1

Gloucestershire Health and Care Overview and Scrutiny Committee (HCOSC)

8 May 2018

NHS Gloucestershire Clinical Commissioning Group (GCCG)

Clinical Chair and Accountable Officer’s Report 1. Introduction

This report has been reformatted to reflect better the new Sustainability and Transformation Partnership (STP) reporting arrangements to HCOSC. Section A provides a general NHS Gloucestershire Clinical Commissioning Group (GCCG) commissioner update, incorporating a National consultation section. Section B provides a CCG commissioner update focussing on primary medical care. Section C provides Trusts’ updates from: 2gether NHS Foundation Trust (2GNHSFT); Gloucestershire Care Services NHS Trust (GCSNHST) and Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT).

Sustainability and Transformation Partnership and Plan (STP) Sustainability and Transformation Partnership Lead Report is provided as a separate agenda item.

2. Section A: Local NHS Commissioner Update, Gloucestershire Clinical Commissioning Group (GCCG)

These are items are for information and noting.

2.1 New GP Clinical Advisor for Diabetes

The CCG has been awarded funding from NHS England to recruit a GP Clinical Advisor for Diabetes. This role will focus on ensuring patients with Type 2 Diabetes receive an equitable service across the county and work to improve the three treatment targets, which are:

Blood pressure

Cholesterol

Blood glucose levels (HbA1c1)

1 https://www.diabetes.co.uk/what-is-hba1c.html

2

2.2 Planning for Integrated Locality Board (ILB) pilots

Building on our place based work with our STP partners the CCG is making final plans for the introduction of three Integrated Locality Board pilots in the Forest of Dean, Stroud and Berkeley Vale and Cheltenham. It is expected that the ILBs will promote the development of virtual patient-centred teams able to work across organisational boundaries. They will focus on better care coordination and joined-up service delivery as a means of reducing the three gaps of health and wellbeing, care and quality, and funding and efficiency. This will include using local intelligence and risk stratification to ensure proactive and timely support to those at risk and prioritisation of resources to support the shift from acute to community based care. ILBs are intended to be practical forums, focused on delivery, able to work in an agile way to respond to the needs of their communities.

2.3 Clinical Programmes Cancer

Somerset, Wiltshire, Avon and Gloucestershire (SWAG) Alliance Cancer Transformation Funding SWAG cancer partners have been invited to begin drawing on the Cancer Transformation Funds (CTF) for 2017/2018. The funds are held by Bristol CCG on behalf of the SWAG Alliance. Gloucestershire’s allocation will support Gloucestershire Community Trust (GCSNHST) and Gloucestershire Hospitals Trust (GHNHSFT) to support the delivery of the Early Diagnosis and Living Well and Beyond Cancer (LWBC) programmes. Straight to test (STT) endoscopy project In February 2018 the CCG received approval from the Cancer Alliance on “Early Diagnosis – Optimal Lung Cancer Pathway” and “Early Diagnosis – Straight To Test (STT) Endoscopy” Plans on a Page. The Optimal Lung Cancer Pathway project concentrates on a roll out of the chest x-ray reporting tool and the implementation of the chest x-ray “hot” reporting and provision of CTs within 7 days, following an abnormal chest x-ray scan. The straight to test (STT) endoscopy project is offering one-year funding for STT endoscopy nurses. The nurses will be carrying out patients’ fitness assessment for a two week wait straight to test colonoscopy pathway, that we are hoping to launch in June 2018. Macmillan next steps Cancer Rehabilitation - Advancing Healthcare Awards 2018 The Macmillan next steps cancer rehabilitation (MNSCR) programme, based at GCSNHST, has been shortlisted for the national Advancing Healthcare Awards 2018 in the category for leadership and innovation in cancer rehabilitation. This

What is HbA1c? The term HbA1c refers to glycated haemoglobin. It develops when haemoglobin, a protein within red blood cells that carries oxygen throughout your body, joins with glucose in the blood, becoming 'glycated'. By measuring glycated haemoglobin (HbA1c), clinicians are able to get an overall picture of what our average blood sugar levels have been over a period of weeks/months. For people with diabetes this is important as the higher the HbA1c, the greater the risk of developing diabetes-related complications.

3

provides the opportunity to recognise the invaluable work that MNSCR do to support Gloucestershire cancer patients’ recovery by improving patients quality of life following diagnosis and treatment. The awards will be presented in London at the end of April 2018. Musculoskeletal (MSK) Self-Management and Self-Referral to Physiotherapy Services Many MSK conditions are self-limiting and therefore, with time, and the right support, patients will get better without medical intervention. The MSK Clinical Programme Group is working to ensure patients have access to good quality information which gives them the confidence and knowledge to self-manage their condition (without seeing a GP). GHNHSFT and GCSNHST have excellent MSK self-management information on their internet sites and newly designed posters and business cards are promoting these resources. When initial self-management has not been successful or when additional support is needed, patients are able to refer themselves into physiotherapy services. The physiotherapists at GHNHSFT and GCSNHST offer specialist assessment and treatment for a wide range of problems and work with people to promote their own health and wellbeing. They both have referral forms on their websites, which patients can send electronically or print off to send by post. Patients can also call the department(s) to request a form. Referrals into physiotherapy are triaged and patients are seen according to need with urgent cases being seen within two weeks. Over the next few months we will be actively promoting the patient resources and physiotherapy services to patients directly and via GP practices. Social prescribing & cultural commissioning Our work to develop a comprehensive social prescribing offer is continuing to make good progress. We are working closely with both statutory and the voluntary and community social enterprise (VCSE) partners in a coherent commissioning approach, which spans both a primary care based universal offer, and a targeted offer for self-management of long term conditions. The Community Wellbeing Service is now at the end of Q2 and the mobilisation phase for all providers is nearing completion. Our social prescribing approach has been identified as a national exemplar, and we have been asked by NHS England and Public Health England to share our learning in order to support the national approach to scaling up and replicating social prescribing across the country. The cultural commissioning programme, which is integrated within the wider social prescribing framework, continues to receive national recognition for targeted arts on prescription activity within clinical pathway re-design. Commissioning of Phase Two Arts on Prescription in Clinical Pathways Phase two of the grant programme is underway, in partnership with Create Gloucestershire and the voluntary and community social enterprise arts & culture sector. Phase two includes the development of a quality standards framework; the development of a local consortium of arts on prescription providers, and a series of test and learn ‘arts on prescription’ interventions for patients as follows:

4

Children with long term conditions and mental health needs (to include diabetes type 1, epilepsy and tier 3 obesity)

Adults with chronic obstructive pulmonary disease (COPD)

Adults with chronic pain

Adults with anxiety & depression. Gloucestershire as a Regional & National Exemplar The CCG was invited by Public Health England to present workshop for commissioners at a South West regional event in February 2018. The CCG had a positive site visit from NHS England (NHSE) in February, where NHSE officers spoke with patients, clinicians, providers and commissioners from the CCG and county council. We are one of five national learning sites for social prescribing. The CCG was invited to present its work at University College London in March 2018, on the themes of arts as a mechanism for behaviour change & self-management of long term conditions. The CCG has also been invited to join a task group of The All Party Parliamentary Group for Arts, Health & Wellbeing, to contribute to the implementation of the recommendations made in the 2017 publication Creative Health: The Arts for Health & Wellbeing. http://www.artshealthandwellbeing.org.uk/appg-inquiry/ Community Wellbeing Service (CWS) For the first quarter during which the service has been running nearly 900 referrals into the service were received. Mental health and wellbeing was the most common reason for referral at 62%, closely followed by social isolation at 57%. For 75% of individuals there were at least two reasons for referral. A separate category for loneliness will be added to the list of referral reasons. Social prescribing Pseudonymisation Data Project The development phase of the community wellbeing element of this project is due for completion in March, with all community wellbeing providers now on track to provide high quality data from their operational systems from 1 April 2018. In addition to a performance dashboard, the data project will enable us to track NHS activity of patients referred for universal social prescribing. We hope to extend this to patients referred to targeted ‘social prescribing plus’ interventions in due course.

2.4 Enabling Active Communities

Daily Mile Gloucestershire CCG have been working in partnership with Gloucestershire County Council (GCC) and Active Gloucestershire to build on the success of last year’s Daily Mile initiative. The Daily Mile is a primary school initiative that encourages children to walk, jog or run a mile every day at school with the aim to improve children’s health and wellbeing by being active. Last year over 52 schools took part in the daily mile with a reach of over 10,000 children. A recent audit of schools talking part in the 2017 campaign showed that 71% of schools (37 out of 52) who took part are continuing to do the daily mile. The second 12-week daily mile campaign will be delivered throughout the Spring Term.

5

2.5 Control of Infection

Flu Vaccination We are very pleased to report that the provisional figures for flu vaccination uptake demonstrate the following improvements: Frontline staff: All three of Gloucestershire’s NHS trusts exceeded the Commissioning for Quality and Innovation (CQUIN) target of an uptake of 70% amongst frontline staff, and are well placed to achieve the higher target of 75% in place for the 2018/19 season. School immunisation: This is the first year of a new contract under GCSNHST. The new expanded team came together well and achieved an uptake of 63% of eligible school children, which is a significant improvement on the previous flu season. At risk groups: The flu vaccination uptake amongst ‘at risk’ groups has increased, with the exception of two areas. The percentage of 65+ year olds is at 74.3%. A survey of care homes by the CCG demonstrated an 80% uptake amongst residents. Learning from this most recent flu season has identified areas to target next year. This includes flu vaccination uptake of care home workers and carers/visitors. To support this work being undertaken, we are looking to include within our contracting arrangements with care homes, the requirement to report flu vaccination uptake of care home staff and residents. Promotional material for carers and visitors is planned to encourage these groups to protect residents by having a flu vaccination, and not visiting when they have respiratory infections. Measles In September 2017 Gloucestershire had an outbreak of measles with Stroud being the most affected area. A Stroud engagement group was formed to promote Measles, Mumps And Rubella (MMR) vaccination uptake. During the outbreak in September 2017 it was found that young adults, whose parents had not consented to them receiving the MMR vaccination in childhood, when presented with information selected to have an MMR vaccination. It was therefore decided to deliver a promotional programme for MMR focusing on young adults aged 16 – 25 years across Gloucestershire starting in March 2018 and continuing over the year. Colleges and Universities were also identified as key target areas. The NHS Information Bus will be used to deliver interactive activities to engage young adults. This gives an opportunity to provide information and answer questions.

2.6 Advice and Guidance (A&G)

Improving GP access to specialist opinion, advice and guidance is a key element of the CCG’s approach to elective care demand management. A core part of this approach is the provision of Advice and Guidance (A&G) through the Electronic Referral Service (eRS) platform. During 2017/18 an additional four specialties have been added (Urology, Gynaecology, Gastroenterology, and Pain Management), taking the total number of specialties available to twelve with further specialities to be added in the coming months. Uptake of A&G in Gloucestershire is strong and growing with utilisation set to increase by over 50% by the end of this year.

6

In quarter 3 an average of 600 requests for advice per month were responded to by GHNHSFT providing valuable specialist support to GPs to inform clinical decision making. The scale of A&G utilisation in Gloucestershire compared to other CCG areas is significant, for example, nearly 10% of all dermatology, 8% of all nephrology, and 5% of all paediatric A&G requests in England are made by Gloucestershire GPs. There are planned developments in 2018/19 that will ensure that the CCG continues to be a national leader in this area.

2.7 Appointment Slot Issues (ASI’s)

Gloucestershire Hospitals NHS Foundation Trust (GHFT) has extended polling ranges for outpatient services on eRS in order to eliminate Appointment Slot Issues (ASIs) and the associated difficulties that this causes. The benefit of this change is now being felt with the ASI rate at GHFT reducing from a peak of 73% in July 2017 to just 5.9% in January 2018.

2.8 eRS Paper Switch Off

As part of changes to the NHS Standard Contract from 1 October 2018 it will be a requirement that 100% of GP referrals to consultant led outpatient appointments be completed using NHS Electronic Referral System (eRS). Currently around 75% of referrals made by Gloucestershire GP practices are made through eRS. Locally it has been agreed that paper switch off will take place on 4 June 2018. From this date referrals made by letter, fax or e-mail will be returned to the GP practice to be submitted via eRS. A programme of regular communication with GP practices will run up until the paper switch off date, which will include access to training, benefits of the paper switch off, and frequently asked questions, to ensure the switch off occurs smoothly. Adopting full use of eRS is a key element in the move to a paperless NHS and has the support of NHS England and NHS Improvement. The benefits of using eRS are immediate for patients being referred through the service and for trusts. Patients have more choice and control over their healthcare and trusts benefit through reducing ‘did not attend’ (DNA) rates and improving administrative efficiencies.

2.9 Procurement Update

NHS Gloucestershire’s new e-Procurement system (In-Tend) went live on 1 February 2018. This system is used widely by CCGs, Commissioning Support Units and other UK public sector organisations. All future procurement processes, including competitive quotations and tenders, will be conducted through this system. This will enable us to streamline our procurement processes and timescales whilst fully complying with the European Union’s Public Contracts Regulations. Tender for the Provision of Community Urology Services On 2 February 2018, national and European advertisements were placed for the provision of community urology services. These services are currently provided by GP Care under a short term contractual arrangement which terminates on 30 September 2018. The CCG anticipates awarding a new contract to commence on 1 October 2018 for an initial period of 3-years, with an option to extend the service contract.

7

Tender for the Provision of a Peer Support and Befriending Service Following a competitive tender process, which included the involvement of young people in the evaluation, a 3-year contract for provision of a peer support and befriending service has been awarded to Creative Sustainability Community Interest Company. The contract which is valued at £142,000 for the initial contract period is due to commence on 1 May 2018.

2.10 Disability Confident Employer…..On Our Journey In October 2017, the CCG received confirmation that it had been approved as Disability Confident Committed. This means that the CCG has one year, from October 2017 to October 2018 to work towards being a Disability Confident Employer. We have set up a Disability Confident Employer Task and Finish Group whose remit is to work towards obtaining accreditation by October 2018. The task group is focusing on:

ensuring our recruitment processes are inclusive and accessible

communicating and promoting vacancies to potential applicants who are disabled

offering interviews to people with disabilities

anticipating and providing reasonable adjustments as required

supporting any existing employee who acquires a disability or long term health condition, enabling them to stay in work

developing pages for the website and intranet to raise awareness that the CCG is working towards being disability confident

organising lunch and learn sessions and disability confident employer workshops

undertaking at least one activity that will make a difference to someone who is disabled such as a work placement or work trial.

The task and finish group has representatives from across the CCG and Gloucestershire County Council (GCC) as well as from groups that work with people with disabilities such as Forward. Both GCC and Forward are helping us to deliver a Disability Confident Manager’s workshop scheduled for July 2018.

2.11 Community Offer - Mental Health Initiatives Time to Change Hub Gloucestershire is already involved in the Time to Change campaign, which is a growing movement of people aiming to change attitudes towards mental health and reduce stigma across a number of our work areas. Gloucestershire has recently been working with partners to develop a bid to become a Time to Change Hub, which is a partnership of local organisations and people who are committed to ending mental health stigma and discrimination. Although this bid was unsuccessful, there remain opportunities for Gloucestershire to become an ‘organic’ hub where access to Time to Change support and non-financial resources would be available. This will also allow us to strengthen our existing partnerships across health, social care and the third sector, in aligning and maximising our combined activity. Community Offer - Mental Health - Crisis Care All qualified clinicians in Mental Health Acute Response Service (MHARS) have received training to equip them with the necessary skills to work in a crisis with Children and Young People (CYPS).

8

Performance monitoring of commissioned response times have been undertaken including:

Triage face-to-face assessment within 1 hour when required

Full mental health assessment within 4 hours when required

Mental Health Matters 12 months pilot are providing 24/7 helpline for service users known to 2gether NHS Foundation Trust (2gNHSFT) who frequently call MHARS for telephone support. The Street triage scheme is having a positive impact on reducing the use of s1362 by the Police. Alexandra Wellbeing House and The Cavern (Wellbeing Café) continue to receive positive feedback from people who use them and are providing timely alternatives to prevent crisis.

Community Offer - Hospital to Home Service (H2H) The Hospital to Home service provides a supported discharge service delivered by a selection of home care providers. Patients, from acute and community hospitals are discharged home, allowing for 4 visits by 2 carers for a period of 48 / 72 hours. The carers carry out an initial assessment at home to ascertain whether someone needs:

any service or support at all, information & signposting;

straight forward home-care; and

short term intervention/reablement for up to 4 weeks. This service commenced in May 2017 and has been steadily growing as dedicated discharge teams have been recruited to each locality in the county. The statistics for this service show, of the 195 positive outcomes:

71.% benefited from the short term service with no ongoing needs

7.2% needed longer than the 4 weeks

7.5% required a package of care

13.7% did not require the service, but benefited from being supported home. This service has released a significant number of bed days. However further work is underway to understand the findings and improve the service. It is anticipated that H2H will become the default for new identified care needs from hospital. This will release reablement to provide therapy led support and step up services to avoid hospital admission. Eight workshops have been arranged and are open to any adult/parent carer to attend – one in each district, a Black and Minority Ethnic (BME) focussed workshop and a parent carer workshop has also been arranged. Further workshops have been organised including:

Two workshops for young carers (including young adult carers 18-25), using a graphics artist

A workshop for key Voluntary, Community and Social Enterprise organisations

Specialist workshops, including carers of people with mental health issues, learning disabilities and dementia.

2 https://www.legislation.gov.uk/ukpga/1983/20/section/136

9

There are also two online surveys which have been designed in association with the Carers Alliance, who also gave ideas for how best to run the workshops, and Gloucestershire Young Carers.

Community Offer - Engagement with Carers Across Gloucestershire A carer is anyone of any age who on an unpaid basis looks after a family member, partner or friend who needs help because of their illness, frailty, disability, a mental health problem or an addiction and cannot cope without the carer’s support. The 2011 Census recorded 62,644 people in Gloucestershire who reported that they are a carer. This was equivalent to 10.5% of the population. The same census also reports 3,692 young carers (under 18) in Gloucestershire. A substantial engagement programme is being implemented by the CCG and GCC to help us shape future support and services for carers. Our engagement includes:

8 workshops open to any adult/parent carer to attend – one in each district, a BME focussed workshop and a parent carer workshop

2 workshops for young carers (including young adult carers 18-25), using a graphics artist

1 workshop for key Voluntary, Community and Social Enterprise organisations

Specialist workshops, including carers of people with mental health issues, learning disabilities and dementia.

There are also two online surveys which have been designed in association with the Carers Alliance, who also gave ideas for how best to run the workshops, and Gloucestershire Young Carers It is nationally recognised that the economic value of unpaid carers to the UK economy is £132 billion every year (this figure has risen from £68 billion in 2001) and the Office for National Statistics calculates that it would cost £56.9bn to replace unpaid carers with paid workers. Early identification of carers is crucial to ensuring that they access support at the earliest opportunity and therefore maintain their own health and wellbeing, as well as continue in their caring role. Gloucestershire’s GP Practice workforce can help with this early identification and signposting to information and advice. The CCG is requesting a primary care audit of all 80 general practices in Gloucestershire to establish the number of people registered with their GP as a carer. The CCG will then undertake a review of whether carers have had an annual health check in the last 12 months. With the results of this audit, the CCG can help produce best practice guidance. Community Offer - Children’s Commissioning Update The children’s commissioning team have been working to deliver several programmes: The Future in Mind programme has included the launch of the school pilot in the G15 Gloucester City Schools, delivered by members of GCCG, GHLL, educational

10

psychology and 2gNHSFT. Mental health champions for each school have been nominated and we will meet and work throughout the year to progress this project. The early intervention programme includes a partnership with Teens in Crisis to provide face-to-face counselling for young people. Engagement feedback shows 85% of young people reporting that the counselling has helped them significantly. The perinatal mental health community support work continues to grow, with Home-Start scoping the existing perinatal support already in the county and working towards growing home-start throughout Gloucestershire via a bid to the Big Lottery. We are awarding a grant to produce a social media campaign aimed at supporting dads through the perinatal period. The integrated personal commissioning (IPC) programme for children in care with mental health needs has developed to the stage of recruiting young people via the social work teams to receive personal health budgets. A sustainability plan is being developed alongside the wider CCG IPC work to continue the personalised care agenda. A bid is progressing for a local WellChild nurse. WellChild Nurses provide essential care and practical support to children with exceptional health needs and their families. They play a crucial role in enabling children to leave hospital and be cared for at home. WellChild funds each nurse for a period of three years to be employed and managed by the local healthcare trust. Work continues with Education and Social Care in GCC on the SEND agenda to improve outcomes for children with additional needs. Community Offer - Better Births – Maternity Transformation Gloucestershire In February 2016, Better Births set out the Five Year Forward View for NHS maternity services in England. The report identified the need for transformation in the provision of maternity services to achieve safer and more personalised care to improve outcomes and reduce inequalities by 2021. It puts women and their families at the centre of their care. Better Births recognised that its vision could only be delivered through transformation that is locally led, with support at national and regional levels. The report recommended that providers and commissioners should operate as local maternity systems, with the aim of ensuring that women, babies and families are able to access the services they need and choose, in the community, as close to home as possible. In Gloucestershire we have established our Local Maternity System (LMS) bringing together providers, commissioners and all stakeholders involved in providing care to women accessing maternity services. Together we have developed a local transformation plan to drive forward the recommendations from the Better Births report and the national ambition to reduce stillbirths, neonatal and maternal deaths by 2025. This high level local plan sets out the vision for maternity services in Gloucestershire and includes a detailed action plan of how we will transform services, working closely with women, their families. Seven workstreams have been established led by clinicians to take forward our local priorities for improvement: Progress against out transformation plan is monitored by the LMS with oversight and scrutiny from the STP, regional and national Maternity Transformation

11

Programme Board. The work-streams have excellent multi-professional engagement and each have generated a significant number of quality improvement projects which have been supported with funding from Better Births to deliver improvements in care. GHNHSFT Quality Improvement Academy will be providing training and support to staff undertaking projects. Engaging women, their families and local communities in co-designing maternity services in Gloucestershire is key to the successful implementation of the Better Births recommendations. Work is underway to develop a Maternity Voices Partnership (MVP), led by recent users of our maternity service and a website to engage women to influence and share in the decision-making of the Local Maternity System. We are currently agreeing a logo and communications strategy to launch this important aspect of the Better Births plan. A bid to secure further funding has been submitted to the South West Clinical Network to support the development of the MVP. Funding was received from NHS England to support the better births programme locally and a project team have been appointed. Further funding has also been secured for 2018/19.

2.12 An Open Culture: Engagement – Equality – Experience Annual Report: 2017 The CCG published an annual Equality Report3 as required under the specific equality duty of the Equality Act 2010. As in previous years, the CCG has chosen to combine its progress report on equalities work with examples of innovative practice in engaging and involving local patients, carers, staff and communities. The Public Sector Equality Duty came into force in April 2011. It requires the CCG, in the exercise of its functions, to have due regard to the need to:

Eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited by the Act;

Advance equality of opportunity between people who share a protected characteristic and those who do not;

Foster good relations between people who share a protected characteristic and those who do not.

The report covers:

“An Open Culture”: an introduction to our strategies

Legal requirements relating to engagement, experience and equality

A profile of the population of Gloucestershire

Innovative practice that demonstrates the CCG’s commitment to engagement and equality (web links to case studies4)

Equality information regarding our workforce

3 http://www.gloucestershireccg.nhs.uk/about-us/equality-diversity/reports/

4 http://www.gloucestershireccg.nhs.uk/about-us/equality-diversity/case-studies/

12

3. Department of Health and Social Care and NHS England Consultations

Information regarding Department of Health and Social Care consultations is available via the GOV.UK website: https://www.gov.uk/government/publications?publication_filter_option=consultations Information regarding NHS England consultations is available via the NHS England website: https://www.engage.england.nhs.uk/ These websites also include responses to closed consultations. Closed consultation Conditions for which over the counter items should not routinely be prescribed in primary care As HCOSC Members will be aware from the last CCG Chair/Accountable Officer Report (March 2018), NHS England (NHSE) has undertaken a national consultation regarding the NHS prescribing of a wide range of medicines available to buy as ‘over the counter’ (OTC) medicines from supermarkets or pharmacies during December 2017 to 14 March 2018. The outcome of this consultation was published by NHSE on 29 March 2018 as guidance for CCGs. The NHSE commissioning guidance recommends that for 35 minor, short-term conditions, which are either ‘self-limiting’ or suitable for ‘self-care’ (e.g. coughs, colds, hay fever, oral thrush, nappy rash, warts and verrucas, haemorrhoids, earwax, head lice, threadworms), the associated OTC medicines are no longer routinely NHS prescribed in primary care. It additionally recommends stopping the prescribing of OTC available vitamins and minerals unless they are required for the treatment of a proven deficiency. The guidance includes a range of potential exemptions to this prescribing cessation (e.g. required for long term conditions or their complications; symptoms suggesting the condition may not be minor/self-limiting; if OTC product cannot be sold for the condition requiring treatment; any particularly vulnerable patients). However the guidance states that low income alone (i.e. being exempt from prescription charges) is not a reason for NHS prescribing of these OTC items. Gloucestershire CCG is currently considering how to implement the new guidance locally. The NHSE guidance is available in full: https://www.england.nhs.uk/medicines/over-the-counter-items-which-should-not-routinely-be-prescribed/

3.1 Relevant open Department of Health and Social Care consultations

Personal health budgets and integrated personal budgets: extending legal rights https://www.gov.uk/government/consultations/personal-health-budgets-and-integrated-personal-budgets-extending-legal-rights

13

The government is consulting on:

extending the right to have a personal health budget to specific groups of people

extending the right to have an integrated personal budget to specific groups of people

whether individuals would welcome the opportunity to incorporate additional funding streams into integrated personal budgets

This consultation closes at 11:59pm on 8 June 2018. Low alcohol product labelling https://www.gov.uk/government/consultations/low-alcohol-product-labelling The government is consulting on how best to continue to communicate information about low alcohol products to the public once the current legislation expires. It would like views on:

the introduction of recommended low alcohol descriptors through guidance rather than legislation

the current set of low alcohol descriptors and whether new ones should be added

This consultation closes at 11:59pm on 10 May 2018.

3.2 Department of Health and Social Care Policies

The following web link provides access to Department of Health and Social Policies: https://www.gov.uk/government/policies?keywords=&organisations%5B%5D=department-of-health

4. Section B: Gloucestershire Clinical Commissioning Group (GCCG) primary medical care commissioning update

These items are for information and noting.

4.1 Improved Access cluster pilots

At the beginning of March 2018 five Improved Access cluster pilots were running in the county. The pilots deliver access to primary care appointments until 8pm at night during weekdays, with further provision on Saturdays and Sundays; encompassing innovative models of delivery. For the period until 21 January 2018 these pilots provided an additional 701 appointments to their patients. As well as delivering their core provision, the pilots continue to recruit other members of staff to expand the primary care workforce including paramedics, physiotherapists, mental health nurses and advanced nurse practitioners.

The remaining clusters all finalised their delivery plans to go live by the end of March 2018.

14

All Improved Access pilots will run until March 2019 in order to inform the long-term commissioning strategy for Improved Access.

4.2 Gloucestershire’s Primary Care Workforce Strategy

Gloucestershire’s Primary Care Workforce Strategy was received positively by members of the Gloucestershire Primary Care Commissioning Committee meeting in January 2018. Delivery of the interventions within the strategy will be crucial to ensuring the significant workforce growth required to meet the Office of National Statistics (ONS) population projections and associated primary care workload growth.

4.3 New APMS5 contract, Matson Lane, Gloucester

In readiness for the commencement of the ten year APMS contract with GPPC6, the CCG has been working with staff from Matson Lane, locally elected reps, Gloucestershire County Council and Elim Housing on a new partnership project. This will see a part time partnership worker supporting Taylor House and other Matson residents working from the Phoenix Centre adjacent to the surgery. The year-long project has been co-produced with Taylor House residents with activities focussed around the Five Ways to Wellbeing7.

4.4 Online consultations

We are working with colleagues across the CCG and the Commissioning Support Unit to support the development of local plans for online consultations, ensuring the alignment of our proposals with the future direction of 111 Online. This includes consideration of all online routes to improve patient access, minimising patient confusion and ensuring a clinically appropriate and consistent response, while also considering the best solution to support and streamline – rather than increase – GP workload.

A Procurement Plan has been submitted to NHSE. In the interim we will continue to support the three existing practices in Gloucestershire who have already implemented online consultations and are extending this pilot to three additional practices in order to gain further feedback to support development of a robust implementation strategy and support preparation for future 111 online integration.

4.5 Primary Care: Care Quality Commission (CQC) inspections

As at end February 2018, 16 Gloucestershire practices had received visits during 2017/18 and had received their CQC published inspection report.

One practice, Walnut Tree, was rated ‘outstanding’.

Twelve practices were rated ‘good’.

Two practices were rated ‘requires improvement’, one of which (Stow Surgery) has subsequently received a ‘good’ rating.

One practice, Locking Hill, received an ‘inadequate’ rating but following support from the CCG, a subsequent visit by CQC in January 2018 rated the practice ‘good’.

5 APMS: Alternative Provider Medical Services Contract

6 GPPC: Gloucester GP Consortium Ltd

7 https://www.gov.uk/government/publications/five-ways-to-mental-wellbeing

15

4.6 Primary Care Premises update

Additional Improvement Grant Funding - In January 2018, NHS England requested CCGs put forward proposals for Improvement Grant Funding. The CCG applied for a funding allocation of circa £285k for eleven projects to improve primary care premises across the county. Initial feedback from NHS England was very positive and the CCG is waiting for final approval and will begin working with practices to ensure these projects are brought to fruition.

Churchdown Surgery (Gloucester)

Churchdown Surgery has led its own development of a new build state of the art premises that have been operational from the end of March 2018.

Cinderford

The two practices currently based in Cinderford Health Centre, i.e. Dockham Road Surgery and Forest Health Care are working together with a third party developer, to deliver new premises, for the population of Cinderford. In January 2018 the CCG approved the business case presented to it by the practices including the additional recurring costs. The process for delivering the new premises is ongoing with a planned opening date of November 2019.

5. Section C: Local Providers’ updates

This Section includes updates from 2gether NHS Foundation Trust (2GNHSFT), Gloucestershire Care Services NHS Trust (GCSNHST) and Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT),

These items are for information and noting.

5.0 Trusts Merger update

Last September, the Boards of 2gether NHS Foundation Trust and Gloucestershire Care Services NHS Trust announced plans to work on proposals to integrate as a single organisation. Since then, the two Trusts have appointed a Joint Chair, Ingrid Barker, who took up her position in January 2018. The Trusts have also recently appointed Paul Roberts as Joint Chief Executive, who started in his post on 16 April 2018. Shaun Clee, who was formerly Chief Executive of 2gether, and Katie Norton, Chief Executive of Gloucestershire Care Services, have now stepped down from their posts. Both Shaun, who was Chief Executive for 2gether for 11 years, and Katie, who was in her role for 15 months, made significant and lasting contributions to healthcare in the county of Gloucestershire. The respective Boards have thanked them for their unswerving dedication to improving services, championing the rights and needs of patients, service users and carers and their leadership through many challenges and changes.

16

Both Katie and Shaun were strong advocates for proposals to merge the two Trusts, in order to provide joined up mental and physical healthcare services. While the Trusts are working towards formally joining, both will remain separate legal entities with independent Boards until a full business case is completed and necessary approvals are received. Engagement with service users, patients, carers and staff of both Trusts will take place throughout.

5.1 2gether NHS Foundation Trust (

2GNHSFT)

5.1.1 Trust Signs Smokefree Pledge

2gether has reaffirmed its commitment to a smokefree future by signing the NHS Smokefree Pledge and joining the Smokefree Action Coalition. ²gether has been a Smokefree Trust since April 2017. This means the Trust does not allow smoking in any Trust premises (including our gardens, car parks and grounds) because the Trust recognises that smoking is the single greatest cause of premature death and disease in our communities. Smoking is also the primary reason for the 10 to 20 year shortened life expectancy for people with a mental health problem in the UK. It also impacts negatively on mental health, increasing levels of anxiety, and places a huge burden on the NHS and social care services. The Trust offers a range of support to service users, carers and staff wishing to give up smoking, including a network of Quit Advisors. The signed pledge is now displayed in all Trust reception areas, as a visible sign of the Trust’s commitment. Staff Commitment in Winter Weather Trust colleagues have recently been thanked for the efforts they made during recent periods of snow to ensure service users and carers were still well supported, with minimal disruption to service delivery. The Trust reflected on the staff that had walked to work, the staff that had slept over to be available for the next shift, the staff that stayed on duty to cover gaps, the staff that came in on their off duty days to cover gaps for colleagues who could not get in, the staff that came in to just provide extra support, staff that gave others a lift, family who gave colleagues lifts and many other examples of colleagues going above and beyond their usual commitment. 2gether colleagues support some of Gloucestershire and Herefordshire’s most vulnerable people and have ensured that the 23,000 people it is supporting at any one time, continue to be supported safely and professionally in its care, despite the challenges inclement weather can bring. Triangle of Care – second gold star awarded by Carers Trust 2gether NHS Foundation Trust’s commitment to working in partnership with carers has been recognised with a second gold star under a national scheme. The Triangle of Care scheme is run by the Carers Trust, and brings carers, service users, third sector organizations and NHS professionals closer together to promote the recovery of people with mental health conditions. The Trust was

17

accepted as a member of the scheme in April 2015, gained its first gold star in 2016, and has now been awarded its second gold star. This is the highest level that a Trust such as 2gether can attain. To gain the second star, mental health community teams in both counties had to complete a number of actions, as well as appointing carer champions within their teams and nominating young carer champions. The work was carried out in partnership with local organisations including Carers Gloucestershire and Gloucestershire Young Carers. Although the formal Triangle of Care programme has drawn to a close, the Trust will remain strongly committed to the principles of Triangle of Care and makes sure they are followed routinely in practice throughout the Trust.

5.1.2 Care Quality Commission

During February 2018, the Care Quality Commission conducted an unannounced inspection of 2gether’s services across Gloucestershire and Herefordshire. A team of inspectors visited various teams and departments, including, in Gloucestershire, Berkeley House learning disability inpatient unit, the Children and Young People’s Service, and the Older Adult Community Teams. Stakeholder groups were also held for service users and carers, as well as colleagues from across the Trust. In addition, there then followed, in March 2018, a ‘well led’ inspection, during which senior Trust leaders were interviewed over the course of two days. The outcome of the inspection will not be formally announced for some weeks.

5.1.3 Veterans Mental Health Service

NHS England has launched the NHS Veterans’ Mental Health Complex Treatment Service8; further expanding the range of dedicated care and treatment for those who have served their country. The new local community-based service is for ex-forces personnel who have military attributable complex mental health problems that have not improved following previous treatment. Patients using the service will benefit from an enhanced range of intensive care and treatment that may include (but is not limited to) support for substance misuse, physical health, employment, accommodation, relationships and finances, as well as occupational and trauma-focused therapies. Families are also offered care and support where appropriate. Details of the services providing this support are available online.

5.1.4 Staff Survey

The national NHS Staff Survey results were published in February 2018. The results for the Trust show that 921 colleagues took the survey, giving us a response rate of 45% - a 5% improvement from the previous year. Our results shows our overall staff engagement is better than the national average for Mental Health Trusts and also better than that for NHS Trusts generally. Our results also demonstrate that 78% of colleagues feel the Trust

8 https://www.england.nhs.uk/commissioning/armed-forces/veterans-mental-health-services/

18

prioritises the care of service users and 77% feel that the Trust acts on concerns raised by service users. They also show that 69% of colleagues would recommend the organisation as a place to work and 75% would feel happy with the standard of care provided by the organisation, should their friend or relative need treatment. These scores all rate highly when benchmarked. Areas of focus in the coming year are being developed with colleagues to ensure learning and development from the feedback of colleagues.

5.1.5 Flu Vaccinations

The final flu vaccination figures showed that 2gether achieved the third highest vaccination rate for mental health trusts in the UK – just behind Bradford District Care and Mersey Care NHS Trust. 79.2 per cent of Trust front line colleagues were vaccinated, ensuring that they protected themselves, their families, service users and carers from the flu. Planning will soon begin for the 2018/19 flu season.

5.1.6 Online Digital Therapies

2gether’s Let’s Talk service is now offering a digital therapy option, in addition to guided self help, group sessions and face to face therapy. Let’s Talk provides support to anyone aged 18 and above who is registered with a Gloucestershire GP and needs support with common mental health conditions, such as stress, anxiety and depression.

The digital therapy can be carried out from any internet enabled device, such as lap tops, mobile devices and PCs. It can be carried out to fit in around work and caring commitments, and has a high success rate nationally. It is anticipated that the online therapy, called Silver Cloud, will enable increased numbers of people to benefit from the support Let’s Talk can provide.

5.1.7 Whose Shoes?

An event being held at Kingsholm, in Gloucester, on 24 May 2018 will provide an opportunity for anyone who has become a parent within the last five years to talk about mental health difficulties they experienced and help shape enhanced support for others. ‘Whose Shoes?’ is part of a national programme of events and the Gloucester event is being hosted by the county’s Perinatal Mental Health Service. The Perinatal Mental Health Service was established in 2017 following a successful application for £1.5 million of Government funding. The CCG worked with partners including 2GNHSFT, GCC, GCSNHST and GHNHSFT to submit the county's case.

5.1.8 In Tune with Mental Health

A radio marathon took place last month, highlighting children and young people's mental health. 'In Tune with Mental Health' was produced by University of Gloucestershire final year broadcast journalism student Maddie Simpson, who was motivated to start the project by concerns about the mental health and wellbeing of her fellow students. The show was broadcast through

19

Tone Radio. Maddie was supported in the project by 2gether’s Communications Team, and there were interviews with several Trust colleagues, as well as representatives from local organisations such as the Cavern, Teens in Crisis and Action for Children. A charity gig also took place and the proceeds from the event were donated to the Trust’s Charitable Funds.

5.1.9 NHS70

2gether is making plans to celebrate the 70th anniversary of the NHS in July 2018. The Trust’s annual awards ceremony – the Recognising Outstanding Service and Contribution Awards (ROSCAs) – have been re-scheduled to coincide with the national celebrations. The Trust has also got plans for an NHS70 tea party, an exhibition of historic artefacts and other celebratory events in progress. A number of national events are also being organised, including the NHS70 parliamentary awards, for which a number of Trust colleagues and teams have been nominated.

Gloucestershire Care Services NHS Trust (GCSNHST)

5.2.1 Trust celebrates Good rating from the Care Quality Commission

The Trust is delighted to share that the Care Quality Commission has improved its overall rating of the Trust to ‘Good’, following its inspections in January and February 2018.

The full CQC report was published on Thursday 19 April 2018, and is a huge credit to all the hard work from colleagues across the Trust, recognising their efforts to provide safe, effective, caring and responsive services.

Inspectors highlighted the dignity and respect with which patients were treated, co-ordination of care between teams and effective communication with patients. They also praised the leadership of the Trust, saying there were effective management processes and effective oversight from a strong team of executive and non-executive directors.

The Trust welcomes the opportunity to learn from the inspection and is already focusing on new opportunities for improvement based on comments and observations from the inspection team.

5.2.2 Gloucestershire NHS apprentices best in the South West

Three apprentices from the Trust were awarded for their commitment and service to the NHS at a special regional Health Education England’s Star Awards ceremony. Jess Carmen, Meg Cooke and Amanda Spencer won accolades at the Awards, which recognise the best in education and training in the South West’s health and social care sector. The trio attended the awards ceremony at Somerset County Cricket Ground.

Jess, an apprentice endoscopy nurse at Stroud General Hospital, was named Advanced Apprentice of the Year. Meg, who works in podiatry in Stroud, was named Intermediate Apprentice of the Year. Amanda, former e-rostering trainer at

20

the Trust (now with 2gether NHS Foundation Trust), scooped the Higher Apprentice of the Year award.

During National Apprenticeship Week, colleagues from the Trust took part in a live BBC Radio Gloucestershire broadcast, championing the range of fantastic opportunities.

5.2.3 Forest of Dean Community Hospital update

The Citizens Juries Community Interest Company has been appointed to run an independent citizens’ jury, to consider the location of a new hospital in the Forest of Dean. This follows the decision of NHS Gloucestershire Clinical Commissioning Group (GCCG) and the Trust to approve the recommendation to invest in a new community hospital in the Forest of Dean, to replace Dilke Memorial and Lydney and District Community Hospitals.

The appointment of Citizen’s Juries CIC reflects feedback from the public consultation, where people who responded were clear that they wanted local residents to be involved in making a recommendation to the Trust and the CCG, regarding the preferred location of a new community hospital for the Forest of Dean.

Citizens Juries CIC has extended an invitation for applications from local residents to be involved in the jury, ensuring a balance in terms of age, gender and geography. The jury will be presented with information and hear from expert witnesses. The jury will make a recommendation to GCS board and the CCG Governing Body about whether the new hospital should be located in, or near, Cinderford, Coleford or Lydney.

5.2.4 Recognising our healthcare assistants across the county

An increasing number of the Trust’s healthcare assistants across the county have been awarded care certificates after their 12-week training and development programme.

The nationally recognised certificate, developed by Health Education England, Skills for Health and Skills for Care, is awarded to those in healthcare roles who have demonstrated they meet each of the 15 care certificate standards. This includes caring with privacy and dignity, awareness of mental health (including dementia and learning difficulties), safeguarding and infection control.

This is a great accolade for our colleagues across the Trust and they should be very proud of this achievement.

5.2.5 Complex Care at Home service launched

A brand new Complex Care at home service has recently launched in Cheltenham and Gloucester. The service is working with adults struggling to manage their health conditions and wellbeing, often because they are becoming older, losing their independence and resilience or because they suffer from dementia or frailty. The service will operate to enable people to live independently in their own homes for as long as possible, and to prevent this vulnerable group of people attending and being admitted into hospital.

21

The Complex Care at Home Team, led by Community Matrons, proactively identify people with complex needs, carry out a comprehensive assessment, develop person-centred support plans and ensure the care received is co-ordinated around the person. The team helps people to better understand and manage their conditions and access on-going support including that from their local communities.

5 Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT)

5.3.1 Capital announcement: £39.5m for GHNHSFT

Cheltenham General and Gloucestershire Royal Hospitals have been awarded £39.5m of capital funding to modernise hospital buildings, transform services and deliver even better patient care. The money, awarded by NHS England and allocated under the Gloucestershire Sustainability and Transformation Partnership (STP), will be used to provide the next generation of care at the county’s two main acute hospitals and is recognition of the strong partnership working between health, social care and other partners in the county. To date, the hospitals two sites have sometimes been seen as a problem but the Trust believes they present us with a huge opportunity to develop our vision of Centres of Excellence providing outstanding specialist care where more patients can be treated, waiting times are lower, patient experience is improved and patient outcomes are amongst the best. The next steps are crucial and include the development and approval of both an outline and then full business case; both of which need Trust Board and NHS England sign-off and will be the focus of much work for the next few months. Importantly, this capital will be invested in both Trust sites signalling that both have a vibrant future; the investment at GRH will be targeted at addressing the challenges in urgent and emergency care whilst at CGH it will support the delivery of highly efficient, patient-centred elective care. The timelines are currently being finalised but subject to successful progression through the approval gateways, it is expected that work will commence in spring 2019 and be completed within 24 months. The plans are not contingent upon public consultation but will be developed in conjunction with the ongoing work to develop the One Gloucestershire System Business Case for Urgent and Emergency Care and Centres of Excellence which would be subject to consultation in the future.

5.3.2 A&E performance against the four-hour standard*

As we come out of what has been a long and extremely challenging winter period for the NHS nationally, GHNHSFT has continued to maintain a sustained improvement in A&E performance. These improvements are set out in figure 1 below. In addition to improved performance against the standard, GHNHSFT was one of the very few Trusts in the region not to breach the 12 hour ‘trolley wait’ standard. Another key measure of Winter performance is the number of patients

22

whose handover to hospital, from ambulance conveyance is delayed and again this year, we have seen some of the strongest performance in the region; not only is this good for the patients in transit but it also ensures that ambulance crews are back on the road as soon as possible and ready to respond to the next call for help.

November 2017

December 2017

January 2018 February 2018

March 2018

April 2018 (forecast)

95.3% 90.7% 89.7% 88.4% 86.9% 91%

November 2016

December 2016

January 2017 February 2017

March 2017

April 2017

86.62% 73.86% 74.69% 77.5% 77.7% 82.8%

Figure 1: Performance against the four-hour standard* *A&E four-hour standard: That 95% of patients attending an A&E department must be seen, treated, and admitted or discharged in under four hours. This year’s winter plans have been the most comprehensive to date and this achievement could only have been made through the hard work and commitment of our staff and the continued support and contribution of our partners.

5.3.3 Financial Update The Trust remains in Financial Special Measures though positively, NHS Improvement has signalled the intention to review this status following submission of the 2018/19 plan on 30 April 2018. All 19 of the recommendations arising from the Financial Governance Review have now been completed and the action plan now closed out by the Trust Board, at its March 2018 meeting. The learning from the review, however, continues to shape the practice and culture of the Trust significantly. The Trust is in the process of finalising its final accounts for the year 2017/18. The last reported forecast for the year (February 2018) was £27.8m deficit against a planned deficit for the year of £14.6m. This performance is set in the context of the NHS sector as whole underperforming significantly against these plans, which has resulted in calls from the new Chief Executive of NHS Improvement (NHSI), Ian Dalton for more realistic plans to be agreed between providers and their regulators for this year. Despite this significant variance, the Trust has made positive progress on many fronts and this is recognised by our regulator, NHSI. The Trust achieved delivery of c6% cost reduction, against a sector average of 3% and a median in Trusts in Financial Special Measures of 4.7%; the Trust’s historic performance range has been 2-3%, largely delivered non-recurrently. The principal driver for the variance against the plan is a reduction in income against the original plan arising from three main sources; a reduction in demand for services, loss of operational capacity following the deployment of the Trust’s new electronic patient record and a loss of income again arising from the deployment of the system as a consequence of being unable to capture and report all activity taking place. Plans to remedy this are well advanced and are income risks are significantly mitigated in the new financial year.

23

5.3.4 New public website launched A new public website for our Trust went live in April 2018 delivering many improvements for users of our online information. Within the first 72 hours of the new website www.gloshospitals.nhs.uk being launched 19,000 people had already visited the site. A new and improved staff intranet will follow shortly with a proposed go live date of 14 May 2018. The website has been developed as part of a year-long transformation project, which aims to significantly alter our approach to designing online information. As well as analysing data to look at what people are looking for when they visit our site, the project team directly engaged with hundreds of staff, patients, visitors and members of the public to ensure that the site was built to meet their needs. For the first time, the website has a prominent search to help users find what they are looking for quickly and easily, and the team took a fresh approach to managing our content by checking information like phone numbers and simplifying and reducing content to make it more useful and usable. To help improve the experience of the 60% of people who visit our website on their mobile phones, the new website has been designed to be fully responsive across a range of different devices and screen sizes including mobile and tablet devices. Before going live, the website was tested with members of the public to identify any major concerns that needed to be made ahead of the launch. This approach to involving those who use the website in future developments will now continue, with quarterly tests to ensure we keep pace with the needs of our users.

5.3.5 New £1.75m Radiotherapy Machine at Cheltenham General Hospital (CGH)

The Radiotherapy Department at CGH recently took delivery of new equipment which will enhance treatments for patients with cancer. Called a linear accelerator or ‘LINAC’, the machine is used for external beam radiation treatments for patients with cancer. It delivers high-energy x-rays or electrons to the region of the patient's tumour. The new replacement Linear Accelerator is a ‘state of the art’ machine that treats cancer patients with high precision beams of radiation which limits the side effects of treatment and takes less time to deliver, thus improving the patient’s experience of care. It will enable our department to progress with new techniques and trials and will future proof radiotherapy in GHNHST for years to come.

5.3.6 Support discussions: Chemotherapy in oncology In 2015 the Trust changed the way it supports patients who were starting chemotherapy in the Oncology Centre by having nurse-led information sessions for patients. Now the Trust has produced an informative video to help better inform and support more family members. To make their visits less daunting, we started to invite all patients and one family member or friend to a small group chemotherapy information session. During this session a short presentation is delivered by a chemotherapy nurse aimed at educating them about what chemotherapy is, the potential side effects it can cause and how to keep them well and safe during treatment. They also receive non-clinical information from our FOCUS information centre manager about complementary treatments such as Reiki and Indian Head Massages and are informed of practical advice available such as financial support, talking to children

24

and the available support groups. This change in practice has been positively evaluated by the patients and the feedback has been encouraging. However, support discussions are limited in terms of reach to wider family members who understandably also want to learn more. To help support those members a new video has been uploaded to YouTube.

5.3.7 Oncology centre opens its doors to Cheltenham & Gloucester Hospitals’

charity supporters To help supporters of our hospitals’ charity better understand how their donations have supported patient care, the Trust opened its doors to them so that they could see for themselves the improvements we have made as a result of their generosity. More than 80 charitable donors attended the Oncology Centre in March 2018 when clinicians took donors around the centre and showed them some of the improvements that their donations have achieved. Of particular interest was the mural on the ceiling in the radiotherapy treatment room. The hospitals charity will continue to work with donors in similar ways in the future.

5.3.8 Spiritual care team appoints new Muslim Chaplain to our hospitals

Our Spiritual Care team have appointed Atique Miah, Muslim Chaplain, to our hospitals. In moments of need our spiritual care team are on-hand to support patients, families and friends in our hospitals. The appointment of Atique Miah will ensure that more patients from different faiths have the ability to call on a vital support service.

5.3.9 Improving patient care

The Trust is one of 20 Hospital Trusts in the country to be selected to work with NHS Improvement (NHSI) to develop ways of reducing pressure ulcers for inpatients. This is a new quality improvement project which started in October 2017 on Avening Ward at Cheltenham General Hospital and Ward 4B at Gloucestershire Royal Hospital. A Pressure Ulcer Collaborative Group was formed in October 2017 following acceptance from NHSI to become one of twenty Trusts to participate in the ‘Stop The Pressure National Collaborative Group’. The Group are aiming to improve pressure damage reporting, to increase quality improvement skills, reduce the number and severity of pressure ulcers, to develop a multi-professional focus, to drive improvements at the Trust and to ensure information and training is widely shared and available to help deliver appropriate care, to reduce patient pressure damage and to improve reporting. NHSI also issue monthly targets to assist with the implementation of the project. The particular focus is on reducing Grade 2 Pressure Ulcers. These are partial thickness skin loss involving the epidermis, dermis, or both. They present clinically as an abrasion or blister filled with clear serous fluid. The ulcer is superficial and without bruising. These ulcers are the most common to occur and are preventable in the vast majority of patients if best care is delivered.

5.3.10 Recognising Success In the past month many of the Trust’s amazing staff have been recognised for their efforts. Three front line nursing staff from GHNHSFT have attended Buckingham Palace in recognition of their service; staff were recognised by local radio station

25

The Breeze, with Matron Tracey Cullerne and Dr Tanya De Weymarn being awarded for their work to support cancer patients and older people in the Trust’s Emergency Departments; staff on ward 7a and the Trust’s Patient Experience Team won first prize in the National Patient Experience Awards for their project Small Steps Big Changes and finally, two projects have been shortlisted for the national Health Service Journal Awards - firstly an initiative led by the Gloucestershire Quality & Safety Improvement Academy and secondly the project to pilot the reconfiguration of Trauma & Orthopaedic Services. Finally, the Trust has launched its own monthly staff awards to support the existing annual awards and numerous staff have been recognised for Going the Extra Mile in our aptly named GEM awards.

6. Recommendations

This report is provided for information and HCOSC Members are invited to note

the contents.

Dr Andrew Seymour Mary Hutton Clinical Chair Accountable Officer NHS Gloucestershire CCG NHS Gloucestershire CCG 27 April 2018