On October 18th I attended the meeting of the shadow Board of Clinical Commissioning Gloucestershire (CCG). The Board is operating in shadow form until April, when CCG will replace NHS Gloucestershire, the NHS primary care trust (PCT). These meetings are held in public so that members of the public like me can attend, and ask questions at the end, but members of the public do not otherwise take part. There were about half a dozen of us in the public area of the room.
I found this meeting of the Board, like previous ones I have attended, lively and fast-paced. GPs made their presence felt, often speaking frankly from clinical experience. One of the non-executive directors, in particular, made his presence strongly felt.
Below I only note some things from this busy meeting that caught my attention. The papers for the meeting are also public, and you can get them here: Gloucestershire Clinical Commissioning Group Shadow Board Papers for October
There was a good presentation by the Gloucestershire’s Learning Disability (LD) Partnership Board, in which the aftermath of the events at Winterbourne View (in South Gloucestershire, a neighbouring unitary district of the county of Gloucestershire) loomed large. A final report from the Department of Health is expected soon, and it will incorporate the findings of seven other reports that there have been into the episode. Gloucestershire’s procedures may be highlighted in the final report as examples of good practice.
Amongst the general conclusions that have been drawn, we were told that too many people with learning disabilities are inpatients for the purposes of assessment or treatment. It is better to provide these things in the community.
Gloucestershire has placed 71 people with LD out of county, and work is ongoing to bring these people back into the county. Some other counties have many more out of county placements, and indeed many of those people are cared for within Gloucestershire.
There was some implied criticism of the Care Quality Commission (CQC), which is no longer entirely relied on:
“So CQC were going in. Commissioners were relying on CQC. CQC were saying, ‘They’re fine.’ Commissioners were going, ‘Well, CQC are saying they’re fine, we don’t have to worry about it.’ — We’re not relying on that any more.”
Several board members asked searching questions, and the impression I got was that things are moving in the right direction, but that quite a few people with learning disabilities do not receive anything like an ideal standard of care at present.
Support for carers
A strategy for supporting carers in Gloucestershire was presented for the Board’s approval, but several members raised issues with the document. In the end it was concluded that it was really only a draft, and that it needed more work to bring it up to standard.
Gloucestershire County Council, however, expected approval so that their procedures could continue. Approval was eventually given grudgingly, with the proviso that the final strategy would again be brought before the board when it is complete. When this board is no longer a shadow of its future self, I hope it will handle this kind of situation more robustly.
One of the issues, for example, was that there is little in the draft strategy for children who are carers. This was felt to be a very disappointing omission.
In a discussion on quality assurance, there was a comment that while lots of information about quality is available, getting it into a manageable format that really relates to patient experience will be a challenge. It will be important to make the reports focussed, readable and understandable. I completely agree.
There was a discussion about the availability of data from primary care (GPs). It was felt that information about the patient experience in primary care is lacking at present, perhaps partly because GPs are reluctant to share their data. It was acknowledged that LINk collects some data in this area, and that the NHS Commissioning Board will be working to improve things, work which CCG will support.
In the regular report on performance against contract targets, the status of the two IAPT indicators had been dropped to amber, after being red previously. Figures for the second quarter (Q2, July to September) were not published.
The IAPT recovery target for Q2 was published as 53.8%, even though governors of the 2gether Trust had been told that it had reverted to 50% and would now stay at that level all year. I suppose when Q2 numbers are available someone will fix that in the report, and we’ll see the correction in the papers for the next meeting in November.
There was discussion about some of the areas of concern, which included waiting times for trauma and orthopaedic treatments, and for diagnostic procedures.
Someone asked why so many (69, nearly a third) of the hospitals trust’s actions following investigations of serious incidents were overdue. There was only a brief, mumbled and defensive, it seemed to me, reply — something to do with contracts.
I noted that 2gether was reported as having nearly a sixth of its 157 actions overdue. It’s a figure that might be worth tracking.
Someone who described herself as a carers’ ambassador made a speech saying that, in effect, she herself should be a member of the Board to represent carers, including statements like:
“I’ve got a wealth of experience.”
It was suggested to her that membership of the Board might not be the most effective way for carers to be represented, and that CCG would be establishing a locality structure that might be more appropriate.
This was the same issue, really, as the one raised at the recent FTGA Development Day in relation to Health & Wellbeing Boards. These boards won’t work well if they are too big, and full engagement with groups like carers is more important than having a token board member.
I also felt that while the shadow Health & Wellbeing Board is only meeting in secret, and Healthwatch Gloucestershire doesn’t yet exist at all, CCG looks like the only place to engage with the new system. But when the new system is actually in operation from April the whole picture will look different, as there will be three levels at which to engage, in addition to the providers.