Agenda and minutes

Health Scrutiny Panel - Thursday, 23rd July, 2020 1.30 pm

Venue: Via Microsoft Teams (Virtual Meeting)

Contact: Martin Stevens  Tel: 01902 550947 or Email:

Note: Please note this meeting will be conducted in line with the The Local Authorities and Police and Crime Panels (Coronavirus) (Flexibility of Local Authority and Police and Crime Panel Meetings) (England and Wales) Regulations 2020. 


No. Item



[To receive any apologies for absence]. 

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Before the main business items commenced the Chairman asked the Scrutiny Officer to read Shakespeare’s Sonnet 30 in an act of remembrance for the people in Wolverhampton who had lost their lives during Covid-19. 


Shakespeare Sonnet 30


When to the sessions of sweet silent thought
I summon up remembrance of things past,
I sigh the lack of many a thing I sought,
And with old woes new wail my dear time's waste:
Then can I drown an eye, unused to flow,
For precious friends hid in death's dateless night,
And weep afresh love's long since cancelled woe,
And moan the expense of many a vanished sight:
Then can I grieve at grievances foregone,
And heavily from woe to woe tell over
The sad account of fore-bemoaned moan,
Which I new pay as if not paid before.
But if the while I think on thee, dear friend,
All losses are restored and sorrows end.


The Chairman on behalf of the Panel then paid tribute to the dedicated work of all health partners during the Covid-19 crisis.  


Whilst Cllr Obaida Ahmed had sent her apologies in advance of the meeting, she was able to join the meeting and is therefore listed as present. 


Cllr Linda Leach, whilst not a Member of the Panel, sent her apologies as the Portfolio Holder for Adults.


Vanessa Whatley, a Deputy Chief Nurse at the Royal Wolverhampton NHS Trust, whilst not a Member of the Panel, sent her apologies. 


New Health Appointments and Awards

To congratulate Rose Urkovskis on her appointment as Interim Healthwatch Advisory Board Chair and as a Co-opted Member of the Health Scrutiny Panel.


To congratulate Paul Tulley on being appointed as Managing Director of Wolverhampton CCG. 


To congratulate Professor David Loughton CBE on being awarded a Professorship from the University of Birmingham. 

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On behalf of the Panel, the Chair congratulated Rose Urkovskis on her appointment as Interim Healthwatch Advisory Board Chair and as a Co-opted Member of the Health Scrutiny Panel.


On behalf of the Panel, the Chair congratulated Paul Tulley on being appointed as Managing Director of Wolverhampton CCG.


On behalf of the Panel, the Chair congratulated Professor David Loughton CBE on being awarded a Professorship from the University of Birmingham. 


Declarations of Interest

[To receive any declarations of interest]. 

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Paul Tulley, Managing Director of Wolverhampton CCG declared an interest as his wife worked for City of Wolverhampton Council. 


Minutes of previous meeting pdf icon PDF 352 KB

[To approve the minutes of the previous meeting as a correct record.]


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The minutes of the previous meeting held on 5 March 2020 were confirmed as a correct record. 


Matters Arising

[To consider any matters arising from the minutes.]


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Cllr Roberts advised the Panel that she had not attended the PPG meeting at Probert Road Surgery as she had initially intended.  This was due to the meeting falling during the Covid-19 crisis.  She intended to attend a meeting of the PPG Group in the future. 


Covid-19 - The Royal Wolverhampton NHS Trust

The Chief Executive of, The Royal Wolverhampton NHS Trust will present on the Trust’s response to Covid-19 and their plans for the future. 

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Dr Jonathan Odum, Medical Director of, the Royal Wolverhampton NHS Trust gave a presentation on the Trust’s response to Covid-19.  The Medical Director stated that there had been a number of preparatory meetings in the weeks leading up to the pandemic in the UK.  The first confirmed case with Covid-19 at the Trust was declared on Saturday, 7 March 2020.  Following the first confirmed case, the Trust setup their Silver and Gold Command meetings.  The Silver and Gold Command meetings were attended by multi-disciplinary partners from within the Trust and elsewhere in the City.  The Silver Command acted as the Operational Command for running the issues related to the pandemic within the organisation.  The Silver Command meetings were held three times daily.  The Gold Command acted as oversight and strategic management.  Initially these meetings took place daily and were Chaired by the Chief Executive of the Trust.  Eventually the Gold meetings were reduced to three times per week and as necessary. 


The Medical Director remarked that during the course of the pandemic the Trust felt they had superb relationships with Partners within the City.  He made particular reference to the good relationships with Public Health England, Public Health Wolverhampton and other teams within the Local Authority. 


The Medical Director stated that Wolverhampton had higher Covid-19 cases per 100,000 during the course of the pandemic than the England average.  This trend was the same across the Black Country.  He commented that early on in the pandemic it was clear that some patients had Covid-19 but had not tested positive for it from a swab test.  They were however treated in exactly the same way.  Early in the testing regime there had been a significant false negative rate and also some people could be positive and then later test negative.  To date 914 patients had been admitted to the Trust with a positive Covid-19 test result.  According to the slide, 44.59% were female and 55.41% were male.  At the peak of the pandemic the Trust had in excess of 300 people being treated for Covid-19 within the organisation.  The length of stay for each person was significant. The Medical Director described the demographics of the 914 patients that had been admitted to the Trust with a Covid-19 positive test result.  70% of the patients were classified as White-British.  A breakdown was given of the ethnicities as follows: -


White British – 70.49%

Black Caribbean – 6.89%

Asian Indian – 6.01%

Not Stated – 9.51%

Asian Pakistani – 1.09%

Asian - Any Other Background – 0.55%

Black African – 1.97%

Black - Any Other Background – 0.77%

White – Any Other Background – 0.87%

Other – Chinese – 0.22%

White – Irish – 0.33%

Other – 0.87%

Mixed White/ Black / Caribbean – 0.44%


The first Covid-19 positive death at the Trust was reported on 8 March 2020.  282 people with a Covid-19 positive swab result had died at the Trust to date.  300 had been reported to the Covid National Reporting System  ...  view the full minutes text for item 6.


Covid-19 - Epidemiology pdf icon PDF 832 KB

[To receive a report from Public Health on the epidemiology of Covid-19 in Wolverhampton]. 


[Report is marked to follow to ensure the latest statistics are provided]. 

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The Director of Public Health asked the Consultant in Public Health to introduce the report on Covid-19 Epidemiology.  The Consultant in Public Health remarked that there was a group of Public Health specialists who regularly reviewed different data indicators from all available sources.  Although data access had been a challenge at some points during the pandemic, they were now in a good position.  They were able to access data from Public Health England, NHS Digital and live access to data sources at RWT.  She reiterated the importance of people being tested if they were showing symptoms of Covid-19, as it was the only way they could keep track of the spread of the infection within the community. 


The Consultant in Public Health stated at the time of writing the report Wolverhampton had 1,385 confirmed Covid-19 cases.  The latest figure as of 23 July 2020 was 1,404.  Presently, on average, they were seeing two confirmed Covid-19 cases per day.  The case rate was therefore low and stable with no immediate cause for concern.  Careful monitoring was taking place to ensure any rise in cases or patterns could be picked up quickly. About 2-3% of people currently being tested for Covid-19 within Wolverhampton were testing positive.  This was a relatively low ratio compared to the peak of the pandemic.      


The Consultant in Public Health stated that to date, 300 deaths of Wolverhampton residents had been attributed to Covid-19 on the Medical Certificate Cause of Death.  71% of those deaths had occurred in hospital.  The age standardised mortality rate in the City was comparable to other surrounding areas.  Mortality rates in the City were now back to normal levels for the time of year, there was therefore no longer any excess deaths due to Covid-19.   During the peak of the pandemic most of the cases diagnosed were through the hospitalised cases and also through the large-scale testing of health and social care staff, if they had become symptomatic.  This consequently meant the confirmed cases were more severe, with men over represented and a high proportion of older people.


The Consultant in Public Health stated that when looking at the ethnicity data it was important to take into account the age profile of the Black and ethnic minorities groups, which tended to be younger than the White population.  When taking this into account the City was seeing more Covid-19 cases and deaths from Black and ethnic minority groups than would be expected. 


The Consultant in Public Health stated there was now a national framework for the action that should be taken if there was a rise in local Covid-19 cases or particular patterns of concern within the City.  The first stage was to engage with Public Health England and the Joint Bio-Security Centre at a national level, where a deep dive into the local epidemiology would take place.  Local testing availability would be ramped up and more messaging would be delivered to local communities about additional action required to contain the cases.  If the  ...  view the full minutes text for item 7.


Wolverhampton Covid-19 Outbreak Control Plan pdf icon PDF 6 MB

[To scrutinise the Wolverhampton Covid-19 Outbreak Control Plan]. 

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The Director of Public Health gave a presentation on Wolverhampton’s Covid-19, Outbreak Control Plan.  He stated that all Local Directors of Public Health had been notified on 22 May 2020 to develop and publish Covid-19 Outbreak Control Plans by 1 July 2020.  Wolverhampton’s plan was co-signed by health partners demonstrating the continued theme of partnership working throughout the pandemic.  The aim of the plan was to reduce the spread of Covid-19 and to save lives.  In addition, to helping as many people as possible return to normal life, in a way that was safe, protected the health and care systems and supported the Wolverhampton economy to recover.  A return to normal life did not necessarily mean a return to normality as the world was still living with Covid-19.  This was a challenge for the health system.  The two aims of the plan meant they would:


·       Prevent the spread of Covid-19 wherever possible.

·       Improve engagement with local residents to encourage participation in prevention and build trust and confidence in the City’s outbreak response. 

·       Identify outbreaks and complex cases early and respond quickly to prevent further transmission.

·       Build on existing partnerships and expanding networks of stakeholders to ensure system capacity and capability.

·       Reduce health inequalities linked to and amplified by Covid-19.


It was critical to remember that every individual had their part to play to keep themselves and other people safe.  Wolverhampton residents had a higher smoking rate, higher long-term illness, higher levels of people overweight, higher under-75 all-cause mortality rate, higher diabetes and a higher proportion of BAME than the national average.  There were two main methods available currently to reduce the spread of Covid-19, lockdown and testing with communication.  They had worked with the CCG and RWT to identify the most vulnerable people within Wolverhampton and help them stay at home during the pandemic.  They had predicted a higher mortality rate in Wolverhampton, this had probably not occurred because of the collective action that had been taken within the community.


The Director for Public Health stated that there were seven themes to the Wolverhampton Outbreak Control Plan.  These had been identified by the Local Government Association and the Department for Health and Social Care.  He thought it was a good approach.  The seven themes were listed as follows: -


·       Theme 1 – Care Homes and Education Settings

·       Theme 2 – High Risk Workplaces, Locations and Communities

·       Theme 3 - Mobile Testing Units and Local Testing Approaches

·       Theme 4 – Contact Tracing in Complex Settings

·       Theme 5 – Data Integration

·       Theme 6 – Vulnerable People

·       Theme 7 – Local Governance


None of the themes operated in isolation, they all interconnected with each other and would continue to evolve over time.  He presented a slide on the Governance system and on how the plan would be communicated.  The Public Health Team in Wolverhampton in conjunction with Public Health England would lead on the communications in the event of a Covid-19 outbreak within the City.  It was also important to have effective communication  ...  view the full minutes text for item 8.


Covid-19 - Adult Services Presentation pdf icon PDF 1 MB

[To receive a presentation from Adult Services on the Covid-19 response on areas that fall within the remit of the Health Scrutiny Panel]. 

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The Director of Adult Services introduced a presentation on the work of Adult Services during the Covid-19 crisis.  He expressed his appreciation to all health partners in the City who had worked closely with Adult Social Care in response to the Covid-19 pandemic.  He paid particular tribute to the Infection Prevention Team and the Rapid Intervention Treatment Service from RWT.  He also praised the approach of Public Health and the CCG to testing which played a huge part in helping them to identify and manage early outbreaks in care settings within the City.  He praised all the Care staff working within the City Council, Providers Services and also the Independent Sector who had faced an unprecedented level of deaths and illness.  Social Workers and Commissioners had adapted to help support the Care staff and it was important to recognise all their work.  He spoke warmly of the Food Distribution Hub and the Stay Safe, Be Kind Helpline, which had helped reduce demand on Social and Health Care services. 


The Head of Service for Adult Improvement commented that the Chairman of the Scrutiny Panel had requested specific information on Hospital Discharge, Infection Prevention within Care settings, Personal Protective Equipment, Public Health and Partner relationships and Public Health funerals. She stated that there had been some issues relating to hospital discharge particularly in the earlier stages of the Covid-19 pandemic.  There had been considerable guidance changes which were often issued late in the day.  They had adhered to national guidance and had put a new pathway in place with partners.  They met a couple of times each week to resolve any issues.  Where necessary additional steps had been agreed amongst partners.  As an example, they had provided extra staff and financial support to allow people to self-isolate for 14 days within Care Homes.  Prior to the pandemic there was sometimes 12 hospital discharge delays a day, since the pandemic they were now consistently at zero. 


The Head of Service for Adult Improvement commented that the work that had taken place on infection prevention had been a huge partnership effort.  The CCG had made sure every Care Home had received the right level of training on infection prevention.  They had robust outbreak control management and proactive action had been taken, with a daily Sitrep report from Care Homes.  The daily collection of data meant Care Homes which needed the help the most could be targeted, Safe and Well checks could be prioritised and Infection Prevention Teams sent to the site if required.    


The Head of Service for Adult Improvement on the matter of PPE stated that the Council did not just wish to rely on the national systems that were in place.  They wanted to ensure every care setting that needed PPE in Wolverhampton would be able to access it and hence why they had put their own system in place.  A tremendous amount of work had taken place in the distribution and allocation of PPE throughout the pandemic.  The Procurement Team had  ...  view the full minutes text for item 9.


Wolverhampton CCG - Organisational Changes pdf icon PDF 1 MB

[To receive a verbal report from Paul Tulley on the organisational changes at Wolverhampton CCG.  The Black Country and West Birmingham CCGs Stakeholders Newsletter 1 is attached]. 

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Paul Tulley, Managing Director of Wolverhampton CCG updated the Panel on the recent organisational changes at Wolverhampton CCG.  He stated that the four CCGs across the Black Country and West Birmingham now had a single Accountable Officer and a single Senior Management Team.  The first of the Stakeholders Briefings had been circulated with the agenda for the meeting.  Paul Maubach was the Chief Executive of Wolverhampton CCG and he was also the Chief Executive for the other three CCGs covering the Black Country and West Birmingham.  Each of the four CCGs had their own Managing Director.  Some senior management posts were shared across the four CCGs.  Alongside the changes to the management structure, the four CCGs were increasingly trying to work on a collaborative basis at a Black Country Level.  Consequently, the Governing bodies for the four CCGs were now meeting in common, as were some of the Committees.  These arrangements had been in place since April 2020, although some of them had been in abeyance due to Covid-19.   


The Managing Director of Wolverhampton CCG stated that they had started at the beginning of the week a conversation on the potential for the four CCGs to merge and create a single Black Country and West Birmingham CCG.  This was something which could be discussed at length at a future meeting.


A Member of the Panel asked for any report on the potential merging of the four CCGs to be received at the next meeting of the Health Scrutiny Panel, provisionally scheduled in September, to contain ten reasons why a merger would be good for Wolverhampton. 




Covid-19 - Wolverhampton CCG Response pdf icon PDF 736 KB

[To receive the attached report on Wolverhampton CCG’s response to Covid-19].

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Paul Tulley, the Managing Director of Wolverhampton CCG presented on the CCGs response to the Covid-19 crisis.  A report had been circulated with the agenda for the meeting.  The pandemic had been run on a national emergency incident basis by the NHS, which had suspended some of their usual planning and decision making.  Where ordinarily they would receive national guidance, they had instead been acting on national and regional instructions. 


The Managing Director stated that as a CCG they had established a single incident room, working with partners across the Black Country to coordinate the local CCG response.  This had shown the value of collaboration in key areas such as Covid-19 testing, Care Homes, a system wide plan for hospital capacity and a useful conduit for communication between the Black Country system and the regional team.  Some CCG staff had been redeployed to work for NHS 111, to help with swab testing at the Wolverhampton Science Park and some staff with a clinical background had returned to frontline work within hospitals.  They had setup a central buying and distribution point for PPE equipment, for use by General Practice across the Black Country.  He praised the effective joint partnership working that had taken place in Wolverhampton.   


The Managing Director remarked that GP Services had dramatically changed since the start of the pandemic.  Telephone triage was the new normal.  Many consultations were now taking place via video call or via the telephone.  A red site had been established in Ettingshall, which had initially been a seven-day service for seeing patients with suspected Covid-19.  Levels of activity in primary care had been lower than usual as had referrals into hospital services, including two week wait cancer referrals.  The CCG had concerns about the impact of the reduced use of local health services.  They had been working with Communication Teams across the system to try and relay messages that the NHS was still open for business, alongside the preventative messages relating to Covid-19. 


A Member of the Panel asked for an update on the financial position of the CCG.  The Managing Director of Wolverhampton CCG responded that the financial position within the NHS had completely changed in the last few months.  The payments to the hospitals had been on a block contract basis, the value of that block had been calculated nationally.  The CCG allocations had been adjusted to ensure that each CCG had enough money to pay the hospital the required block funding.  There had also been other routes where hospitals and other providers could claim funding for additional Covid-19 related costs which were over and above the core level of funding, this included the Local Authority.  The current financial position of the CCG was that it was broadly in balance in terms of the new national rules.     


Covid-19 - Black Country Healthcare NHS Foundation Trust

[To receive a verbal update from Black Country Healthcare NHS Foundation Trust on work undertaken during the COVID-19 emergency]. 

Additional documents:


Chris Masikane, the Chief Operating Officer of the Black Country Healthcare NHS Foundation Trust gave a presentation on the Trust’s response to Covid-19.  He thanked all of their stakeholders and in particular the acute Trusts for the support that they had given to them during the Covid-19 pandemic.  They had established an operational structure to manage the response.  This included a Gold Command, Silver Command, an Incident Management Team (7 days a week) and an Ethical Decision Making Group.  Due to the sheer amount of guidance the Trust had received they had to make considerable changes to their normal ways of working.  This had led to the creation of the Ethical Decision Making Group, as the changes they had to quickly make could not go through their normal governance process.  The pandemic had led to improved relationships with the acute Trusts and the CCGs. 


The Chief Operating Officer stated that in March 2020 they had 15 - Covid-19 positive inpatients, 16 in April, 12 in May, zero in June and 1 in July.  This was a total of 44 cases.  He presented a slide on what had worked well for the Trust during the pandemic.  He was particularly pleased with how well patient testing had gone, working in conjunction with partners.  Whilst the guidance surrounding PPE had been initially confusing, the Trust had eventually got to grips with its appropriate use.  Managing the anxiety of patients was a particular challenge.  The Trust had to change the way beds were configured into red (Covid-19 Positive or Symptomatic) and green zones.  Enhanced training had to be given staff regarding physical health.  Visiting restrictions had to be applied in accordance with national guidance.  A total of 66 service changes were introduced during the course of the pandemic.  One of these had been to introduce a 24 hours a day seven days a week helpline.  The pandemic had demonstrated how changes could be made fast when there was a will to do so. 


The Chief Operating Officer paid tribute to the work of the staff of the Black Country Healthcare NHS Foundation Trust during the course of the pandemic.  A staff self-isolation process and staff testing programme has been developed.  They had developed a staff health and wellbeing offer across the Trust and also to Primary Healthcare partners.  This included activities such as Yoga, exercise sessions and Zoom sessions on coping with isolation and stress.     


The Chief Operating Officer commented that Support Services played a key part in the Trust’s response to the Pandemic.  He cited enhanced cleaning, a central process for PPE, improving remote IT access and distributing laptops for staff.


The Chief Operating Officer stated at the time the slides had been produced, 2020 staff had received a Covid-19 antibody test.  275 (13.5%) of them had tested positive for Covid-19 antibodies.  They were currently still not permitting visitors to the Wards, due to the continued risk.  They were however supporting patients by using innovative IT solutions such as Skype.  The Trust  ...  view the full minutes text for item 12.


Covid-19 - Healthwatch Wolverhampton

[To receive a verbal update from the Manager of Healthwatch Wolverhampton on work undertaken during the COVID-19 emergency]. 

Additional documents:


The Healthwatch Manager presented on the work Healthwatch had undertaken during the Covid-19 crisis.  She stated that the Healthwatch Wolverhampton staff had started working from home a week before the national lockdown had commenced.  They had contacted community groups and Care Homes to let them know that they were still working but under new arrangements.  Much of their engagement work had been through the utilisation of social media, which they had also monitored on a regular basis. One of the areas they had been alerted to was with reference to the messaging regarding the Red General Practice site.  The information that had been put out initially had been confusing to the public, but this was rectified when they contacted the CCG.  They had made improvements to the Healthwatch Wolverhampton website, with a specific Covid-19 page containing the latest national and local information. 


The Healthwatch Manager commented that much of the initial feedback in the beginning of the pandemic had surrounded confusion regarding the differences between self-isolation and shielding.  They had supported people where they could, which had included people with mental health issues.  They had been able to provide information to people regarding shopping deliveries for those that did not wish to shop in person.  Some Healthwatch staff had supported the Community Support Team with the collecting and delivering of medications for people self-isolating and shielding.  They had also supported the Social Prescribing Team in carrying out welfare checks.  Some staff had also joined the NHS responders Team. 


The Healthwatch Manager remarked that they had setup Zoom meetings with their volunteers during the course of the pandemic, which they had found useful.  A care package had also been personally delivered to each of their volunteers at the start of the pandemic.  As lockdown was now being eased more people were coming forward with concerns to Healthwatch. 


Quality Accounts - The Royal Wolverhampton NHS Trust pdf icon PDF 2 MB

[To receive the final version of the Quality Accounts for, The Royal Wolverhampton NHS Trust]. 

Additional documents:


Deputy Chief Nurse, Yvonne Higgins and Alison Dowling, Head of Patient Experience and Public Involvement gave a presentation on the final Quality Accounts of the Royal Wolverhampton NHS Trust.  


The Deputy Chief Nurse commented that the official release date for the publication of the Quality Accounts had been moved to December 2020 because of Covid-19.  However, they had felt it important as an organisation to stick to the original publication date, so they could identify their priorities for quality improvement in the next twelve months and see where they were in terms of quality.  She thanked the Panel for their comments on the draft accounts, which had been incorporated into the final publication.  The priorities for the Trust for the next twelve months remained the same as the previous year.  There were three generic priorities, these were Workforce, Safe Care and Patient Experience.  The Trust were proud of the reduced vacancies within the job types of nurses, midwives and health visitors, which went against the national trend. 


The Deputy Chief Nurse stated that the Trust had won a national award for the Best Workplace for Learning and Development at the Nursing Times Awards.  She was also pleased to report that 140 Fellows now worked for the Trust.  The award-winning Fellowship Programme was now recognised by Health Education England as a recognised training Programme.  They were delighted that the results of the Staff Survey had shown significant improvement from the previous year. 


The Deputy Chief Nurse remarked that there had been a reduction in the number of serious events and never events causing low harm.  There had been a significant reduction in the number of falls resulting in serious harm.  The Trust had seen a reduction of SHMI (Summary Hospital-Level Mortality Indicator) to within the expected range, through a range of improvements at the Trust.  Medication safety was a priority for the Trust, some areas had been identified in the CQC report Action Plan. 


The Head of Patient Experience and Public Involvement presented on Priority Three – Patient Experience.  A key achievement for the previous year had been the implementation of the Trust’s new strategy – Patient Experience, Engagement and Public Involvement Strategy.  PALS concerns had reduced for the second consecutive year.  There had been a 24% reduction when compared with the previous year, which was testament to the good work that had been carried out throughout the previous year regarding the early resolution of complaints at a local level.  72% of the formal complaints to the Trust had not been upheld.  No cases had been fully upheld by the Ombudsman which gave them an assurance of their work. 


The Head of Patient Experience and Public Involvement commented that they had lost much of their normal volunteer base during Covid-19 because of their age profile, health conditions and national guidance.  The Trust had however advertised for new volunteers and they were fortunate to have recruited 350 volunteers.  They hoped some of the original volunteers would return when it was felt safe  ...  view the full minutes text for item 14.