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Gloucestershire Health Overview and Scrutiny Committee (HOSC)

14 July 2020

NHS Gloucestershire Clinical Commissioning Group (GCCG) Clinical Chair’s and Accountable Officer’s Report

1. Introduction

Section A provides a general NHS Gloucestershire Clinical Commissioning Group (GCCG) commissioner update, incorporating national consultations. Section B provides a commissioner update focussing on primary medical care.Section C provides Trusts’ updates from: Gloucestershire Health and Care NHS Foundation Trust (GHC) and Gloucestershire Hospitals NHS Foundation Trust (GHT).

Integrated Care System (ICS)ICS 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.Please note some of the items reported below may also feature in more detail in

other reports prepared for HOSC e.g. ICS Lead Report, wherever possible duplication is avoided.

2.1 Response to Covid-19 (Coronavirus)

2.1(i) NOTE: a separate report is included on the agenda entitled: Update on Temporary Service Changes to support the Gloucestershire Health Services Response to Covid-19.

All Integrated Care System (ICS) partners are working together effectively to respond to the novel coronavirus (COVID-19) and ensure that there is joined up work across health and care partners. The response amongst the Healthcare community is being coordinated through an Incident Coordination Centre (ICC), led

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by Dr Marion Andrews Evans and an Incident response structure involving all partners..

A multi-agency Strategic Co-ordinating Group (SCG) led by Sarah Scott, Director of Public Health, has agreed objectives for managing the outbreak, which are to:

preserve life prevent onward infection protect first line responders provide effective decontamination provide clear public messages maintain essential public services supporting our communities to be resilient and support the vulnerable.

The following work-streams have been established covering Staffing – ensuring that there is staff capacity to manage the increasing

demands on managerial and clinical staff throughout the system and planning for reduced staff availability due to illness.

Bed Availability - modelling the potential bed requirements to cope with: 1. an increase in the number of ‘well’ patients needing isolation2. the number of patients requiring a hospital bed provided in a cohort

isolation facility, to manage respiratory illness 3. the number of critically ill patients requiring critical care support and 4. the availability of care home beds to support discharge and

domiciliary care.This work includes the potential use of other capacity in the county e.g. independent hospitals and community nursing service including rapid response.

Primary care resilience - developing new service provision to support primary care and community services. The aim is to keep potentially infectious patients away from GP surgeries to allow practices to continue with their usual business. The workstream also looks at what further support, equipment, communications and other resources primary care requires.

Digital - exploring the use of digital technology to facilitate remote clinical consultations particularly for OPD, primary care and community services.

Vulnerable citizens - planning for the impact on the elderly receiving domiciliary care and the high risk elderly in care homes. This includes the involvement of voluntary and community services to support individuals isolated in their own homes.

Supplies – at the onset of the pandemic there was a shortage of Personal Protective Equipment (PPE) especially masks across the country. The workstream works in collaboration with local provider Trusts to facilitate mutual aid and with the Local Resilience Forum (LRF), supported through NHS Supplies and NHS E/I South West, establishing a Gloucestershire PPE Distribution Hub to support primary care, care homes and domiciliary care.

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The above work is underpinned by each organisation’s business continuity plans. A review of all current services was undertaken and options considered to support critical functions and which activities/services could be temporarily suspended in the short term. All NHS Healthcare organisations within Gloucestershire have a Mutual Aid agreement in place, whereby organisations agree to share resources and staff where feasible.

A key priority continues to be ensuring that health and care professionals have access to the equipment and information they need and the NHS has also introduced a wide range of staff support and wellbeing programmes providing practical as well as emotional and psychological support to colleagues on the frontline.

It is vitally important that people continue to contact the NHS for support with non-Covid-19 related health issues – whether those relate to physical health or mental health. Our message is clear - please don’t store your health concerns up for when the Covid-19 situation is all over. If you’re worried about something and need urgent help, get in touch.

Covid-19 testing

The SCG has established a testing cell led by the Deputy Director of Public Health to oversee the county-wide testing arrangements. Swab testing for the Covid-19 virus continues with two fixed sites in Gloucester and Brockworth. There are also two mobile testing units in the county run by the military funded by DHSC. Currently one unit is in Stroud and the other has been in Bourton on the Water and moved to Stow on the Wold. It has also been in Cinderford. There have been difficulties in identifying sites for the units to operate from, with some land owners asking for rent and insurance to be paid which has to be funded locally. The Testing Cell has now been able to identify some further sites which will be used in weeks to come.

Should we have an outbreak in a particular location, these mobile units will be moved to the area to provide a mass swabbing service. It is unclear how much longer the central funding for the mobile units will continue. It is likely that these may have to be run locally in the future. It should be noted that although these are mobile units, they do take a couple of days to set them up and take them down when they are moved. In addition, they require people to drive to the testing centre which might not be possible for everyone. Therefore other testing arrangements will need to be in place such as self-swabbing kits and a home visiting testing service. Swab testing is available to all essential workers and also to members of the public who consider they have symptoms of the virus.

Currently we have no clusters of cases in the county that would indicate an outbreak is developing. The numbers of people requesting a test at both the fixed sites and mobile units is reducing significantly week by week as the rate of infection in the county falls. Of the swabs being undertaken there is only about 1

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new case identified each day. For these cases the PHE contact tracing is initiated to ensure the infection speared is controlled.

With the development of the county Local Outbreak Management Plan (LOMP), https://www.gloucestershire.gov.uk/media/2099097/covid-19-local-outbreak-management-plan-first-edition.pdf the Covid-19 Health Protection Board has been established with the testing cell now reporting to this board rather than the SCG. This is an important change as it allows the Covid Health Protection Board to direct the testing service in response to an outbreak.

Patient testing continues to be provided to all patients admitted as an emergency to hospital. Once swabbed, patients are cared for in an ‘amber’ isolation area until their results are known. Once the result is confirmed the patient is then transferred to a ‘blue’ positive isolation area or a ‘green’ negative area. The introduction of these bed zones has restricted the use of some beds and resulted in the Hospitals Trust reviewing the bed use across its two sites to accommodate these requirements. Swab testing of all patients with a planned admission enables patients to be placed in the correct zone when they come for treatment.

Supporting Care Homes

GCC, GHCNHSFT and the CCG continue to work together to support care homes across the county during C19. This can include additional deliveries of PPE, access to swabbing and staff wellbeing initiatives and face to face training for care home staff.

The team continues to work closely with our local public health service and regional PHE. The brokerage team at GCC undertake daily monitoring of Covid-19 infection rates, deaths and occupancy of all care homes and supported living accommodation.

In response to requests from care homes, proactive information on infection control and use of PPE is hosted on a dedicated Care Home Support team website. In addition the existing Gloucestershire Care Home specific Facebook pages continue.

There has been a long-standing arrangement between the NHS and GCC care home quality teams of sharing information and working together to improve care in the local care homes. This is co-ordinated by the Clinical Quality Review Group (CQRG) for care homes. In light of the current situation these meetings are taking place each week. Membership includes the chair of the adult safeguarding board, CQC and Public Health.

The new GP ‘Quality Alerts’ dedicated e-mail is working well and has enabled additional intelligence to be gathered by GCC and the CCG and an appropriate intervention to be enacted.

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Care Homes are reporting that they feel more supported.

One innovation is the introduction of regular ‘virtual ward rounds’ to check on the health of residents and to identify any medical needs that individuals may have. Because strong working relationships have already been established between GP practices and care homes, the foundations have been laid for a swift move to a digital way of working. In most cases, virtual ward rounds are carried out by the Practices’ lead GP for the care home and the senior nurse or carer at the home. The ward rounds vary in nature from a phone call to discuss all the patients with a focus on those highlighted by the care home, to a video ward round.

Infection Control and Prevention and PPE Training in Care Homes

On 1st May 2020, Gloucestershire CCG, under the direction of our Local Resilience Forum (LRF), and in partnership with the NHS and multiagency Covid-19 groups was tasked with sourcing and training approximately 40 ‘trainers’ for care homes. The training is based on a ‘train the trainer’ model with a ‘super trainer’ providing very practical training on infection prevention and control, as well as the correct use of PPE. This training is provided to ‘trainers’ on either a face-to-face basis or remotely. Training offered to care homes must be on a face-to-face basis.

The CCG super trainer completed her super training on 8 May, and has trained 40 ‘trainers’ from across the NHS, Police, Fire and Rescue, County Council and Environmental Health to provide training to care homes across the county. Following completion of this programme the training programme has been rolled out by the LRF to domiciliary care providers in the County.

Hospitals

Planning is underway to transition to Business As Usual (BAU) whilst retaining the focus on Covid-19 to ensure the system is prepared to respond to any further surges within Gloucestershire.

Continued use of digital technology to undertake as many non-face to face appointments as possible and this is working well for both patients and clinicians.

Bed planning, capacity and flow and the Scenario planning bronze cells have been focusing on the medium and long term ability to flex and maintain pathways in order to accommodate the varying demand for the Covid-19 ve+ and ve- bed bases whilst also recognising the need to balance a return to BAU in GHNHSFT, community hospitals and the community discharge pathways.

Community modelling is well advanced we have capacity for Covid-19 ve- across all pathways and capacity for Covid-19 ve+ in our community hospitals, GHCNHSFT have flexed criteria to facilitate acute flow and the shifting demands.

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Commissioned discharge to assess hubs have been opened jointly.

Patient delays to discharge are minimal.

Patient Experience and Public Feedback

A significant amount of activity has taken place, or is planned, to gather patient, carer and staff feedback relating to the health and care response to Covid-19 in Gloucestershire. Gloucestershire has also been influencing the plans for regional and national research on the subject of capturing the experience of patients and carers to Covid-19.

Examples of how One Gloucestershire ICS NHS partners and Healthwatch Gloucestershire have been maintaining service user and carer involvement during Covid-19

During the pandemic all Patient Support, Advice and Liaison Services have adapted to ensure that patients, carers are families are able to access the support they require. As well as resolving issues, these services are recording current experience of local services.

Reporting of Friends and Family Test (FFT) data to NHSE/NHSI was suspended from March 2020 onwards. However, Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) made the decision to continue to monitor FFT feedback as the Trust runs surveys electronically and could continue to use this as a Quality measure of services during Covid-19.

The Gloucestershire Health and Care NHS Foundation Trust (GHCNHSFT) Social Inclusion Team has remained actively involved with over 100 people: including Experts by lived Experience, Students and Peer support Volunteers within Recovery College and Live Better, Feel Better programmes and other Patient representatives through community stakeholder groups, e.g. Inclusion Gloucestershire.

This has been achieved via a combination of: Holding MS teams virtual weekly meetings (with those registered on the

Experts programme: Carers, Service Users and Patients) Email communications Co- production and sharing of newsletters to Student and Peer Support

Volunteers Use and sharing of Easy Read resources developed by GHC (Coronavirus

Easy Read Patient Resources for People With a Learning Disability) endorsed by NHS England

Regular phone calls and text messages

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Maintaining these connections has ensured that Experts by Experience, Patients, Service Users and Carers feel valued as part of the organisation and has provided an opportunity to rapidly test the use of technology to support involvement activity.

NHS Gloucestershire CCG (GCCG) has been collecting Patient Stories of Covid-19, inviting patients and carers to tell their story in their own words either in writing or through a telephone interview.

Healthwatch Gloucestershire (HWG) has been asking local people: Has your health and care been affected by coronavirus? Through an online survey, HWG has been gathering feedback from local people about their health and care experiences during the virus outbreak. HWG has also recently undertaken a series of online workshops. The valuable insight gained will be shared with local ICS partners to help us to understand how to adapt and improve services right now and, in the longer term.

Examples of how ICS NHS partners have been gathering feedback from staff during Covid-19

At GHCNHSFT the process for capturing lesson learned has included workshops hosted between operational / service delivery teams to capture feedback from operational service managers and professional leads. The methods for capturing feedback from all GHCNHSFT staff builds on the organisation and system wide work already underway for capturing key learning points from Covid-19 – these are as follows:

A brief questionnaire for capturing key lesson learned has been targeted at Senior Leadership Network staff members.

Global email requesting All Staff to share experiences and learning from Covid-19 incident management arrangements.

Programmes and Transformation Team has facilitated de-briefing meetings to be held in district localities sites - A combination of drop in sessions in main site foyers to give direct feedback alongside facilitated sessions with Staff invited to attend ( via MS Teams)

GHNHSFT has coordinated its collection of feedback from staff under the ‘Silver Linings’ programme. ‘Silver Linings’ has facilitated the collection of feedback using the following mechanisms:

Daily Staff Update emails 2020 Staff Support Hub A dedicated Silver Linings Mailbox Daily SitRep conference calls Emails from individuals directly to me (either directly to highlight something,

or that I’ve spotted and pulled out). CEO weekly vlog COVID step-down and step-up plans

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The CCG has established weekly Covid-19 staff briefings and a weekly VLOG from a member of the Executive Team. A GCCG staff wellbeing newsletter has provided the opportunity to share ideas and provide feedback about how to cope during the pandemic and new ways of working.

All feedback will help to build a picture of the overall impact of COVID-19 to inform future decisions about services.

Local and regional activity planned

A range of local and regional activity is planned in order to capture experience of Covid-19. This will include the following over the next few months: GHCNHSFT is planning to capture Service User and Carer feedback via virtual focus groups. The Trust is also exploring the potential to use the feedback mechanism in ‘Appointments Anywhere’ to capture patient feedback. The Trust has launched (w/c 8 June 2020) a Caring through Covid-19 – Your Experience survey. The survey is aimed at individuals who have either had experience of GHCNHSFT services as a patient, service user or as an unpaid carer during the current Covid-19 crisis. https://www.smartsurvey.co.uk/s/AGW35S/ The CCG is working with colleagues from NHS England/Innovation (NHSE/I), Dorset CCG and Somerset CCG to develop a regional Covid-19 Experience Survey. The purpose of developing a regional survey is to identify any regional variation in patient experience of Covid-19 and to allow for comparison across systems. The intention is to soft-launch the survey w/c 29 June 2020 and to promote the survey actively to coincide with the NHS Birthday on 5 July 2020. The survey is available via https://www.smartsurvey.co.uk/s/Covid19SWExp/

The CCG will be hosting a Microsoft Teams Patient Participation Group (PPG) Network meeting with approximately 50 PPG participants in July 2020. The focus of the agenda will be Covid-19.

The CCG has signed a contract with ‘Bang The Table’ for a licence to use the online engagement tool: ‘Engagement HQ’. The system provides a range of integrated online engagement tools, information and communication resources, as well as participant record management, reporting and data analysis capabilities. The package the CCG has procured provides initial support with design, a comprehensive training package, licence for unlimited use of the software/site URLs and ongoing technical and on-line moderation support. In addition to providing a stakeholder management system, it has the capacity to simultaneously run an unlimited number of communication projects, engagement and consultation programmes. It will replace the CCG’s existing survey software, providing all of the functionality that the current system provides for staff, stakeholder (including GPs) and public engagement and consultation. Key Features include:

Our preferred domain name – Get Involved in Gloucestershire (GIG) Capacity to engage in open community consultation projects or protected

consultation projects; specific on-line stakeholder panels or focus groups;

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Capacity to determine, capture and manage participant demographic data and participant records;

Comprehensive analytics including tagging, analysis and reporting of all quantitative and qualitative;

Accessibility via mobiles, tablets and PCs; Access to discussion forums to engage in and facilitate discussion;

GCCG Engagement and Communications staff will receive training in June 2020 and the anticipated go-live is July/August. The system will be used for Covid-19 and non-Covid-19 activity, in particular it will support Fit for the Future consultation activities later this year.

National activity under consideration

Gloucestershire has been seeking to influence planning in relation to the collection of nation-wide (England) feedback regarding Covid-19. In particular:

National GP Patient Survey: The CCG is represented on the national Steering Group for the development and delivery of the GPPS. The CCG has suggested to the NHSE/I Insight Team that the GPPS, and other national surveys, should consider incorporating a series of Covid-19 related questions (focussing in particular on experience of new ways of working, specifically digital solutions), into the 2021 national survey programme. The national Steering Group will discuss this at its meeting in July 2020. In 2019, the GPPS collected 777,000 responses, including feedback from 450,000 patients with a long term condition and 140,000 carers. A data set of this size would provide invaluable quantitative insight into Covid-19 new ways of working to inform policy development nationally.

The University of Manchester has funding from the National Institute for Health Research(NIHR) Applied Research Collaboration (ARC) to bring together researchers, health and care providers, patients and communities to deliver large programmes of qualitative research. One strand of funding is dedicated to the design and running of one or more citizens’ juries. The focus of the research will be: Digital transformation post-Covid-19. The University plans to work with Citizens Juries c.i.c. and the Jefferson Center. Citizens Juries c.i.c. have previously worked with ICS partners in Gloucestershire and sought our advice to define the focus and design of this research. GCCG has been liaising with colleagues at University of Manchester, Citizens Juries and NHS England to seek opportunities for greater collaboration across England with this research in order to consider the extension of its reach beyond the initial scope.

Patient Transport

The Gloucestershire NHS Non-Emergency patient transport provider (E-zec Medical) continues to operate a good service for all patients, regardless of their Covid-19 status. Through the installation of vehicles partitions and use of PPE they

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have met the requirements of national guidance and maintained their service for those patients who really need to make essential journeys to or from healthcare settings. E-Zec medical now have access to the NHS Supply Chain for PPE procurement and report daily to the ICS on their operational capacities – which are described as challenging but manageable.

NHSE/I recently issued national guidance, which is in place in Gloucestershire. This confirms that the normal eligibility requirements for Non-Emergency Patient Transport have been suspended and replaced with four categories of patients who will now be able to use this service. Those categories are:

Patients who have been discharged and need to be transported from one care setting to another, or home, if there is no alternative means of transport;

Patients defined on medical grounds as extremely vulnerable from Covid-19 who need to attend ongoing care appointments and have no access to private travel.

Patients suspected of having Covid-19 who need to attend ongoing care appointments and have no access to private travel.

Patients with life-sustaining care needs who need to attend a care setting, such as for dialysis, and have no access to private travel.

Locally, we have also ensured that those patients on an End of Life pathway can also access the service so that patients and their families do not need to worry about transport, at what will be a very worrying time.

Supplies/PPE

Gloucestershire Hospitals and Gloucestershire Health and Care NHS Foundation Trusts continue to receive regular (almost daily) PPE drops.

A central PPE Distribution Hub containing PPE supplies has been established by the CCG with LRF partners. This provides a range of essential PPE to the following areas:

Adult Social Care including private and local authority controlled Care Homes and Domiciliary Care providers

Carers of End of Life Patients (Covid-19 positive) electing to die at home Children’s homes Community Pharmacies Emergency Dentists / Dental Hubs General Practitioners (GPs) HM Courts

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HM Prison and Probation Service Hospices and Palliative Care Local Authority (Children's and Adult Social Care) Mental Health Community Services/Adult Social Workers Mortuary Optometrists Police Funeral services Residential Special Schools Some VCS organisations

Requests for stock arrive via a dedicated email address and PPE items are checked and picked by a small team of CCG and Adult Social Care staff. All requests are then delivered by retained GlosFire personnel the same day through a centrally co-ordinated transport hub.

PPE stock is being replenished regularly from items sourced locally, nationally and internationally by Supplies and Equipment Bronze Cell team staff. Stock takes are undertaken daily and are reconciled with issues made. In addition, the store accepts regular bulk delivery drops from the Local Resilience Forum and donations from businesses across the county. Stock is checked to ensure that quality standards are met and CE/British Standard compliance certificates are obtained as required.

The PPE store relies on multi-agency effort to ensure that there is a constant supply of stock for the county. Staff from Health, Council, Military Planning, Police and Fire services continue to explore potential supply routes.

The system has received many donations of PPE. All donors have been thanked in writing and these donations have made an enormous difference to our ability to deliver PPE to over 700 sites with confidence. By mid-June 3million items of PPE have been distributed from the Gloucestershire PPE Hub.

Emergency Dental Services

Because of Covid-19 all routine dental treatment was stopped [this is now resuming gradually] and urgent dental care has been significantly restricted by the commissioner for NHS dental services, which is NHS England.

The pathway for urgent dental patients, seven days a week, during Covid-19 pandemic has been as follows:

Urgent dental services should be accessed via the patient’s own dentist. If deemed appropriate the local dentist would refer the patient through a referral process administered by Gloucestershire Local Dental Committee (GLDC). National guidance used to decide whether a referral is appropriate.

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If the local dentist is unavailable (e.g. weekend or out of core hours) or the patient is not registered with a dentist the patient should call NHS 111 or 0300 421 6440 for advice, guidance and if appropriate complete the referral process designated by the GLDC.

GHCNHSFT have set up emergency dental hubs to take the GLDC referrals. Dentists at the hubs contact and triage the patient and make a decision as to whether a face to face consultation or treatment is needed and if required they will be given an appointment.

Staffing

More than 150 staff have been supported to remain in work through the provision of safe accommodation. Through co-ordinated internal and cross system re-deployment, staffing levels have been effectively maintained.

Following concerns about the number of Black Asian and Minority Ethnic (BAME) individuals and NHS colleagues up and down the country being adversely affected by Coronavirus, each organisation is contacting its BAME colleagues (and other vulnerable groups) to carry out risk assessments and where appropriate, redeploy to ensure safety.

More than 30 returning healthcare professionals have been deployed into the local system via NHS England’s ‘Bring Back Scheme’. This includes Nurses, Doctors, Midwives and Allied Health Professionals.

Recovery

Our focus is now, not only on continuing our efforts in dealing with the pandemic, but also on planning our recovery. This extensive programme of work is being co-ordinated by the ICS and there are four main programmes of work; task and finish (including service reinstatement), transformation (including maintaining innovation), and future needs (including meeting the needs of vulnerable and shielded people) and cross cutting themes (including finance, digital and performance recovery). Our NHS recovery response is closely aligned to the work of the LRF recovery cell and reporting arrangements are in place in both directions.

A letter was received in early May 2020 setting out the national requirements for NHS recovery, accompanied by a detailed action plan that we have put into place locally. Additional cancer surgery capacity is now in place and we are currently working on the detail of how other elective services can be brought back on line safely. There has been an increase in attendances to A&E and in 2 week wait cancer referrals from general practice, both of which are early signs that some normality is being regained in the patterns of our population’s use of healthcare services, albeit this remains well below usual levels of demand.

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2.2 Learning Disabilities and Autism update

Learning from deaths of people with a learning disability (LeDeR)

People with a learning disability often have poorer physical and mental health than other people. It is known that too many people with a learning disability are dying earlier than they should from things which could have been prevented.

The learning from deaths of people with a learning disability or LeDeR programme was set up to look at why people are dying. By finding out more about why people died, there can be learning about what can be changed to make a difference to people’s lives. The programme is using the findings from reviews to change the care and treatment which people with a learning disability receive so that their life chances are improved.

The CCG has completed 67% reviews with 150 reviews in scope; meaning that 102 are completed and 48 are still open, since the start of the programme. All the reviews received before December 2019 have been allocated for review.

A Quality Assurance (QA) Panel process has been set up to scrutinise each initial review and obtain the learning which will be put into action. The CCG has successfully applied for additional funding from NHS England for the year 2019/20.

£35k to fund independent reviews and an expert by experience to support the QA panel process.

£18k to clear the backlog of reviews. £20k to undertake an audit of the PEG pathway (LeDeR Learning into

Action) – this project has been scoped with clinical colleagues and will commence once recruitment has been completed.

The Annual report is available on the CCG website: https://www.gloucestershireccg.nhs.uk/wp-content/uploads/2019/12/LeDeR-annual-reportPresscopy_October19.pdf

2.3 Annual Health Check Project The CCG met the 65% target for annual health checks given by GPs to people with learning disabilities in 2018-19. The CCG continues to focus on the Gloucester and Cheltenham localities with a particular emphasis on young people aged 14-17 years old. A new programme called Supercharged Me was commissioned and specifically targeted those people with learning disabilities who are living independently and not accessing social care; as well as those who are still living with family.

Approximately £35k was received from Health Education England (HEE) to help support annual health checks and the rollout of the Supercharged Me campaign across the South West. We are supported in this work by Kingfisher Treasure Seekers who continue to develop this wider regional work. The CCG also ran a

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series of forum theatre training events delivered for Primary Care Learning Disabilities Champions in April/May 2019 https://youtu.be/ao8GmsS67Vk and https://youtu.be/K1komdzoLlc. Additionally the CCG commissioned a 12 month project from Inclusion Gloucestershire to continue to run the Marking Adjustments workshops during 2020/21.

2.4 Disabled Children & Young People Service (CYPS)

A revised service specification for Learning Disabilities CYPS has been developed by commissioners. Additional staff will be recruited and the service specification criteria will cover all special schools in Gloucestershire. The current waiting list within learning disabilities CYPS has significantly reduced through recent staff recruitment.

Gloucestershire has been successful in obtaining £10k funding from HEE for website development and training related to challenging behaviour.

Gloucestershire developed a business case during 2019 using a co-production approach with the Parent Carer Forum to review the Children’s Autism pathway. One of the options within the business case has been approved, which has resulted in an additional resource commitment. This means that planning for implementation of improvements can commence, and this will be co-produced with the parent carer forum. In addition, a small amount of NHS England funding is also being utilised to support post diagnosis support and timely assessment.

2.5 Personalised Care

Personalised Care aims to give people more choice and control over their own health and wellbeing and requires a fundamental shift in the relationship between health and care professionals and people. Gloucestershire has been one of three national demonstrator sites for the NHS England Personalised Care programme since 2016. The demonstrator programme finished in March 2020 and key achievements include:

Developing the social prescribing and cultural commissioning offers. Embedding Health coaching approaches as part of services e.g. Pain

Management service, Integrated Community teams in Berkeley Vale and Complex Care at Home. (for example see Better Conversations Health Coaching https://www.youtube.com/watch?v=nCP4joBUVhc )

Establishing Network Multi-Disciplinary Team meetings within primary care, and developing personalised care and support plans: Me at My Best/ My Goals for people with long term conditions (for example see South Cots Frailty Service https://www.youtube.com/watch?v=bykrZXXew6w&t=15s )

Working differently with people with serious mental illness, with a new narrative assessment replacing the FACE assessment (for example see The Girl who Climbs www.youtube.com/watch?v=XOHGN7ikxF0 )Developing new approaches for working with high users of services.

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Hosting successful events for existing staff and health and care University of Gloucester students to promote personalised care: these have been organised by Gloucestershire Health and Care NHS FT and include experts by experience sharing their stories.

Using Personalised care approaches to design interventions for patients in primary care as part of the Wave 2 population health management programme.

From April 2020 we moved from our position as a demonstrator site towards embedding Personalised Care approaches as “business as usual” across the Integrated Care System (ICS). A new ICS strategic board for Personalised Care will be set up to take the work forward; Margaret Willcox (Executive Director of Adult Social Care, GCC) and John Campbell (Chief Operating Officer, GHC) will be co-chairs of this board, with representatives from across the system.

The Board will help to steer the work programme in line with the key deliverables within the NHS Long Term Plan and will review and promote the following key messages about the vision for Personalised Care in Gloucestershire, recently developed by a cross system task and finish group.

Talking about people, not patients. Asking ‘What matters to you’ is a priority in all organisations and is part of

conversation at every level. People in One Gloucestershire feel listened to, understood and supported. We use language that everyone understands. Everyone understands the different relationship; professionals move

between being fixer and enabler as appropriate, and more people are empowered to take responsibility for their health and wellbeing.

There is a culture of creativity, collaboration and a balanced approach to risk.

The system is better connected, with shared records and fewer handoffs within and between organisations.

2.6 We Can Move Programme

The We Can Move programme continues to work to increase people’s levels of physical activity, through tackling the barriers at individual, community and system levels. Wrapped around this Gloucestershire partners continue to promote social movement in which physical activity becomes the social norm, with everybody getting active every day.

The social movement element of We Can Move was evident in the Parkrun Special event on 7 March 2020 with less active women attending for the first time and joining the movement. While Gloucestershire fares better than the rest of the country in terms of the percentage of women being inactive (22.2% vs 26.1%), they are still less active than men in the county.

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2.7 Gloucestershire’s National Diabetes Prevention Programme (NDPP)

Since transitioning to a new NDPP service provider (ICS Health and Wellbeing) in August 2019 there have been 1,526 referrals to the service. Since July 2017, there have been 4,839 Gloucestershire referrals onto the diabetes prevention programme. In line with the NHS Long Term Plan to double the NDPP capacity support up to 200,000 people at risk per year by 2023/24, the NDPP project team has worked with GHNHSFT to pilot a work-based diabetes risk screening for staff to reach out to people of working age to offer a work based diabetes prevention programme.

This diabetes risk screening pilot launched at the end of January 2020 with GHNHSFT staff members invited to complete a Diabetes Risk Screening Questionnaire. Those identified moderate to high risk had the opportunity to get a free blood glucose test with their Occupational Health Team. The project team visited every department within Gloucestershire Royal Hospital and Cheltenham General Hospital as well as having a promotional stand to support staff members in completing their questionnaire and providing advice. The project team met members of GHNHSFT staff who had been informed by their GP practice that their blood glucose levels were high but had not yet taken any action or made any lifestyle changes.

The NDPP project team has started communicating with other large organisations such as the Gloucestershire Constabulary for the purpose of replicating a similar pilot for those workforces. The project team has also been working with the CCG’s Workplace Wellbeing Consultant Susan Doran to highlight organisations that are working towards their ‘Gloucestershire Healthy Workplace Award’ and would potentially be interested in offering their staff members free risk screening for type 2 diabetes.

The NDPP project is taking this approach to engage with more people of working age who are at risk of Type 2 Diabetes and help to reduce the barriers to take up of NDPP through the offer of a work based prevention programme.

2.8 ESCAPE-Pain

ESCAPE-Pain is a well-established evidence based intervention for patients diagnosed with knee and/or hip Osteoarthritis (OA), delivered in a non-clinical setting by physiotherapists and level 3 trained exercise professionals.

The programme is delivered to small groups of people (usually around 8-12 participants) twice a week, for five weeks (total 10 classes) and comprises an educational component where participants learn about OA, what might be causing it, why they experience pain, simple ways to cope and self-manage their problems and a supervised exercise regimen where participants undertake a progressive exercise programme tailored to each individual’s needs and abilities. The peer support element is also valuable in reducing social isolation and allowing

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participants to share their experiences – several participants from the programme have gone on to “buddy up” in continuing to attend the gym or exercise classes.

The provision for ESCAPE Pain in Gloucestershire commenced in late 2017 in Cheltenham with Gloucester following in early 2018. Such is the success of the programme that there are now have a total of 6 venues with Tewkesbury, Forest of Dean, Cirencester and North Cotswold joining the initiative in 2019 and early 2020. The North Cotswold and Cirencester programmes have been made possible by funding from the CCG.

Data collected from the two longest established programmes in Gloucestershire show a marked improvement from participants in terms of pain, function and quality of life. There are also reported improvements in general physical and mental wellbeing and, in particular, a reduction in social isolation. One participant described the programme as “a life saver”. Other benefits include increased self-confidence, better and more effective medication management, delayed surgical interventions and better outcomes from surgery due to the “pre-hab” effect of physical exercise.

The ESCAPE Pain programme has been highly successful in Gloucestershire and demonstrates effective collaborative partnerships between our Providers, the CCG, the Academic Health Science Network and local leisure centres.

2.9 New campaign launched to encourage Gloucestershire parents to help build their baby’s brains

A new local campaign based on the NSPCC’s ‘Look, Say, Sing, Play’ approach has been launched to help parents build their baby’s brains right from birth.

The campaign is a partnership with the CCG, GHNHSFT, GCC, GHCNHSFT, Home-Start in Gloucestershire, Peter Lang Children’s Trust, and The Friendship Café.

The campaign aims to encourage parents to take a look at what their baby is focusing on and how they react, say what they are doing and copy the sounds their baby makes, sing along to their favourite tune or plays simple games and see what their baby enjoys.

During launch events on 27 February 2020, professionals learned about the brain-building science behind the campaign, heard from other local partners supporting Gloucestershire parents and families received campaign resources such as leaflets, flashcards and posters to share with new parents.

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2.10 Community phlebotomy services

BackgroundFrom the previous update on this topic in March 2020, members will be aware that community phlebotomy services have historically been provided in a range of settings and locations within Gloucestershire, including ‘drop in’ hospital clinics and GP practices. Whilst some patients currently access a local phlebotomy service from their GP Practice, there are also many other patients that have to travel into hospital just to have their bloods taken. High levels of demand within the hospital setting has led to long waiting times for many patients. On occasion, hospital services have had to close earlier than scheduled in order to manage safely the number of patients waiting, with some patients then needing to come back on another date.

UpdateThe CCG wants to improve this service for patients by ensuring all patients get timely access to a safe and high quality community phlebotomy service at a location as close to their home as possible. This involves reducing the need for patients to have to travel to a hospital and ensuring the provision of a consistent service across the county. Therefore from 1 July 2020, the CCG is funding all Gloucestershire CCG Member GP practices to provide this service to their patients.

For those patients who already access phlebotomy services from their local GP practice, there will be no change. For those patients who currently make use of hospital ‘drop in’ phlebotomy clinics, the move to a new service model with phlebotomy provided from their GP practice, will result in reduced travel and waiting times and the avoidance of hospital car parking charges. The vast majority of practices in county who have not previously provided phlebotomy to their patients commence doing so from 1 July 2020, with all practices providing a service by the end of the summer. Patients requiring more specialist phlebotomy services such as those requiring specialist tests, those under the care of hospital consultants and those aged 6-11 years will still need to travel to either Cheltenham General or Gloucestershire Royal Hospitals.

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

3.1 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

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3.1.1 Caldicott Principles: a consultation about revising, expanding and upholding the principles https://www.gov.uk/government/consultations/caldicott-principles-a-consultation-about-revising-expanding-and-upholding-the-principlesSeeking views on the Caldicott Principles and appointment of Caldicott Guardians. This consultation closes at midday on 3 September 2020

3.2 Information regarding NHS England consultations is available via the NHS England website: https://www.engage.england.nhs.uk/

The Department of Health and NHS England websites also include responses to closed consultations.

3.3 Department of Health and Social Care PoliciesThe following web link provides access to Department of Health and Social Care 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 Primary Care response to COVID-19

The CCG would like to report the important progress made by Primary Care in the response to COVID-19, with specific focus on communications, the approach to setting up and implementation of Community Hubs, digital implementation and workforce support. Primary Care has shown great resilience and adaptability in transforming its ways of working during COVID-19.

The CCG Primary Care and Localities Directorate remain in daily two way communication with Practices, GPs and Primary Care Network (PCN) Clinical Directors to understand and alleviate any issues and concerns.

A briefing for General Practice has been shared daily since 13 March 2020 with GPs, Locums, Practice Managers and the LMC from Dr Andy Seymour and Helen Goodey. The briefing includes timely national and local updates and is shared for urgent reading by recipients. Following Government advice that we are past the peak of the virus outbreak, the briefing has been reduced to three times a week in line with the reduced amount of information to be disseminated.

A daily SITREP is undertaken with all 73 GP practices to understand workforce levels and any business continuity concerns including personal protective

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equipment (PPE) concerns and therefore able to offer support quickly where required.

New pathways have been developed and implemented at pace including the primary care clinical pathway for Covid-19. This and others, such as the deteriorating patient pathway, end of life pathways, clinical guideline changes across specialities and in response to the Covid-19 crisis, have all gone through and been endorsed by the Clinical Advisory Group. This group is system-wide and has ensured oversight of such pathways and clinical sign off. Subsequent to this they have then actively been promoted in the daily briefing and are available on G-Care.

Currently the vast majority of appointments in practice take place via the phone or using video consultations, moving away from the largely face-to-face clinical model. Practices and patients have embraced phone/video triage and online consultations in this period. Practices and Primary Care Networks, with the support of the CCG, will consider how the digital triaging model can be continued post Covid-19 challenges.

Primary Care Networks utilised the opportunity to draw on additional roles such as Social Prescribing Link Workers to support the cohort of vulnerable, shielded patients.

The CCG is working closely with system colleagues and GP Clinical Directors to consider a plan for general practice to move to a new “normal” way of working following the peak of COVID-19.

4.1.2 Digital implementation in Primary Care

The CCG has supported the enablement of remote home working for GPs and other practice staff by providing laptops and Away from my desk dongles which has enabled staff to work more flexibly around family or other commitments, as well as allowing clinical staff who are potentially vulnerable themselves to continue to work.

All 73 practices have accuRx video consult installed; and online consultation capability (Total Triage, E-Consult/Footfall) is being supported for all practices by the CCG.

Video conferencing, like Microsoft Teams, has helped Practices and PCNs visual communication and offered flexibility.

Practices are being provided with digital access to GHNHSFT’s Electronic Patient Record (EPR) to view COVID-19 related hospital admission and discharge information.

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4.1.3 Workforce support and development

The CCG and the Gloucestershire Primary Care Training Hub have been continuing to develop workforce solutions during the Covid-19 pandemic to ensure that practices are sustained during this time. All information is being publicised on the Primary Care Workforce Website at https://glosprimarycare.co.uk/

Workforce gaps have been highlighted in the daily SITREPS provided by practices with locums available to fill gaps if required; the requests for locums has been low as practices have been able to support patients remotely to date.

During lockdown practices have predominantly moved to telephone and video consultations. However, face to face consultations are expected to rise as lockdown is eased and planning is underway to support practices through this demand.

A primary care relevant volunteer toolkit has been developed for all practices in county. This is based on an ICS wide volunteer recruitment framework released in May. The generic toolkit is relevant for COVID-19 related activity and for any future primary care use.

The CCG governance and communications teams are developing resources and information for the well-being of staff across primary care and an offer for an Employee Assistance Programme is made available for practices through the Primary Care Offer.

An assessment of workforce and training programmes has taken place to inform recovery planning for GP Practices and Primary Care Networks.

There is a return to some non-Covid-19 work streams with certain projects under consideration for inclusion within the ‘new normal’, this includes exploration of video learning and interaction software to enable continuity of all primary care workforce and education projects pending social distancing requirements.

Primary Care Networks have been encouraged to continue with recruitment of the additional roles.

Primary Care Networks have made applications for funding focused on Education, Training and Workforce Development relevant to their populations health care needs. This is funded through the Gloucestershire Primary Care Training Hub and aims to increase educational capacity in PCNs to support activities such as the embedding of the new roles in primary care, delivery of specific training on prevalent disease conditions and training support for non-clinical staff as well.

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4.1.4 Care Quality Commission (CQC) for General Practice, mergers, branch closures and changes to Primary Care Networks

There have been five new CQC reports issued. Four GP Practices in Gloucestershire have a CQC overall rating of “Outstanding”, the majority (66) have a rating of “Good”, two have a rating of “Requires Improvement” and one practice has a rating of “Inadequate”.

A request for a merger of Rosebank Health and Bartongate Surgery was approved by the CCG Primary Care Commissioning Committee in June 2020.

Two requests were received from practices for branch closures by the CCG Primary Care Commissioning Committee in June 2020. As required by the CCG Standing Operating Procedure, engagement with patients, HOSC, Healthwatch Gloucestershire, local practices and Local Medical Committee was undertaken. Both closures were approved: The Brunston and Lydbrook Practice to close their branch surgery at Lydbrook and Rendcomb Surgery to close their two branch surgeries at Winstone and Duntisbourne Abbotts.

There have been some changes to the Gloucester City Primary Care Network (PCN) configurations as at May 1 2020. Please see below for the PCN reconfigurations:

Inner City PCN now comprised of: Gloucester City Health Centre, Gloucester Health Access Centre, Kingsholm Surgery and Partners in Health;

Rosebank & Bartongate PCN comprised of: Rosebank Health and Bartongate Surgery;

Hadwen & Quedgeley PCN comprised of Hadwen Health and Quedgeley Medical Centre;

North South Gloucester PCN no changes, comprised of: The Alney Practice, Brockworth Surgery, Churchdown Surgery, Hucclecote Surgery and Longlevens Surgery;

Aspen PCN no changes, comprised of: Aspen Medical Practice.

These changes have not affected respective patient populations and there continues to be 100% population coverage in the county.

4.1.5 Primary Care Infrastructure

The CCG continues to invest in primary care infrastructure with construction on the Cheltenham Town Centre development commencing at the beginning of April 2020. This exciting improvement will see three Cheltenham practices, Berkeley Place, Crescent Bakery and Royal Crescent Surgery moving into the new purpose built premises on Prestbury Road.

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4.1.6 Primary Care Strategy Progress

Following consultation, the revised GP Network Contract Directed Enhanced Service 2020/21-2023/24 was released at the beginning of February 2020. Changes had been made to the content of the service specifications and also to the timeframes for implementation. Three specifications are now due for delivery commencing from April 2020. These are Structured Medication Review and Medicines Optimisation; Enhanced Health in Care Homes and supporting Early Cancer Diagnosis. The specifications on Anticipatory Care and Personalised Care were deferred until 2021/22 along with the planned Cardiovascular Disease (CVD) Diagnosis and Prevention and Tackling Health Inequalities specifications.

4.1.7 Improving Access

In partnership with NHSE/I, Gloucestershire has been taking part in the Community Pharmacy Consultation Service (CPCS) pilot since September 2019. This pilot aims to improve the patient journey and ease the burden on primary care by receptionists and care navigators referring suitable patients to their local community pharmacy.

5. Section C: Local Providers’ updates

This Section includes updates from Gloucestershire Health and Care Services NHS Foundation Trust (GHCNHSFT) and Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT),

These items are for information and noting.

5.1 Gloucestershire Health and Care NHS Foundation Trust (GHCNHSFT)

5.1.1 Coronavirus

Gloucestershire Health and Care NHS Foundation Trust has been a key part of the county’s response to the Covid-19 pandemic. The Trust cared for 151 patients with Covid-19 between March and the end of June 2020 and sadly 35 of those patients died. More positively, many patients were supported, rehabilitated and able to return into a home environment.

Trust colleagues worked tirelessly both within hospitals and communities to support patients, service users and carers throughout. Here are some key facts and figures:

395 Trust colleagues were redeployed into new roles

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More than 1,000,000 pieces of PPE were distributed around the Trust (at time of writing)

New wards were set up and patients were cohorted into red (Covid positive), amber (suspected Covid) and green (Covid negative) areas throughout our community and mental health hospitals

A testing service was set up initially to test people in their own homes, but latterly to test healthcare staff and care home residents for Covid-19.

A serology testing service was rolled out in June 2020 to find out whether Trust colleagues had contracted Covid-19 and developed antibodies as a result

New staff health and wellbeing services were introduced, including counselling, ‘wobble rooms’ and the use of online forums and apps

Accommodation was provided for colleagues who needed to move out of their homes and live elsewhere to reduce the spread of infection to their families, who may have underlying health conditions, be shielding or self-isolating

The Trust worked with system partners to provide childcare for colleagues who were unable to find keyworker places in either schools, nurseries or other providers

New IT solutions were introduced to enable more colleagues to work remotely, reducing the risk of infection in our buildings and supporting those colleagues who were shielding or self-isolating

New digital consultation and therapy solutions were introduced. Since March, more than 5,640 video consultations having been carried out using the ‘Attend Anywhere’ system, across services including child and adolescent mental health services (CAMHS), Let’s Talk, speech and language therapy and physiotherapy.

Throughout the pandemic, only very few services entirely ceased. The majority of services continue to offer treatment and support, albeit differently and in the case of some services only to those in the greatest need. The Trust is now working through ‘active recovery’, bringing services back online and adapting to new methods of working, in light of the need to retain a focus on infection prevention and control and ‘Covid-secure’ working. Importantly, the Trust is also planning for any second peak and is developing thorough plans for responding to further Covid outbreaks through the always challenging winter period.

5.1.2 Dental Services Update

Gloucestershire Health and Care NHS Foundation Trust provides the Community Dental Services for Gloucestershire. This service is primarily aimed at supporting people with disabilities, dental anxiety, mental health issues, medically compromised patients and the socially excluded. Most patients are referred to the service for special care dentistry and we have clinics across Gloucestershire.

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The current contract to provide this service was due to expire on 31 March 2021, however NHS England and Improvement confirmed the contract has been extended until 31 March 2023. This is great news for the service as it gives an opportunity to get through the Covid-19 pandemic challenges and to use recovery to look again at transformation and how to develop dental services further to ensure the Trust is 'tender ready' for our future. Find out more about the service by clicking here: https://www.gloscommunitydental.nhs.uk/

5.1.3 New Non-Executive Director

A new Associate Non-Executive Director has been appointed to the board of GHCNHSFT. Steve Brittan lives in Gloucestershire and has been a Partner at TecHorizons Ltd - established to identify, incubate and source investments into innovative UK Dual-Use Technology companies seeking growth capital since 2018. Before this he was the Chief Executive of the UK Defence Solutions Centre – an Innovation Centre comprised of a UK Government/Industry partnership to promote, develop and invest in UK technology. Between 2009 and 2014 he was a Technology & Innovation Consultant working with various clients to identify options/strategies to create new market entry points to create additional commercial value. He previously spent eight years at QinetiQ Group Plc, as a Managing Director and Chief Operating Officer. The majority of Steve’s early career was spent at Marconi Underwater Systems (1990-1998). In addition he was a Council Member of Cranfield University Advanced Manufacturing Group (from 2015-2020), a non-executive Director of V-Auth Ltd (from 2013-2018); he is also a former Non-Executive Director of the Numerical Algorithms Group (2013-2016).

GHC has Non-Executive Directors with backgrounds in health, finance, construction, law, business and other professions and Steve has some unique experience to bring to the Board, particularly in light of the opportunities and challenges presented by technology and digital working. You can view details of the Trust’s other Directors by visiting https://www.ghc.nhs.uk/board-and-governors/meet-our-board/

5.1.4 Winter Flu Planning

Planning is already well underway for delivering the winter flu vaccination programme to children in the county. The Trust’s Children’s Immunisation Team will need to operate slightly differently this year and a new cohort of children has been added into the programme for 2020 – Year 7 – so the team will need to cover secondary school as well as primary and pre-school children. There is also a requirement for a significant increase in uptake from 75% this year (which was achieved) to 95%. This will be extremely challenging in the context of Covid and school re-opening plans, however planning has begun on how best to deliver this service.

In tandem, GHCNHSFT is planning its staff flu vaccination programme, which will again need to be delivered differently for 2020/21.

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5.1.5 University of Gloucestershire – Learning Disability Nursing Degree

The Trust is helping the University of Gloucestershire to promote its new Learning Disability BSc degree, which is starting in January 2021. There will be 30 spaces on the degree course and it is hoped this partnership with the University will help to ensure a steady flow of new LD nurses into the Trust. GHC provides both community and inpatient learning and disability services and having a local LD nursing degree provider will be very beneficial.

5.2 Gloucestershire Hospitals NHS Foundation Trust (GHT)

5.2.1 £39.5m transformation programme is step closer

Exciting plans to transform Cheltenham General and Gloucestershire Royal Hospitals as part of a £39.5m investment have taken a step forward after planning applications were submitted. Architects IDP Health has submitted applications for full planning permission to Cheltenham Borough Council and Gloucester City Council.

Under the plans Cheltenham General Hospital (CGH) will benefit from two additional theatres and a new day surgery unit. If approved, the development would provide additional operating capacity in purpose built facilities that will improve patient and staff experience, enable more efficient ways of working, reduce waiting lists and result in fewer operations being cancelled.

Gloucestershire Royal Hospital (GRH) will benefit from an improved Emergency Department and Acute Medical Unit facilities designed to improve diagnosis, assessment, treatment and patient flow. These changes will also include a redesigned orthopaedic outpatients area, additional x-ray capacity and improved ward facilities.

Subject to planning permission and additional Trust and NHSE assurance processes, work will start on site next year (2021) with the aim of new patients being treated in 2023.

5.2.2 Royal visit

Their Royal Highnesses The Prince of Wales and The Duchess of Cornwall visited (16/6/20) Gloucestershire Royal Hospital and met staff working in health and social care throughout the county. During a 50-minute visit to the hospital, their Royal Highnesses, accompanied by the Lord Lieutenant of Gloucestershire, Edward Gillespie and the Chief Executive of the Hospitals Trust, Deborah Lee thanked staff for their dedication during the COVID-19 pandemic.

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It is the first time since the lockdown that Their Royal Highnesses have had an opportunity to thank front line health workers for their contribution during the pandemic. They addressed a range of health and social care professionals including clinicians, social workers, domestic staff, volunteers and other frontline colleagues from the health and care system locally.

5.2.3 NHS72

At the time of writing, preparations are underway to mark the 72nd birthday of the NHS (5 July) with a spectacular light projection show. Across the county including the two acute hospitals in Cheltenham and Gloucester, the public are being invited to show their appreciation of the NHS by recoding their words in one of our recording booths. These will then be shared on social media. Landmark buildings would also be lit up. The public will also be encouraged to share their experience through the regional Covic-19 survey.

5.2.4 Covid-19 Communications

A huge amount of public information has been shared in relation to the ongoing Covid-19 pandemic. A summary of this information is shared below:

Communicating service change: In response to the initial peak (April/May) system partners worked collaboratively to communicate service change using a range of methods including regular press and media updates (Sarah Scott, Director of Public Health, Dr Jeremy Welch, GP and CCG lead, and Professor Pietroni, GHNHSFT Medical Director), strong social media presence (regularly achieving 180,000 engagements when the average was 4,000 - 7,000) and review of onsite information points (posters, patient facing information etc) ensuring these were contemporary and accessible.

Harnessing community spirit: Hospitals’ Charity triangulated ‘good will’ from the community regularly promoting the vital help and support.

The clap for NHS staff, carers and key workers: Both acute hospitals were well represented in the Thursday night clap for carers. The Trust featured prominently in the national one minute silence (May) after being profiled on national BBC.

Patient support (Patient Support Service Hub): The Trust’s new Patient Support Service Hub helped relatives, family members, carers and patients by providing the information they needed in one place. Whether you’re a relative, family member, carer looking for information about your loved one in hospital, or a patient who needs someone to talk to, the Trust provided a link/go between to ensure support was available.

Virtual wards: The roll out of technology to enable patients to talk to loved ones.

Every Name a Person: As health and social care professionals across Gloucestershire, the Trust made a commitment to patients/service users. We would never forget:

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o Every name is a person.o Every person a life lived.o Every life a story behind it.

This was symbolised through the ‘Dandelion’ initiative.

Staff support: A wide package of staff support was made available ensuring provision/facilities were available covering mental, physical and wellbeing. Initiatives include Caring for Those Who Care, Staff Wellbeing Support and Psychological Wellbeing (free car parking, emergency childcare places and the 2020 hub).

Staff communications: Daily updates issued throughout the initial phase of the pandemic. These updates also incorporated regular video messages/Vlogs. Information was concise, informative and inspirational.

National/internal days of recognition:International Day of the Midwife: Light show projected onto Tower Block/Pillars, Nurses Day: Light show projected onto Tower Block/Pillars, Dying Matters Awareness Week, and Mental Health Awareness Week.

The new normal

Communicating service change: A campaign programme to communicate out the changes in response to phase 2 planning overseen/supported by system partners. This campaign predominantly focussed on changes to service provision at CGH A&E and incorporated media management, digital/social advertising and traditional advertising (newspapers, radio adverts etc)

Communicating behavioural change: A programme of work informing the public of social distancing measures has been overseen (Keep Your Distance). Throughout Trust sites are reminders of the distancing regulations, cleaning hands.

6. RecommendationsThis report is provided for information and HCOSC Members are invited to note the contents.

Dr Andrew Seymour Mary Hutton Clinical Chair Accountable OfficerNHS Gloucestershire CCG NHS Gloucestershire CCG

3 July 2020