level of care and service for the population of Lydney Practice.
5.6 RESOLUTION: The committee members noted the contents of the Lydney Practice Paper.
6. PCN Update Presentation
6.1 SR summarised that the GP contract agreement was issued in February 2020, reducing the anticipated five specifications for 20/21 to three. SR explained that this was updated in March as we entered into lockdown, postponing the specifications to October 2020 due to the primary care response required for COVID-19, while other elements of the PCN DES continued. SR stated that there had been a further update to the DES in September.
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the Additional Reimbursable Roles (ARRs) scheme for 20/21, with posts now 100% funded up to a maximum reimbursable amount. There was additional investment on top of this, with the ambition to create 26,000 additional posts nationally. The additional roles had been expanded from five to fourteen roles with the addition of the Nursing Associate and Training Nursing Associate from October 2020 (although Mental Health worker posts were not due to go live until April 2021).
6.3 SR explained that the new specifications for 2020/21 were therefore: Structured Medication Reviews and Optimisation; Enhanced Health in Care Homes and Supporting Early Cancer Diagnosis. Anticipatory Care and Personalised Care have been deferred until April 2021, when two further specifications are also anticipated: Cardiovascular Disease and Health Inequalities.
6.4 With regards to the Network Investment and Impact Fund (IIF), this was reduced in year 1. SR explained that this was mainly due to the change to the ARR scheme. However the intention was that there would still be £300m investment by the end of the contract.
6.5 SR explained that the IIF had been postponed until October 2020, with interim ‘PCN Support Funding’ at £0.27 per patient. The ARR scheme had continued as planned, although the workforce plans submissions due in August and October were both postponed by a month.
6.6 SR explained that there was a further DES update during September 2020 and although there were no significant changes, it did reflect an allowance for some flexibility in Enhanced Health in Care Homes and stated that the clinical lead may now be a non-GP clinician. In addition to this, the details of the IIF from 1st October were released.
6.7 SR summarised the key delivery from May 2020 to October 2020 and explained that a significant amount of work had been done on workforce plans and the ARRs, amongst other areas. In terms of the ARRs, SR explained that the workforce planning identified 114 Whole Time Equivalent 15 Page 4 of 14 PCCC Part One Minutes 22nd October 2020
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(WTE) ARRs being added to Gloucestershire prior to the additional two roles being made available. SR further explained that this mainly consisted of growth in clinical pharmacists, social prescribing link workers, pharmacy technicians and care co-ordinators. SR explained that the Forest of Dean area were struggling to recruit into the ARR Scheme and the CCG were providing support in terms of centralised recruitment and exploring alternative employment models. SR advised that there had initially been challenges with the employment model in the Forest of Dean which had contributed to challenges in moving forwards with recruitment.
6.8 SR reminded the committee that, in terms of PCN Development Funding, the schemes for the previous year were brought to the committee for approval. SR explained that there would be similar funding for this year. SR further explained that the national priorities for 2020/21 were similar to last year; however, there was more focus on workforce, improving patient access, practice waiting times, and reducing health inequalities. SR emphasised that the funding had come through quite late in the year.
6.9 With regard to the ARRs, AE expressed concern that the areas of highest deprivation were experiencing the most challenges in recruiting to these new posts. AE queried if the CCG Primary Care Team had been able to focus efforts on supporting the PCNs in areas of higher need in recruiting the ARRs. SR responded that this was an area of high priority and they were keen to see that areas such as the Forest of Dean were able to recruit but there was further work to be done in this respect.
6.10 CG queried whether the funds remaining from the previous prioritisation were still available. SR advised that it was available on a draw-down basis. CG emphasised that the Forest of Dean was notoriously difficult to recruit to. CG queried if there was more that could be done to ensure the Forest of Dean was considered a more attractive place to work, and emphasised that the issue of recruitment within the Forest of Dean was frequently highlighted as a 15 Page 5 of 14 PCCC Part One Minutes 22nd October 2020
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challenge.
6.11 MAE highlighted the importance of practices welcoming the ARRs which were joining primary care. MAE explained that funding had been received for two more primary care pharmacy technician apprenticeships. MAE explained that Trainee Nursing Associates were fully funded for within primary care. This was, however, not the case in secondary care where they had to pay the salary for the Trainee Nursing Associates. SR suggested doing a joint communication to promote the Trainee Nursing Associates within Primary Care. MAE agreed that this was a good idea.
6.12 AE emphasised that the recruitment to the ARRs in Primary Care would have an impact on other organisations in the system and queried if detail was known on what this impact was. MAE responded that there was concern that the acute trust would pay to train nursing associates, who would then leave to secure employment in primary care. MAE explained in this context that primary care was being encouraged to recruit into the Trainee Nurse Associate roles.
6.13 CGi explained that the workforce group had recently met and, with regard to the People Plan, a gap analysis needed to be completed. CGi observed that SR was likely to be completing similar work and requested that SR send the NHSE submission to CGi, so the information can be utilised efficiently.
6.14 SR explained that, within the DES, there had been limitations imposed, so that there could only be one physiotherapist and one pharmacy technician per PCN until March 2022, unless there was approval from the CCG. This was on the basis of the system impact. SR explained that The Forest of Dean PCN and Stroud Cotswold PCN had received the approval to recruit more than one pharmacy technician via a central recruitment. SR explained that some networks had not wished to take the opportunity to recruit a physiotherapist; therefore SR was looking into a proposal to allow some networks to have more than one physiotherapist and noted that they would like to gain ICS support for this. CG emphasised that although the ICS should be informed of 15 Page 6 of 14 PCCC Part One Minutes 22nd October 2020
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the decision, the approval for such a request would lie with PCCC. AE agreed with that but noted the proper involvement of the ICS.
6.15 JD highlighted that there were many changes in the Forest of Dean such as investment in the infrastructure and new housing developments. JD also emphasised that this was resulting in an increase in population in the Forest of Dean.
6.16 AE emphasised that the CCG teams were working hard to ensure the residents of the Forest of Dean had access to quality NHS services.
6.17 RESOLUTION: The Committee members noted the contents of the PCN Update Presentation
8. Next phase for Winter: Covid-19
8.1 JW emphasised that primary care had been required to initiate very quick changes in their response to Covid-19 in order to offer remote consultation, safe working with Covid- 19, and virtual appointments. Since then there had been a shift in work back to Business as Usual.
8.2 JW explained that there had been work done to look into the appointment statistics which has shown that there had been more appointments compared to the previous year (2019). JW stated that one practice in particular had 50% more appointments due to significantly higher demand. JW highlighted that in many cases there had been a good use of a broader skill mix, such as clinical pharmacists, phlebotomists, and health care assistants.
8.3 JW explained that generally face to face appointments and additionally home visits had been reduced in line with national guidance. However there had been a significant increase in eConsult and telephone appointments. JW summarised that there had been between 31% to 50% increase in primary care overall workload in the practices that had provided data, which seemed to be consistent with other practices in Gloucestershire and nationally. 15 Page 7 of 14 PCCC Part One Minutes 22nd October 2020
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8.4 JW described the factors behind the increase in workload including the backlog of work following first wave of Covid- 19 and the Phase 3 priorities around Long Term Conditions, screening, vaccinations and immunisations. In addition to this there was an increase in primary care activity to support transformational projects such as hospital virtual outpatients and new pathways including the use of Cinapsis. JW explained that due to the recovery plans in the hospital, patients were waiting longer for hospital appointments so some were returning to their GP during this time. JW added that there was an increase in general anxiety and mental health issues.
8.5 JW explained that there were challenges around resourcing the Business as Usual activities in conjunction with the additional demands on primary care. JW emphasised the impact on smaller practices when staff were required to isolate.
8.6 JW explained that Phase 3 was effective from 1st August 2020 and General Practices were asked by NHSE/I to restore activity to usual levels where clinically appropriate address the backlog, build on the enhanced support provided to care homes, and offer face to face appointments at their surgeries whilst triaging patients remotely in advance. Practices should continue to use video, online and telephone consultation wherever appropriate. JW added that the process of remote triaging needed to be made clear to patients as some were not understanding why they were being offered a telephone consultation rather than being able to book directly into a face to face appointment.
8.7 In terms of the Sustainability and Surge Management Plan, JW explained that due to Covid-19 this winter plan was unlike any previously prepared to cover multiple combinations of illness. JW emphasised that there needed to be a resilient system over winter which was able to respond to changes in levels of Covid-19. This was managed through the Covid-19 Bronze Cell structure, which included a Primary Care cell. 15 Page 8 of 14 PCCC Part One Minutes 22nd October 2020
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8.8 JW explained that there were four scenarios that were being used to formulate options. The first was a baseline scenario as per previous winters, secondly, a maintenance level which reflected the baseline plus a low level of Covid-19, and thirdly the baseline plus a second or subsequent peak with high levels of Covid-19. The final scenario was baseline plus high levels of Covid-19, together with outbreaks of Flu, Norovirus or other communicable disease.
8.9 JW explained the high impact solutions to look at how primary care will manage the scenarios. One of these was in establishing ‘Hot Hubs’ to ensure patients could be seen face to face while showing potential symptoms of coronavirus in a safe environment. There was also a Home Visiting service for people with potential symptoms which was successful in the first wave which could be reinstated if required. From a communications perspective there was a Practice Bulletin to primary care which was circulated twice a week and the frequency could be increased if required. JW explained that there were regular Sitreps which collected practice information around sickness rates, the ability to order PPE, Flu vaccinations and business continuity planning.
8.10 AE emphasised that, on the basis of the evidence presented, primary care was overworked and queried if further analysis would be completed. JW explained that primary care was very busy, although acknowledged that some of the additional appointments were quicker as they were not face to face consultations. JW added that there was also a cancer campaign to encourage patients to visit GPs. AE acknowledged that the Phase 3 response added a lot of pressure in an already busy area.
8.11 MAE explained that from a PALS point of view, there had been a lot of enquiries around the limited availability of face to face appointments. MAE expressed support in digital solutions however emphasised that we must not allow digital inequalities to be introduced. With regards to planning, MAE explained that the EU Exit was now officially called ‘D20’. MAE advised that that D20 might have implications over 15 Page 9 of 14 PCCC Part One Minutes 22nd October 2020
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winter with regards to supplies.
8.12 MW highlighted that there had been very strong engagement with the sector from primary care colleagues throughout this period of time and this had supported the resilience of primary care. With regard to remote triage, MW suggested that there was learning from primary care which could be transferred into other parts of the system.
8.13 CG raised concern that there was no national database that could be used to benchmark activity. CG explained that the media had given the impression that primary care may not be as busy as they were. CG queried if NHSE were aware of this and if they were trying to develop a standard to measure against and if not then could the CCG drive this work forward. AE stated that we needed to be clear about what pressures were being faced in primary care. JW responded that the data presented during this session had been prepared and analysed by the practices. Prior to Covid-19 there were plans introduced to develop a standard; however, due to the diversity of recording systems being used in primary care, this would take time to achieve. JW explained that the GPs would be likely to recognise the benefit of this work as it would demonstrate how busy practices often are.
8.14 RESOLUTION: The Committee Members noted the contents of the Next phase for Winter: Covid-19
7. Primary Care Delegated Financial Report
7.1 CL stated that, due to Covid-19, the CCG were operating within revised financial guidelines. CL stated that budgets were set by NHSE/I and the CCG would report on these budgets and explain any variances against the budgets in seeking a top-up. There was a variance for months 1 - 6 and the CCG will be informed at the end of November if this had been agreed. CL added that this process applied to the CCG as a whole.
7.2 CL explained that substantial recruitment by PCNs of ARRs were increasing costs. CL stated that this variance was 15 Page 10 of 14 PCCC Part One Minutes 22nd October 2020
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straightforward to report to NHSE/I and there was a claim basis in place. CL stated that the second largest variance was around the Quality Outcome Frameworks (QOF).
7.3 CL explained that there had been some re-assessment around assumptions of sickness and maternity payments in primary care and, as a result the expected spend had been reduced.
7.4 In terms of months 7–12, CL explained that a revised financial framework and system allocation for the period M7- M12 had been received. CL explained that the system had been working through the changes in the framework and producing plans against this value which currently highlight a potential deficit position. CL explained that the revisions to the CCG and System position would be presented to the Governing Body.
7.5 RESOLUTION: The committee members noted the contents of the Primary Care Delegated Financial Report
9. Primary Care Quality Report
9.1 MAE explained that there was likely disruption to stock availability due to D20. MAE stated that stock flash alerts were regularly being sent to GP Practices to ensure they were kept up to date.
9.2 With regards to safeguarding, MAE explained that there would be an Annual Safeguarding Report which was due to be presented to the Quality and Governance Committee.
9.3 MAE explained that the current process for Serious Case Reviews was due to be replaced with Rapid Reviews. MAE explained that two Rapid Reviews have so far been escalated to the National Panel. MAE highlighted that the Rapid Review process was positive and there was quick learning from this.
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measures for three years and had recently had a focussed visit from OFSTED. The feedback from this was due to be received. The inspector had raised concern that there was poor access to dental services at the current time for children in care and there has been a national request to make this a priority.
9.5 With regards to serious incidents and significant events, MAE explained that few serious incidents were reported from Primary Care. MAE stated that there had been six events which had been uploaded to the National Reporting and Learning System (NRLS) and detail of this was contained within the quality report.
9.6 With regard to Patient Experience and Engagement, MAE explained that the Patient Advice and Liaison Service (PALS) had been extremely busy in recent months. In addition to concerns around Covid-19 and limited availability of face to face GP appointments, there had been a number of calls around recent changes to the prescribing of vitamin B12. MAE explained that there had also been a relatively large volume of calls relating to community phlebotomy services. MW explained that there had been issues in terms of the Cirencester phlebotomy service and a strengthened service was due to begin. There were wider issues in terms of some changes made to virtual appointments and a number of outpatient appointments were now taking place virtually, whereas previously a blood test may have been taken as part of the outpatient face to face appointment. MW added that there had been some supply issues which have impacted on blood testing. MAE explained that the supply issues had been related to laboratory products and should now be resolving.
9.7 CG stated that the changes to phlebotomy services had not been handled as well as it should have been and there should have been improved communication.
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9.9 MAE explained that there had not been any CQC inspections; they had taken a light touch approach during Covid-19. However, we had maintained communication with CQC and have had meetings with them. MAE said that we have continued to work with practices in preparation for their next CQC inspection and this had been going well. MAE said that the CQC had been undertaking supportive phone calls to practices that had elements of their inspection judged as ‘requires improvement’.
9.10 In terms of Primary Care Education, MAE explained that there was a Clinical Learning and Development Matron. She has undertaken a training needs analysis and is identifying the main training needs. Every registered nurse or allied health professional has been allocated £1000 of CPD over three years to support their professional development and education. This money for primary care has been through the primary care training hub, which is how opportunities will be commissioned.
9.11 MAE said that there were now 11 student nurses on placement in primary care in Gloucestershire. MAE highlighted that there were payments associated with having student nurses which was supporting practices to give the students more time. The CCG is encouraging practices to take on student nurses. Clinical placement expansion programmes are currently under review as a systems approach.
9.12 With regard to prescribing, MAE explained that there had been a pilot on a follow up on discharge medication for recently discharged care home patients. MAE explained that we are finding it difficult to recruit pharmacy technicians.
9.13 With regard to flu, MAE highlighted that there had been a very high demand for the Flu vaccine this year which had created pressure on supplies. MAE stated that there was enough flu vaccine to meet the demand. MAE explained that practices were able to access flu vaccine from the national stock and they been given information on how they could replenish their supplies. MAE explained that the local fire stations had been utilised to deliver flu vaccinations. There 15 Page 13 of 14 PCCC Part One Minutes 22nd October 2020
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had been a drive-through flu vaccination service, which had worked well with positive feedback being received. AE emphasised that the way in which the flu vaccinations were delivered was hugely efficient. JW highlighted that in terms of mass flu vaccinations, many practices had reported great success and excellent patient feedback. With regard to face to face appointments, JW explained that every practice had been contacted to ensure that they were being supported to continue to offer these.
9.14 JD highlighted that the schools flu vaccinations appeared to have progressed well and had also been well planned. JD explained that feedback from parents had been highly positive. JD said that the CCG needed to ensure that they continued to communicate the importance of the flu vaccinations. MAE explained that all children were entitled to receive the flu vaccination and that there had been a very good uptake. MAE explained that there was a flu Communication Plan which should be visible on social media.
9.15 RESOLUTION: The committee members noted the contents of the Primary Care Quality Report
10 Any Other Business
10.1 With regard to the Prestbury Road Practice development, AH highlighted that the £10m development was due to begin imminently. There was a formal start on site on the 2nd November 2020.
CG declared an interest as being a patient at Crescent Bakery Surgery.
The meeting closed at 11:16 am.
The next meeting will take place on the 17th December 2020 at 09:45 am.
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Quality and Governance Committee (Q&GC)
Minutes of the meeting held on Thursday 29th October 2020 at 9.30am, Virtually via Microsoft Teams
Present:
Julie Clatworthy JC Chair, Registered Nurse and Lay Member, Quality
Mary Hutton MH Accountable Officer
Dr Marion Andrews- MAE Executive Nurse & Quality Lead Evans
Cath Leech CL Chief Financial Officer
Peter Marriner PM Lay Member, Business
Alan Elkin AE Lay Member, Public and Patient Engagement
Christina Gradowski CGi Associate Director of Corporate Affairs
Becky Parish BP Associate Director, Engagement and Experience
Dr Will Miles (from WM Governing Body GP 10:00)
Dr Lesley Jordan LJ Secondary Care Specialist
Teresa Middleton TM Deputy Director of Quality
In Attendance:
Lauren Peachey LP Governance Manager (minutes)
Julie Symonds JS Deputy Director of Nursing
Annette Blackstock (for AB Designated Nurse Safeguarding item 6) Children and Safeguarding Adult
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Manager
Richard Thorn (for item RT Planned Care Programme Manager 10.1)
Jade Dobson (for item 7) JD Lead Prescribing Support Dietitian
Will Chapman (for item WC Senior Programme Manager (Self-care 10.2) & Prevention)
Heike Fanelsa (for item HF Project Manager, Self-Care and 10.2) Prevention
1. Apologies
1.1 Apologies were received from Dr Andy Seymour, Mark Walkingshaw, Dr Caroline Bennett
1.2 The meeting began at 09:34
It was confirmed that the meeting was quorate. JC explained that the agenda would be deviated from to ensure that guests could present their items according to their availability.
2. Declarations of Interest
2.1 The chair, JC, requested that all members declared if they held an interest on any items on the agenda. The GPs declared a general GP interest in the provision of healthcare services in Gloucestershire. JC declared the interest of having been appointed a Governor at Gloucestershire Health and Care (GHC).
The members other than JC noted the interests and concluded that there were no grounds for the chair, JC who had declared the interest to not to take part in discussions and decision making.
3. Minutes of the meeting held on 13th August 2020
3.1 The minutes were agreed as an accurate record of the meeting.
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4. Matters Arising
4.1 Item 5.1, 18/10/18, Children’s Services MAE explained that Children’s Services had been in special measures for three years now. There was a focussed OFSTED visit during September and feedback was due to be received. MAE explained that, although there was more work to be done, parts of the service had demonstrated notable improvement. MAE explained that discussions were required regarding what constitutes an appropriate referral to the CAMHS service. MAE stated that children in care should be prioritised in terms of accessing dental services which had been raised at a national level. A further update will be provided at Q&GC in December.
Action to remain open.
4.2 Item 5.13, 11/06/20, Winter Planning and Infection Control Action Plan. JC advised that this would be discussed during the meeting and remain open on the matters arising over the winter period.
Action to remain open.
4.3 Item 6.13, 13/08.20, Datix incident. JC advised that an update had been brought to Q&GC during October and therefore the action should be closed.
Action closed.
4.4 Item 5.13, 11/06/20, Winter Planning and Infection Control Action Plan. This item was to be discussed during the meeting.
Action closed.
4.5 6.13, 13/08.20, Children’s Services, MAE to discuss the process of releasing the additional funds for children’s services with John Trevains, Director of Nursing, Therapies and Quality at GHC. MAE advised that this had been completed.
Action closed.
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4.6 6.13, 13/08/20, Children’s Services, IB to write to lead managers of the Children’s Services informing them of the process. MAE advised that this had been completed.
Action closed.
4.7 PM observed that there was an action recorded in the minutes which should be included on the matters arising for December 2020:
Item 5.0.12, BP had completed a report on learning from the Patient Participation and Engagement hub which would be shared with Q&GC.
4.8 MAE emphasised that the EU Exit, which was now to be known as ‘D20’, would likely result in possible stock shortages around Personal Protective Equipment (PPE). JC requested that this was also added to the matters arising.
ACTION: MAE to provide further updates on D20.
6. Annual Safeguarding Report
6.1 AB emphasised that the Annual Safeguarding report was an analysis of the work that had been completed by the CCG Safeguarding Team over the recent year. It demonstrated the breadth and variety of safeguarding across adults and children. AB explained that there would be a one page executive summary added to the report prior to uploading to the public facing CCG website.
6.2 AB highlighted that the year 2019/20 began with a positive and successful Safeguarding Conference prior to the Covid-19 pandemic at the start of 2020/21. In terms of arrangements for safeguarding during Covid-19, AB explained that safeguarding was linked in to the Vulnerable Peoples’ Covid-19 Bronze Cell.
6.3 AB explained that the report highlighted the investment which the CCG had made into safeguarding by bringing the designated doctor and the designated nurse for Children in Care into CCG employment. There were further plans to undertake an assessment of the CCG safeguarding work and to
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work within the Integrated Care System (ICS).
6.4 In terms of safeguarding children, AB highlighted that the Safeguarding Children’s Executive had progressed well with MAE as the Chair. AB explained that she was the Chair of the Quality Improvement in Practice sub-group.
6.5 AB explained that Gloucestershire had been challenged as a county with a number of Serious Case Reviews (SCRs) and that Q&GC were kept informed of these through the regular Quality Reports. AB highlighted that there was a change in the process and SCRs had been replaced with Rapid Reviews. Gloucestershire were commended by the national panel on the work on Rapid Reviews.
6.6 AB emphasised that the work of the Gloucestershire Domestic Abuse Support Service (GDASS) and the Early Intervention Service had been powerful tools for both the Gloucestershire Hospitals Foundation Trust (GHFT) and for primary care.
6.7 AB explained that there was concern around the Multi-Agency Risk Assessment Conference (MARAC) in terms of timely researching to inform MARAC conference needs and this had been identified as a risk on the risk register.
6.8 In terms of the Mental Capacity Act (MCA), AB explained that the Liberty Protection Safeguards (LPS) had been updated over the last year; this change reflected that the responsible body the Deprivation of Liberty (DOLs) was within healthcare.
6.9 CGi explained that she and Jo Bridgman, Specialist Nurse for Safeguarding at the CCG, had been trained as Level 2 MCA trainers and would be training clinicians on the MCA. CGi explained that they would be addressing the DOLs and LPS during the training.
6.10 RM joined at 09:55
6.11 JC commended the quality of the report and emphasised that the report highlighted the hard work and progress which had been made over the last year.
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Regarding mandatory safeguarding training, JC queried which level of mandatory training was required and whether Gloucestershire deviated from the national requirement. AB clarified that level one safeguarding was mandatory for CCG staff and the increased level of safeguarding training would be required for specific roles. AB explained that there was a basic introduction to safeguarding provided at the CCG staff induction; however it did not provide in depth face-to-face training. AB explained that there was an ambition to provide in depth face-to-face safeguarding training for CCG staff. Regarding face to face training, MH queried if there could be a targeted approach and focus on specific areas and teams within the CCG. CGi explained that there needed to be an electronic means of capturing who needed the advanced safeguarding training and also who had completed it.
6.5 JC queried whether the research that was being undertaken, referred to within the report, had been linked in with nursing. AB clarified that the research was focussed on system records and needed to be undertaken by someone who understood clinical terminology.
6.6 JC queried if there was a satisfactory level of GP attendance at the Safeguarding Training. AB responded that there was good GP attendance at the Children’s Safeguarding Forums; however there was a lower attendance at the Adult Safeguarding Forums. AB explained that there were safeguarding leads that covered both Adults and Children’s safeguarding and therefore did not attend both forums. AB clarified CCG provide a safeguarding training offer for GPs.
6.7 PM stated that at a previous meeting, it was noted that there safeguarding audit work and Rapid Reviews were underway. PM queried if it would be possible to share lessons learnt from these audits to Q&GC members. AB advised that this could be included in the Quality Reports.
6.8 RESOLUTION: The committee members noted the contents of the Safeguarding Annual Report.
5. Countywide Quality Report
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5.1 MAE explained that there were ‘Stock Flash Alerts’ which were regularly circulated to primary care to provide up to date information on medications which were in short supply.
5.2 In terms of safeguarding, MAE highlighted that the Adoption Medical Team were to be integrated into the Gloucestershire Health and Care (GHC) Children in Care Team.
5.3 MAE explained that the Safeguarding Executives had raised concern over the level of child sexual exploitation and abuse and there were additional Rapid Reviews planned in this area.
5.4 Regarding the Serious Incidents (SI’s), RM explained that GHC had reported a number of SI’s due to suicide/attempted suicide; RM stated that the figures were similar to previous years.
5.5 JC asked if there was a ‘zero tolerance’ approach on preventable suicides and queried whether there was more that could be done to reduce suicides and suicide attempts. JS explained that it was possible that patients who were known to the system experienced increased exacerbated pressures from the Covid-19 lockdown. JS explained how these patients may have been significantly affected by not having in-person contact. JS explained that we needed to continue to focus on helping individuals prior to them reaching a crisis stage.
5.6 WM emphasised that there were a number of people who were experiencing significant distress and despite best efforts these people may still attempt/complete suicide. WM explained that in comparison to other parts of the country, Gloucestershire was not an outlier in terms of suicides rates.
5.7 Patient Engagement and Experience
5.8 BP explained that there had been a large number of Patient Advice and Liaison Service (PALS) enquiries over the recent quarter. BP stated that community phlebotomy in Cirencester had been a cause for concern for many people contacting PALS and, as a result of feedback received, further work had been undertaken to expand the offer in the Cirencester area. BP explained that there had been a statement issued in October to
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explain how additional services would be made available at Cirencester Hospital for secondary care requested blood tests. BP stated that there remained an issue around blood tests related to Oncology and colleagues in primary care contracting and acute contracting were working to resolve this issue.
5.9 BP explained that there had also been a large number of calls into PALS with regards to Covid-19 around accessing health services.
5.10 With regards to Friends and Family Tests (FFT), BP explained that data submission was restarting from December 2020.
5.11 BP highlighted that a series of papers on the FFTF consultation had been taken to the Health Overview and Scrutiny Committee (HOSC). A series of discussion forums had been launched on the new Get Involved in Gloucestershire platform. There was a live-streamed clinical question and answer session planned to be hosted on YouTube. BP explained that the CCG were expecting a letter of assurance of the CCG Consultation plan from the Consultation Institute. BP explained that there had so far been over 100 responses on the consultation.
5.12 BP explained that the Forest of Dean Community Hospital consultation had also been presented to HOSC and this consultation followed the same timeline as the FFTF consultation.
5.13 BP explained that there had been a systematic review of patient experience feedback collected in relation to Covid-19 and the local response. This included both regional work and the work which had been gathered within Gloucestershire. A systematic presentation had been taken to the Covid-19 Recovery Cell. It is expected that the survey would be repeated early in 2021.
5.14 AE emphasised that the data on Covid-19 experience split by localities would be useful. BP advised that data was available by localities and this would be shared. BP added that this report had also been shared with the ICS Executives. BP added that there were no notable differences between Gloucestershire and elsewhere in the region. BP explained that data showed that the data indicated that the population of Cheltenham were Page 8 of 20 Minutes from Quality and Governance Committee (Q&GC) – 29/10/2020
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concerned that the A&E department in Cheltenham would be closing. BP added the consultations documents were clear that there were no proposals to change the opening hours at Cheltenham A&E department.
ACTION: Report and presentation on patient Covid-19 experience to be shared with Q&GC.
5.15 With regard to dental services for Children in Care, AE added that GHC had done some positive work to provide dental services.
5.16 JC queried whether clarity had been provided for GPs and patients around over the counter tablets versus vitamin B12 injections? BP explained that further communications had been provided to GPs. WM emphasised that GPs would make a decision around prescribing of vitamin B12 injections based on clinical need.
5.17 MAE explained that CQC had not been doing inspections. However, they had been undertaking supportive phone calls to practices. MAE explained that there was a GP Practice in the county which the CCG were working with to improve their CQC rating for the next inspection. WM observed that there would be lessons learnt which could be shared with regards to practices merging. MAE added that there were no major concerns from CQC.
5.18 MAE explained that primary care education had been progressing well and there had been a survey of practice nurses and AHPs across primary care. This had identified ten main areas on which to focus additional training. Helen Acock, the Practice Nurse Learning and Development Matron, was developing a training programme based on the areas identified. MAE emphasised that practices were encouraged to employ student nurses and emphasised they would receive the funding for the student nurse.
5.19 MAE highlighted that there had been a lot of work with regards to Medicines Optimisation. MAE explained that the growth had been significant during the early part of the year. MAE emphasised that Pharmacy Technicians were in short supply;
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however there was an opportunity from Health Education England to train pharmacy technicians locally. MAE highlighted that the CCG had been offered the funding to train two pharmacy technicians.
5.20 MAE highlighted that Flu had not been an issue in the county and there had also been no cases of Methicillin Resistant Staphylococcus Aureus (MRSA). MAE explained that Clostridium Difficile (C.Diff) infections remained largely in line with the previous years’ figures, although there was a slight increase in August, which could be attributed to an increase in antibiotic prescribing.
5.21 JC queried if there was a correlation between the increase in antibiotic prescribing and the increase in telephone appointments. WM responded that this was likely, and in the first wave of Covid-19, some antibiotics were also been used as a diagnostic tool.
5.22 AE raised concern that some staff Flu vaccination clinics had been cancelled. MAE explained that this issue had been escalated. MAE further explained that there had been delays in the delivery of Flu vaccinations which had been ordered early in the year.
5.23 MAE highlighted that the Flu programme was proceeding very well this year and Fire Stations had been used which had worked well and enabled people to maintain social distancing. MAE stated that clinical governance arrangements were in place.
5.24 JD joined at 10:45. JC advised that the remainder of the item ‘County Wide Quality Report’ would continue following item 7.
7 Position Statement: Blended Diets
7.1 JD explained that the British Dietetics Association (BDA) had moved to be more supportive of the approach outlined within the paper. JD explained that the paper was to seek approval from the committee to support GHFT in adopting the position outlined in the paper where it was clinically safe to do so.
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7.2 JC emphasised that paper was well written, clear and reflected the work that had been undertaken. JC suggested that JD included a statement explaining the process around the reporting of incidents for providers. WM highlighted that the approach focussed on de-medicalising and normalising life for people affected. WM queried who should be responsible for raising the change to the diet to incorporate a blended diet. JD explained that the paper was written to clarify that joint decisions should be to be made to ensure risk awareness, and also considering the capacity of GHFT dietitians (the lead organisation) in managing the changes.
7.3 RESOLUTION: The committee members approved the Position Statement on blended diets
There was a break from 10:55 – 11:05
5.1 Clinical Effectiveness Group (CEG) Minutes 21st September 2020 and Draft Letter for Comment
5.1.1 JC explained that the endometrial biopsy issue referred to within the CEG minutes had been taken to the ICS Clinical Council. JC explained that over time, GHFT and the CCG had committed to move towards compliance with NICE Guidance which they currently deviated from.
5.1.2 TM summarised the purpose of the draft letter which had been circulated. TM explained that an issue arose earlier in the year regarding a lack of an accessible list of patients on immunomodulatory drugs. It had been a challenging process to identify these patients as required due to Covid-19. TM explained that Dr Alan Gwynn, Chair of the CEG, had pushed for a resolution to this issue. TM explained that this issue had been included on the GHFT and CCG risk register and that it had been taken to the Medicines Optimisation Committee. TM stated that the electronic prescribing system was planned to be implemented in July/August 2021 which would ensure issues like this would not arise again.
5.1.3 MH queried the risk associated with this issue. MAE explained that the issue created challenges in identifying a number of
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patients which should have been shielding during the first wave of Covid-19. MAE further explained that the process to identify the patients on immunomodulatory drugs had been a very manual process. WM emphasised that the current list would become quickly outdated and if an updated list of patients on immunomodulatory drugs needed to be identified, then the time consuming and manual process would need to be repeated. WM emphasised that there should be a technological solution to this issue. WM further explained that hospital staff should not be taken away from their main duties to manage a manual process which should have an electronic solution.
5.1.4 RESOLUTION: The Committee Members noted the contents of the CEG minutes of the 21st September and supported the draft letter.
5.2 ECCP Minutes
5.2.1 Resolution: The committee members noted the contents of the ECCP minutes.
5.3 GHFT Quality Report
5.3.0.1 JS explained that there had been one new never-event reported of medication being put down a naso-gastric tube that wasn’t positioned correctly. JS had been in discussion at the two most recent Surge Meetings to determine the reasons behind the never-event. JS explained that there were lessons to be learnt from this event and all staff involved were keen to understand the cause of the issue further. LJ emphasised that there was a prompt response to the never-event.
5.3.0.2 JS summarised that there had also been five Serious Incidents reported. JS explained that one of these was around an empty oxygen cylinder and additional measures had since been put in place to ensure empty oxygen cylinders were dealt with appropriately.
5.3.0.3 JS explained that a case, which did not meet the serious incident criteria, was being investigated as though it were a serious incident. This incident involved a patient who had a
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learning disability.
? Summary hospital level mortality indicators SHM1 and HSMR were reviewed. Three diagnoses were impacting on SHMI rates: septicaemia, COPD and Acute Cerebro vascular accidents. These would continue to be monitored.
5.3.0.4 In terms of Covid-19, JS highlighted that the survival outcome from the Intensive Care Unit (ITU) at GHFT was good in comparison to other areas in the country. JS added that Gloucestershire had a fairly low BAME population, who were more adversely affected by Covid-19. There had been discussion about the importance of follow-ups with the patients who had been discharged from the ITU. JS explained how follow-ups of these patients would need to address a range of concerns. JC added that the issue of follow- ups had also been picked up through the Respiratory and Rehabilitation Clinical Programme Groups (CPGs). LJ added that similar broad-range follow ups were also required for other conditions. LJ however further explained that there would be an additional psychological impact arising from patients who had Covid-19 due to additional fear of their condition, and not being able to have friends and family visit whilst in hospital. JS emphasised that hospital staff were also in need of additional support. JS added that they would not have had their usual holidays and had been through a particularly stressful time. JS explained that staff feedback highlighted that psychological support had gone well. JS explained that some of this support had since ceased and there were proposals to reinstate this enhanced level of support.
5.3.0.5 AE queried the plans for the hospital to purchase unused annual leave from certain members of staff and enquired as to whether it was appropriate, given the level of stress that staff had been in over recent months. MH responded that this was a provision rather than a confirmed plan. CL added that there was also an option for staff to carry over additional unused annual leave into the following year, and therefore take it at a later date.
5.3.0.6 In terms of Planned Care, JS stated that the planned care Referral to Treatment Time (RTT) was at 66%; however they
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were the least poorly performing in the south west. JS explained that Cancer Care was at ‘green’ level and they were the top performing trust in the south west. JS emphasised that the presentation of lung cancers was reduced and there was great scrutiny as to why this was.
5.3.0.7 With regards to theatre visits, JS explained that there had been a recent visit which had been very positive. LJ added that process improvements could be seen following the previous visits.
5.3.0.8 JS emphasised that there had been unprecedented demand at the Emergency Department (ED) and morale was a concern for ED staff.
5.3.0.9 In terms of scrutiny of maternity services at Cheltenham General Hospital (CGH), JS advised that GHFT had been given clear feedback from Healthcare Safety Investigation Branch (HSIB). JS explained that there was a robust action plan in place to address the issues relating to maternity services.
5.3.1 GHFT CQRG Minutes
5.3.1.1 RESOLUTION: The Committee noted the minutes of the 16th July and 17th September 2020
5.3.1.2 WC and HF joined the meeting at 11:30 for item 10.2.
10.2 Specialist Tier 3 Weight Management and Bariatric Surgery Policy
10.2.1 WC highlighted that the Specialist Weight Management and Bariatric Surgery Policy would bring Gloucestershire in line with National Institute of Clinical Excellence (NICE) Guidance and reach people at an earlier stage of obesity management WC emphasised that this was a new policy and there had not been an Adult Weight Management policy previously. It should promote less complex and revision bariatric surgery as people as patients would be able to access the specialist service in a more timely way. The committee noted GCCG was not carrying out gastric band surgery in line with best practice.
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10.2.2 WM queried the financial impact of the policy. WC responded that the financial impact was not yet known. WM further explained that there was an initial plan to spend time on developing the services around the Specialist Weight Management Policy and a financial impact would be developed in due course. MH added that there were also discussions around how to get Multi-Disciplinary Teams (MDTs) in place.
10.3.3 JC highlighted that the policy does clarify NHS funded services versus private surgery which is not NHS funded.
10.2.4 RESOLUTION: The Committee approved the Specialist Weight Management Policy
5.4 GHC Quality Report
5.4.0.1 WM summarised the key points from the GHC Quality Report. With regard to the SI’s, WM explained that weekly meetings were taking place between the CCG and GHC and learning from the incidents was taking place. WM emphasised that each significant incident was carefully reviewed and challenged. Falls and pressure ulcer rates (Grade 3 and above) were consistent themes.
There had been two suicides in this reporting period.
5.4.0.2 WM explained that a lot of work which had been undertaken relating to falls had paused during the peak of Covid-19. Action plan was reviewed and monitored.
5.4.0.3 In terms of stock levels for PPE and fit testing for asks, WM explained that these were in hand and being actively monitored. WM explained that GHC had good support in place for staff who were feeling under pressure and experiencing stress.
5.4.0.4 JS explained that a new Quality Lead for the GHC contract was joining the Quality Team during November. JS explained that going forward there would be additional focus on the Learning and Assurance Group which had been established since GHC had formed.
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5.4.0.5 JS summarised that an Intravenous (IV) antibiotic, which required only weekly administration, had been proven to be effective for the treatment of bacterial pneumonia.
5.4.0.6 LJ explained that there had been work in Gloucestershire to pilot the ability to monitor patient oxygen saturation levels at homes.
5.4.0.7 RESOLUTION: The committee noted the contents of the GHC Quality Report
5.4 GHC CQRG minutes of the 2nd July and 24th September
5.4.1 RESOLUTION: The committee noted the contents of the GHC CQRG Minutes of the 2nd July and 24th September
10.1 IFR Policy Review
10.1.1 RT highlighted that the policy was due for review in October 2020. RT explained that minor changes had been made to the policy and emphasised that the flow of the policy had been improved and included greater clarity. RT explained that the appendices had also been updated and an additional appendix had been included. RT explained that that additional appendix included information from the NHSE policy regarding what may or may not be clinical exceptionality and value judgements.
10.1.2 AE highlighted that this policy review had been taken to the IFR Panel. AE emphasised that the addition of the NHSE/I policy information was welcomed.
10.1.3 PM suggested that lay worker is amended to ‘lay member’ to be consistent with CCG terminology.
10.1.4 CGi queried how up to date the clinical exceptionality information that was taken from the NHSE policy was. CGi also queried if the policy would be made available to the public. RT explained that the policy was publically available on the CCG website as per the national requirement. RT explained that the definitions of the clinical exceptionality in the NHSE policy had
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been updated within the last year.
10.1.5 JC requested that the wording could be revised in section 2.1.4 to strengthen use of the evidence base alongside the clinical information. JC further requested that it was clarified that if the treatment was new, and therefore had not got a track record, that there was a requirement for separate clinical governance authorisation by the provider.
10.1.6 WM highlighted that it may be useful to clarify in the operating procedure, that the referring clinician could be either a secondary care clinician or primary care clinician. WM emphasised that in many cases it would be more appropriate for a secondary care clinician to apply for approval for some treatments.
10.1.7 RESOLUTION: The committee approved the IFR Policy review based on the aforementioned changes being made.
5.5 Seasonal Flu Planning Group Minutes 15th October
5.5.1 RESOLUTION: The committee noted the contents of the Seasonal Flu Planning Group Minutes 15th October
8. The Independent Medicines and Medical Devices Safety Review
8.1 RM summarised that the briefing was in response to the Julia Cumberledge Report: First Do No Harm. RM explained that this report had not gained as much traction as some of the other reports that we have had in. RM had also asked GHFT to provide their position on this report as well.
8.2 JC highlighted that the full report had been published and commended the report to members. JC asked if the CCG was to develop an action plan to identify patients affected by the topics contained within the report. For example re use of pelvic mesh: do we know how many women have been affected and captured on a data base? Has the CCG complied with the ban on use of pelvic mesh? Where is our specialist centre for women? Likewise assurance re the reports other
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recommendations.
8.3 JC explained that the report identified areas of concern that may need to be assessed for inclusion in the risk register.
8.4 RM explained that the review made a number of recommendations relevant to patient safety, redress and resolution. RM emphasised that the actions were focussed at a national level, such as calls for a patient safety commissioner. RM explained that we would need to gain assurance from a local position which would follow the response from GHFT.
8.5 RESOLUTION: The Committee noted the contents of the Independent Medicines and Medical Devices Safety Review. The summary of the local position would be added to matters arising. (Lauren you’ll word this better for me please)
9. Risk Management Update
9.1 CGi explained that the report presented had been taken to Audit and Risk Committee and narrative included a summary of the feedback from the Audit and Risk Committee. CGi explained that LP and CGi had met with Colin Greaves, Chair of the Audit and Risk Committee, to discuss how the CCG would better utilise the 4Risk system, the process of risk reporting to committees. CGi advised that LP and CGi were happy to receive feedback on risks from members via email.
9.2 RESOLUTION: The committee noted the contents of the Risk Management Report
11 HR update
11.1 CGi explained that the report had been ran prior to the sickness absence being uploaded to the system by HR and therefore had mistakenly indicated that there had been a 0.6% sickness absence rate which was expected to be incorrect.
11.2 CGi highlighted that the Staff Survey had been circulated and staff were being advised to check the ‘junk mail’ folder for the
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link to complete this. CGi stated that results would be available in February 2021.
11.3 RESOLUTION: The committee noted the contents of the HR update
12 People Plan Response
12.1 The Local Workforce Action Board (LWAB) had considered the People Plan for the ICS and had identified that there were gaps. A gap analysis was underway and findings from this would be shared with the committee when available.
12.2 RESOLUTION: The committee noted the contents of the People Plan Response
13. Data Security & Information Governance Update
13.0.1 CL summarised that the Information Commissioning Officer (ICO) had recently launched the Children’s Code requiring organisations to provide better online privacy protections for children. The CCG Information Governance manager was working through this code with the relevant staff members to determine the impact for the CCG and identify any changes required. CL stated that the Control of Patient Information (COPI) notice had been extended to the 31st March 2021.
13.0.2 In terms of Joining Up Your Information (JUYI), CL explained that there had been approval for the expansion of an authorised JUYI to include the staff team involved in a person’s care, which could include an administrative team member who supported the clinical team.
13.0.3 CL explained that the Data Security Toolkit for 2020/21 deadline has been extended to June 2021. The CCG has developed a plan to achieve the toolkit and this was being progressed.
13.0.5 CL highlighted that all GP practices had submitted their Data Security Toolkit by the 30th September deadline. The GP Data Protection Officer (DPO) had been undertaking virtual practices visits throughout Covid-19.
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13.0.7 RESOLUTION: The committee noted the contents of the Data Security & Information Governance Update
13.1 Data Security & Assurance Working Group meeting
13.2 RESOLUTION: The committee noted the contents of the Data Security & Assurance Working Group meeting
14 AOB
14.1 There was no other business raised.
The meeting closed at 12:41
Date of Next Meeting: Thursday 10th December 2020, 9:30am via Microsoft Teams.
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Verbal discussion.
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