Agenda and minutes

Venue: Committee Room One, County Offices, Newland, Lincoln LN1 1YL

Contact: Katrina Cope  Senior Democratic Services Officer

Items
No. Item

86.

Apologies for Absence/Replacement Members

Minutes:

Apologies for absence were received from Councillors C Matthews, M A Whittington and Mrs P F Watson (East Lindsey District Council).

 

It was noted that the Chief Executive, having received notice under Regulation 13 of the Local Government (Committee and Political Groups) Regulations 1990, had appointed Councillor M A Whittington to replace Councillor Mrs R H Trollope-Bellew on the Committee until further notice; and Councillor L Wootten had replaced Councillor M A Whittington for this meeting only.

 

An apology for absence was also received from Councillor Mrs S Woolley (Executive Councillor for NHS Liaison & Community Engagement).

87.

Declarations of Members' Interest

Minutes:

Councillor Mrs K Cook advised the Committee that she was a patient; and on the governing body of Lincolnshire Partnership NHS Foundation Trust.

88.

Minutes of the Health Scrutiny Committee for Lincolnshire meeting held on 20 February 2019 pdf icon PDF 149 KB

Minutes:

RESOLVED

 

That the minutes of the Health Scrutiny Committee for Lincolnshire meeting held of 20 February 2019 be agreed and signed by the Chairman as a correct record.

89.

Chairman's Announcements pdf icon PDF 392 KB

Additional documents:

Minutes:

Further to the Chairman's announcements circulated with the agenda, the Chairman brought to the Committee's attention the Supplementary Chairman's announcements circulated at the meeting.

 

The Supplementary Chairman's announcements made reference to amendments to the Healthy Conversation 2019.  The amendment headings were: Women's and Children Services, Engagement Events, Video Library, and Grantham A & E – Urgent Treatment Centre Proposal.

 

The Chairman invited the Committee to consider the establishment of a working group to look into item 4 (Proposed Changes to Legislation).  The Committee agreed to consider this matter further at agenda item 12, Health Scrutiny Committee for Lincolnshire – Work Programme.

 

The Chairman confirmed that following the previous meeting, he had on behalf of the Committee written to the Rt Hon Theresa May, the Prime Minister, the Secretary of State for Health and Social Care, and to all Lincolnshire MP's expressing the Committees concerns.  The Committee was advised that to-date an acknowledgment letter had been received from the Rt Hon Theresa May, the Prime Minister advising that a response would be received in due course. 

 

RESOLVED

 

That the Chairman's Announcements presented as part of the agenda on pages 15 to 20; and the supplementary announcements circulated at the meeting be noted.

90.

United Lincolnshire Hospitals NHS Trust - Update on Care Quality Commission Inspection pdf icon PDF 240 KB

(To receive a report from United Lincolnshire Hospitals NHS Trust, which provides the Committee with an update on progress with the response to the Care Quality Commission inspection.  Senior Managers from United Lincolnshire Hospitals NHS Trust, will be in attendance for this item)

Additional documents:

Minutes:

The Chairman welcomed to the meeting the following presenters from United Lincolnshire Hospitals NHS Trust:-

 

·         Kevin Turner, Deputy Chief Executive;

·         Dr Neill Hepburn, Medical Director; and

·         Michelle Rhodes, Director of Nursing.

 

The Director of Nursing provided an update on United Lincolnshire Hospitals NHS Trust progress in response to the Care Quality Commission inspection.

 

The Committee was advised that the Trust had a Quality and Safety Improvement Plan (QSIP) in place which included twelve work programmes, with individual Executive Directors being responsible for each of the work programmes.  It was noted that the QSIP was scrutinised on a weekly basis and was presented to the Quality Safety Improvement Board bi-weekly; and to the Quality Governance Committee (QGC) monthly, with escalations of issues being referred to the Trust Board via the QGC.

 

Detailed at Appendix A to the report was a Glossary of Terms; and Appendix B provided the Committee with an overview of progress made up to the end of January 2019.

 

It was reported that since the inspection in February 2018 measurable progress had been made in response to the CQC's immediate concerns, and that all twelve programmes were on track to deliver what had been agreed.

 

The Committee was advised that there were still some risks attached to the programmes and that everything was being done to mitigate those risks.  The Committee noted that some significant work had been done relating to Children and Young People.  The Committee was advised further that a senior nurse had been on secondment from Leicestershire to identify any gaps relating to provisions for children.  It was reported that from the analysis of the data captured, a plan would be created which the Trust would be happy to share with the Committee (in approximately two months' time). 

 

It was reported that all the posts had been filled within the Children and Young People Directorate; and that the new structure would take forward the work programme.

 

The Trust was pleased to advise the Committee that its hospital mortality rates had reduced significantly.

 

It was highlighted to the Committee that governance was still not as strong as it could be; and that governance procedures had been developing over the last year.  The Committee was advised that when the new structure came in to force from start of April 2019, more governance arrangements would then come into place.

 

It was reported that the biggest clinical risk was the lack of staff at Pilgrim Hospital, Boston.  The Committee was advised that on 25 February 2019 an unannounced visit had been made by the CQC to the Emergency Department at Pilgrim Hospital, Boston.  The Committee was advised that the inspection report was not available yet, and that when it was it would be shared with the Committee.  The Committee noted that the CQC had seen improvements, which confirmed what the Trust was experiencing.

 

It was highlighted that the main issue at the Emergency Department at Pilgrim Hospital, Boston was overcrowding, this was an issue the Trust was encountering on  ...  view the full minutes text for item 90.

91.

Children and Young Persons Services at United Lincolnshire Hospitals NHS Trust - Update pdf icon PDF 513 KB

(To receive a report from United Lincolnshire Hospitals NHS Trust, which provides the Committee with an update on the current position regarding children and young persons services.  Senior Managers from United Lincolnshire Hospitals NHS Trust, will be in attendance for this item)

Additional documents:

Minutes:

Consideration was given to a report from the United Lincolnshire Hospitals NHS Trust, which provided an update on Children and Young Peoples Services.  The report also provided the status of the Royal College of Paediatric and Child Medicine report and its relevance to the interim model.

 

Kevin Turner, Deputy Chief Executive and Dr Neill Hepburn, Medical Director were in attendance for this item.

 

The Committee was advised that the interim paediatric service model currently in place at Pilgrim Hospital, Boston had been introduced on 6 August 2018 was working well to address the significant challenges faced by the Children and Young People's Services.  The Committee was reminded that the interim service comprised of an enhanced paediatric presence in the Pilgrim Hospital Emergency Department and an acute paediatric assessment unit with a twelve-hour length of stay; and outpatient clinics and surgery continuing at Pilgrim Hospital, Boston.

 

The Committee was advised that since the introduction of the dedicated ambulance transfer service, there had not been any instances where an ambulance had not been available to meet the needs of the service.  Details of the transfers were shown on pages 30 and 31 of the report.

 

It was reported that since the introduction of the interim model at Pilgrim Hospital, there had been a significant improvement in throughput, as well as there being an improvement to the patient experience.  It was highlighted that during the first 26 weeks of operation of the interim model, 1,869 patients had been seen in the paediatric assessment unit.  A breakdown of the source of referrals was shown on page 32 of the report.

 

The Committee was advised that since the introduction of the interim model, no patient safety incidents had been experienced, or reported as a result of the change.

 

The Committee was advised further that staffing was still an on-going problem.  It was noted that there had been a successful outcome from discussions with Health Education East Midlands to allow junior doctors to undertake additional locum work to fill some of the gaps in the rota.  It was noted further that the recruitment of children's trained nurses continued to be a challenge.  It was reported that a staff survey was to be undertaken in March to obtain the views of staff on the interim arrangements. 

 

It was reported that risks were managed through the project risk register, a copy of which was attached at Appendix A to the report.   It was highlighted that no incidents of patient harm had been reported.

 

Details relating to what had been learnt from complaints specific to the new paediatric model of care were shown on pages 36 to 38 of the report.

 

In conclusion, the Committee was advised that the interim model was addressing the difficulties and challenges caused by a shortage of doctors and nurses in the young people's services at Pilgrim Hospital, Boston; and that an update on the progress made on the recommendations following the Royal College of Paediatrics & Child Health report would be made available in  ...  view the full minutes text for item 91.

92.

Arrangements for the Quality Accounts 2018-2019 pdf icon PDF 180 KB

(To receive a report from Simon Evans, Health Scrutiny Officer, which invites the Committee to consider its approach to the Quality Accounts for 2019 and to identify its preferred option for responding to the draft Quality Accounts, which will be shared with the Committee, by local providers of NHS-funded services)

Minutes:

The Committee gave consideration to a report from Simon Evans, Health Scrutiny Officer, which invited the Committee to consider its approach to the Quality Accounts for 2019 and to identify its preferred option for responding to the draft Quality Accounts.

 

Details of the options for handling Quality Accounts were shown on pages 127 to 129 of the report presented.

 

During a short discussion, the Committee agreed to pursue option 3A – Lincolnshire Based Provider with Quality Challenges and to include East Midlands Ambulance Service with United Lincolnshire Hospitals NHS Trust.

 

The Committee also agreed that a working group should be established and that the Health Scrutiny Officer would be contacting members of the Committee after the meeting asking for volunteers.

 

RESOLVED

 

1.    That option 3A from Section 4 of the report be adopted as the Committees approach to Quality Accounts 2019 and that East Midlands Ambulance Service be added to that option.

 

2.    That a working group be established for the Quality Accounts process for 2019; and that the Health Scrutiny Officer would be seeking volunteers from members of the Committee after the meeting.   

93.

Update on Developments at North West Anglia NHS Foundation Trust pdf icon PDF 410 KB

(To receive a report from North West Anglia NHS Foundation Trust, which provides the Committee with a clinical and financial update.  Caroline Walker, Chief Executive of North West Anglia NHS Foundation Trust, will be attendance for this item)

Minutes:

The Chairman welcomed to the meeting Caroline Walker, Chief Executive, North West Anglia NHS Foundation Trust, who provided a clinical and financial update for the North West Anglia NHS Foundation Trust.

 

The Committee was advised that the North West Anglia NHS Foundation Trust oversaw the running of Stamford and Rutland Hospital, Peterborough City Hospital and Hinchingbrooke Hospital in Huntingdon.  The Trust also ran outpatient and radiology services at Doddington Hospital, Princess of Wales Hospital, Ely and North Cambs Hospital, Wisbech.  The Committee was advised that the last two years had been challenging, as the Trust had only formed on 1 April 2017 and was then inspected by the Care Quality Commission in June/July 2018. 

 

Details of the Care Quality Commission inspection at the Hinchingbrooke Hospital and Peterborough City Hospital were shown on pages 46 to 49 of the report presented.  The published report from CQC in October 2018 gave the Trust the overall rating of 'Requires Improvement.'  The Trust had been very disappointed with the rating.  Prior to the report's publication, the Trust had responded to the draft CQC report with more than 100 pages of factual accuracy amendments, only to find that many of the inaccuracies were still published in the final report.  

 

The Committee was advised that since the inspection, the Trust had resolved the 'must improve' actions; and the lessons learned from the recommendations were being applied across all the Trust's hospital sites.  The Committee was advised further that work continued against a detailed action plan of remaining improvements against the said plan and that the plan was reviewed monthly.  It was highlighted to the Committee that the plan had been submitted to the CQC on 3 December 2018 to show the Trusts compliance against key areas highlighted in their report.

 

It was reported that the Trust was continuing with its own CQC-style inspections of ward areas across all three acute sites to maintain assurance that services were consistently being run to a high standard of care.  The Committee noted that the said in-house inspections were called CREWS (Caring, Responsive, Effective Well-led and Safe).  The Trust also had senior–level walkabouts across the hospitals to see first-hand improvements, and that these were led by the Chief Nurse.

 

The Committee was advised that the Trust was anticipating a re-inspection of services in the next few months.

 

It was reported that for 2017/18, the Trust had achieved its control total of £39.9m; and as a result had received a System Transformation Funding Budget of £5.7m.  However, due to increasing cost pressures in 2018/19; at the end of the first quarter of the financial year 2018/19 the monthly spending rate was on course to be £10m higher than the control total set of £46.5m.  It was highlighted that some of the increased spending had been the result of greater activity and additional staffing costs through agency and staffing banks.  The Committee was advised that the Trust had seen increased activity from Lincolnshire which had resulted in extra bed capacity being  ...  view the full minutes text for item 93.

94.

NHS Dental Services Overview for Lincolnshire pdf icon PDF 415 KB

(To receive a report from NHS Dental Services, which provides the Committee with an overview of Dental Services in Lincolnshire.  Carol Pitcher, Primary Care Senior Contract Manager, NHS England and Jason Wong, Local Dental Network Chair for NHS England Central Midlands, will be in attendance for this item)

Minutes:

The Chairman welcomed to the meeting Carole Pitcher, Primary Care Senior Contract Manger, NHS England – Midlands and East (Central Midlands) and Jason Wong, Local Dental Network Chair, NHS England, Central Midlands.

 

In guiding the Committee through the report, reference was made to the local context with regard to commissioning and dental care services.  It was reported that there were 71 contracts providing dental services in Lincolnshire, a breakdown of how these services were provided was shown on page 54 of the report.

 

It was highlighted that following the outcomes of the Oral Health Needs Assessment, agreement had been made for the commissioning of new contracts as part of the dental procurement programme to improve access to general dental services in priority areas.  These were highlighted as being Boston, Lincoln, Sleaford and Spalding.  Details of the Dental Procurement across Lincolnshire and Leicestershire were shown on page 60 of the report; and results of the procurement process were shown on page 61.  It was highlighted that preferred bidders had not been identified for Louth and the Skegness/Spilsby areas as the bids evaluated had not met the financial sustainability requirements.

 

It was also highlighted that the new services identified for Boston, Spalding and Johnson Community Hospital had not commenced in January 2019, as originally planned.  The Committee was advised that NHS England were disappointed not to have the new services in place for January 2019.  It highlighted that the preferred bidders had been unable to find the workforce required to operate these services safely.  The Committee was advised further that local providers in Spalding had confirmed that they were able to continue to provide urgent dental services as an interim measure; and two dental sessions a week were being provided from the Johnson Community Hospital Dental practice; and that this arrangement would run until January 2020.  The Committee was advised that care taking options were currently being reviewed for the provision of NHS dental services in the Mablethorpe area.

 

It was reported that the NHS England Local Office had offered Lincolnshire dental providers the opportunity to bid for additional non-recurrent activity to improve access to NHS dental services, whilst longer term commissioning plans were considered.  It was noted that the outcome had been the award of non-recurrent activity equating to an additional capacity for approximately 5,000 patients in Gainsborough, Skegness, Spilsby, Lincoln, Boston and Spalding.  The Committee was advised that following the results of previous procurement, the Local Office was planning to re-procure the NHS dental services for Spalding, Boston, Louth, Spilsby/Skegness and Mablethorpe in 2019.

 

The Committee was advised that Lincolnshire did not have the number of dentists it required; and as a result steps were being taken to up skill the existing workforce.  Details of dental foundation training were shown on page 57 of the report. 

 

The Committee was advised that all dentists' delivering services as part of an NHS contract were required to be registered with the General Dental Council, and needed to be included onto  ...  view the full minutes text for item 94.

95.

Non-Emergency Patient Transport Service - Update pdf icon PDF 571 KB

(To receive a report from NHS Lincolnshire West Clinical Commissioning Group (CCG), which provides the Committee with an update on the Non-Emergency Patient Transport Service.  Sarah-Jane Mills, Chief Officer, Lincolnshire West CCG and Tim Fowler, Director of Commissioning & Contracting Lincolnshire West, will be in attendance for this item)  

Minutes:

The Chairman welcomed to the meeting Wendy Martin, Executive Lead Nurse & Midwife, Lincolnshire West Clinical Commissioning Group (CCG) and Tim Fowler, Head of Contracting, Lincolnshire West CCG.

 

The report presented provided the Committee with the background surrounding Thames Ambulance Service Limited (TASL).  The Committee was reminded that at the January 2019 meeting the CCG had stated that they would continue to work with TASL to address the earlier concerns raised by the Committee regarding TASL's unacceptable levels of performance and to the fact that the CCG were of the view that there would be an unacceptable level of risk of giving notice to exit the contract and move to a new provider at that time.

 

Representatives from TASL had then attended the February meeting of the Committee, at which disappointment had been expressed concerning the CQC results and to the lack improvement.

 

The Head of Contracting Lincolnshire West CCG advised that the CCG was working with other CCGs that commissioned TASL and NHS England to co-ordinate oversight of TASL's response to the findings of the CQC report. 

 

The Committee was advised that following the publication of the CQC report the CCG had issued to TASL a Contract Performance Notice for breach of Service Condition 1.1 of their contract in that TASL had failed to deliver the Fundamental Standards of Care.

 

The Committee was advised that the CCG teams had recently undertaken quality visits to TASL sites in order to seek assurance that issues and requirements of the CQC report were being addressed.  It was highlighted that these visits had observed improvements in training compliance, the use of equipment and some improvement in the visible cleanliness of vehicles.  It was highlighted that the CCG still had concerns relating to journey planning, sharing of learning from complaints and incidents, reliability of Personal Digital Assistant devices and engagement between staff and senior management.  The Committee was advised that these concerns had been raised with TASL, and TASL were developing actions to alleviate these issues.

 

Detailed at Appendix A to the report was a summary of the activity and KPI performance for the contract for the period up to January 2019 for the Committee to consider.  The Committee was advised that call handling performance had exceeded the contract requirement of 80% and had achieved significant improvement from the December 2018 figure of 36%.  It was highlighted that no other KPIs had been achieved for January, although improvement had been seen on the December position for seven of the remaining KPIs.

 

The Committee was advised that the decision by NHS Hull CCG to give one year's notice to TASL of the termination of their contract with the CCG would not adversely impact the Lincolnshire service; and that reassurance had been received from TASL to that effect.

 

In conclusion, the CCG confirmed that it would continue to address the concerns raised by the Committee with regard to the unacceptable level of performance by TASL.  The CCG also reiterated that it was still of the opinion that  ...  view the full minutes text for item 95.

96.

Healthy Conversation 2019 - Listening and Engagement Exercise pdf icon PDF 275 KB

(To receive a report from Simon Evans, Health Scrutiny Officer, which provides an overview of the Healthy Conversation 2019 listening and engagement exercise)

Additional documents:

Minutes:

The Health Scrutiny Officer presented a report for the Committee to consider and comment on the launch of the Healthy Conversation 2019 listening and engagement exercise.

 

The Committee was invited to look at the details summarised in pages 115 to 118 and to decide which elements would warrant looking at in further detail.

 

During discussion, the Committee raised the following points:-

 

·         The possibility of having an informal group to look at the differences between Types 1 and 3 A & Es and Urgent Treatment Centres;

·         The need for an informal workshop following the election to help any newly elected representatives;

·         Thanks were expressed from some members to officers for their help and advice; to the members of the Committee for mutual respect and to the Chairman for chairing a meeting which at times had contentious areas of debate;

·         The need to incorporate a geographical overview of the area covered by the proposed service; 

·         The need to include Sleaford, Spalding and Gainsborough when discussing emergency and urgent care, to ensure that the whole County was covered;

·         The need to look at the quality of the Healthy Conversation 2019 website;

·         Ensure that comments raised by the Committee were fed back in to the engagement exercise, and

·         The need for members of the Committee to feed back their comments on engagement events.

 

RESOLVED

 

1.    That the Committee notes:

 

(a)  The launch of Healthy Conversation 2019 listening and engagement exercise by the NHS in Lincolnshire on 5 March 2019;

(b)  That full public consultation will be undertaken by the NHS in Lincolnshire 'in due course' on any permanent substantial changes to health services.

 

2.    That the Committee considers the following themes and topics in Healthy Conversation 2019, in the coming months:-

 

·         15 May 2019 - Emergency and Urgent Care and Stroke Services;

·         12 June 2019 – Women's and Children Services and Breast Services;

·         10 July 2019 – Mental Health and Trauma and Orthopaedics; and

·         18 September 2019 – Integrated Community Care and Haematology and Oncology.

 

3.    That consideration be given to engagement arrangements at a future meeting, with a view to seeking assurance that efforts were being made to engage and involve as many people as possible, including  'hard-to-reach' and vulnerable groups.

97.

Health Scrutiny Committee for Lincolnshire - Work Programme pdf icon PDF 546 KB

(To receive a report from Simon Evans, Health Scrutiny Officer, which invites the Committee to consider and comments on its work programme)

Minutes:

Consideration was given to a report from Simon Evans, Health Scrutiny Officer, which enabled the Committee to consider and comment on the content of its work programme, to ensure scrutiny activity was focussed where it could be of greatest benefit.

 

The Committee gave consideration to the work programme as detailed on pages 132 to 133 of the report presented.

 

The Committee was invited to consider whether it wished to respond to item 4 – Implementing the NHS Long Term Plan – Proposals for Possible Changes to Legislation; and whether an informal working group should be established.  The Committee agreed that the Health Scrutiny Officer should draft a response on behalf of the Committee and circulate to all members of the Committee for their comments.

 

RESOLVED

 

1.    That the work programme be agreed subject to the inclusion of the items highlighted in minute numbers: 90 (1), (2); 91 (1), (2); 93 (1), (3); 94 (2); 95 (4); and 96 (2) and (3).

 

2.    That the Health Scrutiny Officer should draft a response to the Implementing the NHS Long Term Plan – Proposals for Possible Changes to Legislation on behalf of the Committee and circulate to all members for their comments.

 

 
 
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