Agenda and minutes

Apologies for absence were received from Councillor M A Whittington and P Howitt-Cowan (West 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 R Wootten to replace Councillor M A Whittington on the Committee for this meeting only.

An apology for absence was also received from Councillor Mrs S W Woolley, Executive Councillor for NHS Liaison and Community Engagement.

Councillor Mrs P F Watson advised the Committee that she was currently a patient of United Lincolnshire Hospitals NHS Trust. 

RESOLVED

That the minutes of the meeting of the Health Scrutiny Committee for Lincolnshire held on 21 March 2018 be agreed and signed by the Chairman as a correct record, subject to the meeting closed time being amended to read '3.25 pm'.

The Chairman advised that since the despatch of the agenda for the meeting, emails had been received concerning the orthopaedic service at Grantham Hospital.  In response to the emails the Chairman advised further that he had written a joint letter to Jan Sobieraj, the Chief Executive of United Lincolnshire Hospitals NHS Trust and John Turner, Senior Responsible Officer for the Lincolnshire STP to ask for further clarification regarding this and other matters.  The Committee noted that once responses had been received they would be circulated to all members of the Committee.  It was reported that this matter would also form part of the Acute Services Review, which would be considered by the Committee at its 16 May 2018 meeting.

As Jan Sobieraj, the Chief Executive of United Lincolnshire Hospitals NHS Trust was present at the meeting; the Chairman invited him to provide a brief statement concerning Grantham orthopaedics.

The Committee was advised that Professor Tim Briggs, National Director for Clinical Quality and Effectiveness, NHS Improvement had assisted United Lincolnshire Hospitals NHS Trust with the issue of orthopaedic service provision in Lincolnshire to improve quality and standards going forward.

It was reported that the Acute Service Review was still in its early stages; and that no firm decision had been made regarding service provision.  It was highlighted further that any changes to services would be subject to consultation as part of the STP.

Some concern was expressed regarding the proposed removal of services from Grantham Hospital; particularly when further housing development was proposed, which would increase the size of Grantham.  Reference was also made to the methodology of a review.  The Committee was advised that there would be a wide review, and all options would be looked at and considered.  It was clarified that the review was still at an early stage.  Further clarification was given that the review was not being driven as a result of staff shortages.  It was highlighted that the review was part of a national programme which would improve the quality of services provided. 

It was highlighted that some services were very fragile as a result of staff shortages; and that a report would be presented to the Committee in due course.

In conclusion, the Chief Executive of United Lincolnshire Hospitals NHS Trust advised that he was not aware of the changes specifically identified in the said emails; and that any substantial changes to services would be subject to full public consultation, as well as consultation with the Committee.

RESOLVED

That the Chairman's Announcements presented as part of the agenda on pages 17 to 25; and the supplementary verbal update provided by the Chairman at the meeting be noted.

(To receive a report on behalf of United Lincolnshire Hospitals NHS Trust, which provides the Committee with an update on Financial Special Measures)

The Chairman introduced this item, and advised that attached to the report for the Committee's information were two Appendices.  These Appendices related to:

·         Appendix A - Update on Quality Special Measures; and

·         Appendix B – Mortality rates at United Lincolnshire Hospitals NHS Trust.

The Committee were asked to primarily focus on the issue of Financial Special Measures at ULHT.

The Chairman advised further that he had received requests from two members of the public to speak on this item.  The Committee was advised further that the requests had been received from Melissa Darcy and Liz Wilson. 

The Committee was advised that it was proposed that each speaker would be allowed a maximum of three minutes to speak on the issue of Financial Special Measures first; this would then be followed by a presentation from Jan Sobieraj, Chief Executive, United Lincolnshire Hospitals NHS Trust and Karen Brown, Director of Finance, United Lincolnshire Hospitals NHS Trust.

In their presentations to the Committee, the two presenters made reference to: the emails and letters from United Lincolnshire Hospitals NHS Trust staff; the continued overnight closure of the A & E Department at Grantham Hospital and to the continued lack of any progress towards its re-opening on a 24 hour basis; the proposed intention to remove Orthopaedic trauma from Grantham Hospital and the effect that would have on the survival of the Grantham Hospital A & E.  Reassurance was sought that consultation would be undertaken before the removal of Orthopaedic trauma from Grantham Hospital; the record of ULHT and its approach to public information and consultation; and due to the small amount of progress made by ULHT, what was the Trust Board's recovery plan; and what action the Health Scrutiny Committee would be taking to ensure that accurate, and timely information was provided, and that consultation occurred to ensure that services were preserved.

The Chairman of the Health Scrutiny Committee for Lincolnshire advised that United Lincolnshire Hospitals NHS Trust had stated that no changes to orthopaedic trauma had taken place at Grantham Hospital, or were planned to happen in the near future.  This particular item was not for discussion as part of the agenda, but would be discussed further as part of the Lincolnshire Acute Services Review; and that the Committee would consider any proposals for Grantham Hospital following that stage.  It was also highlighted that if any changes were implemented on the grounds of the health and safety of patients, the public or staff, these would be considered by the Committee as a matter of urgency, and as yet no such changes had taken place or were planned.  It was also highlighted that the Committee had made two referrals to the Secretary of State in relation to the Grantham Hospital A & E Department.  The Committee also noted that the Acute Service Review would be considered by the Committee at its 16 May 2018 meeting.

In response to the issues highlighted, the Chief Executive of United Lincolnshire Hospitals NHS Trust advised the Committee that  ...  view the full minutes text for item 86.

(To receive a report from the Lincolnshire Sustainability and Transformation Partnership, which provides the Committee with information on the development of the GP Forward View as part of the Lincolnshire Sustainability and Transformation Partnership)

The Chairman welcomed to the meeting Martin Kay, Head of Commissioning, NHS Lincolnshire West CCG and Dr Sunil Hindocha, Chief Clinical Officer, Lincolnshire West Clinical Commissioning Group.

Consideration was given to a report from the Lincolnshire Sustainability and Transformation Partnership (STP), which provided information on the development of GP Forward View as part of the Lincolnshire STP.  It was noted that the GP Forward View was one of the four current priorities in the Lincolnshire Sustainability and Transformation Partnership, which the Committee had decided to look at in more detail.

It was reported that Lincolnshire CCGs were accountable for the delivery of the GP Forward View Programme of work.  It was highlighted that the Primary Care Programme was influenced by the General Practice Five Year Forward View (GPFV), which brought together GP Federations, practices, CCGs and the Lincolnshire Local Medical Committee.

The Committee was advised that in addition to local initiatives, Lincolnshire had through the Local Medical Committee been successful in recruiting 26 GPs from abroad; and a second bid had been successful for a further 39 international recruits, which would enable Lincolnshire to reach its required target.  As well as the recruitment Lincolnshire was also working with NHS England and others to achieve greater working flexibility to retain current GPs.  Lincolnshire also had a target to increase the number of other staff in primary care, the target was to recruit a further 53 additional posts by 2020.

Paragraph 2.2 (1) and (2) of the report provided information as to the Primary Care Workload and Redesign.  Particular reference was made to ensuring that existing capacity was being used appropriately; a number of initiatives being developed in primary care were shown on page 46 of the report presented; and to the fact that GPs were key contributors to the development of integrated neighbourhood working. 

The Committee noted that significant change was required across general practice; and page 47 of the report identified 10 High Impact Actions, which included active signposting; developing practice teams; partnership working and developing self-care support.

The Committee noted further that with the workforce working differently in different areas would mean that improved infrastructure support would be required to enable them to be effective.  This would be achieved by changes to information management and technology.  Also, as services changed, some buildings would also need to change so that services could be delivered in a more appropriate environment.  It was highlighted co-locating services would provide synergy and benefits for patients and staff; and that this factor would be particularly significant with the development of Neighbourhood Teams.

It was reported that many general practices were now working as part of federations or super practices, but some practices still remained independent.

In conclusion, the Committee was invited to provide feedback on the GP Forward View Update.

Note: Councillor K Cook advised the Committee that she was a Lincolnshire Partnership NHS Foundation Trust Governor; and a Lincolnshire NHS Foundation Trust service user.

During discussion, the Committee raised  ...  view the full minutes text for item 87.

(To receive a report from the Lincolnshire Sustainability and Transformation Partnership, which updates the Committee on the progress that has been made in the collaborative design and implementation of Integrated Neighbourhood Working)

The Chairman welcomed to the meeting Kirsteen Redmile, Lead Change Manager – Integrated Care, STP System Delivery Unit.

The Committee gave consideration to a report from the Lincolnshire Sustainability and Transformation Partnership (STP), which provided an update on the progress that had been made in the collaborative design and implementation of Integrated Neighbourhood Working.  The report highlighted the key successes and the links to the GP Forward View programme.  The Committee was reminded that Integrated Neighbourhood Working was one of the four priorities in the Lincolnshire Sustainability and Transformation Partnership.

In guiding the Committee through the report, particular reference was made to the national context behind Integrated Neighbourhood Working; the four characteristics that make up a Primary Care Home; the Lincolnshire context; Integrated Neighbourhood Working – 2017 onwards; Better Care Funding; and Integrated Neighbourhood Working Programme; and the progress made to date.

The Committee was advised that each Neighbourhood had identified a GP lead to support their local programme.  It was noted that Phase 1 sites had plans in place; and had identified their next steps to ensure that by 1 April 2018; they would all have to be able to start to demonstrate Integrated Neighbourhood working in their area; and Phase 2 sites would start to implement planning and delivery of Integrated Neighbourhood Working from 1 April 2018.

It was noted that the progress of each Neighbourhood was being managed through the Countywide Learning and Development Forum and that each area was accountable to the Integrated Neighbourhood Working Strategic Group.

It was highlighted that the report was not a statutory consultation item within the scope of the 2013 Regulations; this was because the direct service impact on patients in terms of accessibility of services was not substantial enough to warrant a statutory consultation.

Detailed at Appendix A for the Committee's was a copy of the 'Neighbourhood House'.

The Committee had also received two further supplementary reports prior to the meeting, which provided details of the outcomes and impact on individuals who had been supported through the Integrated Neighbourhood working; and a making a Difference Case Study from the Gainsborough Neighbourhood Team.

During a short discussion, the Committee raised the following issues:-

·         How the patient experience would be affected.  The Committee was advised that the introduction of the Integrated Neighbourhood working would be a positive experience for the patient.  The two supplementary reports provided confirmation that this was the case;

·         The need for any structure to be clear.  Acceptance was given that any changes would need to be communicated very clearly to patients;

·         The need to ensure that all GPs become involved.  It was noted that some GPs were more engaged than others; and that there was particular challenges in the east of the county and also Gainsborough.  The Committee was advised that East Lindsey District Council had been involved with Neighbourhood Teams since 2013.  Officers confirmed that the district councils had a role to play with regard to Integrated Neighbourhood working;

·         Some members still expressed concern  ...  view the full minutes text for item 88.

(To receive a report from Mike Casey (Interim General Manager, Thames Ambulance Service Ltd (TASL)), which provides the Committee with the most recent performance activity relating to TASL)

The Chairman welcomed to the meeting Derek Laird, Chief Executive Thames Ambulance Service Ltd (TASL) and Mike Casey, General Manager, TASL.

The Committee were reminded that a report had been issued to them prior to the meeting.  Figures relating to the March performance were circulated at the meeting for the Committee's consideration.  Apologies were given for the lateness of the performance information for March.  It was noted that the figures provided were only interim at this stage, and when finalised, a copy would be made available to members of the Committee.

The Chief Executive of TASL introduced himself; and provided the Committee with some background information relating to his knowledge and expertise.

The Committee was advised that since the last meeting, TASL had made further improvements: better management sustainability, the implementation of a performance improvement plan in February 2018; that work was ongoing with the CQC and Commissioners; and that the Quality Directorate had set up a High Impact Quality Team who were going into bases and working with local management teams to address issues and concerns. Details of the improvements were contained on pages 2 and 3 of the report presented.

Particular reference was made to the work that had been undertaken with voluntary car service drivers.  The Committee was advised that since the revised offer had been sent to the voluntary car service, 16 of the existing drivers had returned.  As there was now a realisation of the importance of the voluntary car service, the Committee was advised that TASL would continue working with them to improve relations.  It was highlighted that a further revised offer would be going out to the drivers to encourage them to come back into the organisation.  It was highlighted that the first 10 mile payment exclusion had been removed, and drivers would now get paid from when they left home.

The Committee was advised that a new call process had been implemented; which had led to some significant improvements in call answering times.  The Committee was advised further that recruitment of staff continued; however a fleet expert was now overseeing the areas of Louth and Horncastle; and that an advertisement was to be placed for a Manager of the Contact Centre.

It was reported that journey planning was now part of daily routine; with the introduction of daily and weekly reporting to improve the KPI reporting, and the overall efficiency of TASL.

It was highlighted that there was still work to be done, but with the appointment of the new management structure, the current recovery action plan, and support from the parent company, HTG, TASL was expecting the current improvements to service delivery to continue.

During discussion, the Committee raised the following issues:-

·         Some members were encouraged by the improvements made.  Some concern was made as to whether the progress made was static.  Reassurance was given that now some voluntary car drivers were offering their services again, it was felt that performance would improve further;

·         The Committee was  ...  view the full minutes text for item 89.

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

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 would be of greatest benefit.

Detailed within the report were populated work programmes up to 11 July 2018, and on pages 65 and 66 was a list of items to be programmed.

The Committee was invited to put forward items for consideration, these included:-

·         Update from the ULHT Board on 27 April 2018;

·         Paediatric Service Update;

·         STP Quarterly update;

·         Integrated Neighbourhood Working; and

·         Orthopaedic Services at Grantham.

RESOLVED

That the work programme as presented be agreed subject to the inclusion of the items mentioned above.