Agenda and minutes

Apologies for absence were received from Councillors R H Trollope-Bellew, P Gleeson (Boston Borough Council), C Burke (City of Lincoln Council), and T Boston (North Kesteven District Council).

It was noted that Councillor Mrs P Whittaker (North Kesteven District Council) had attended the meeting on behalf of Councillor T Boston (North Kesteven District Council) for this meeting only.

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 Health Scrutiny Committee for Lincolnshire meeting held on 16 May 2018 be agreed and signed by the Chairman as a correct record.

Further to the Chairman's announcements circulated with the agenda, the Chairman brought the Committee's attention to the supplementary Chairman's announcements circulated at the meeting concerning changes being made to arrangements for community pain management services.

Some members expressed concern relating to item one of the chairman's announcements, Minor Injury Nursing Service, Grantham and District Hospital – Consultation, particular reference was made to the financial summary within the proposal.  The Chairman advised the Committee that there would be an opportunity for the Committee to discuss the matter as part of the Health Scrutiny Committee for Lincolnshire – Work Programme item later in the agenda.

RESOLVED

That the Chairman's Announcements presented as part of the agenda on pages 19 -23; and the supplementary announcement circulated at the meeting be noted.

(To receive a report from United Lincolnshire Hospitals NHS Trust, which provides the Committee with an update concerning the situation in relation to Children and Young Persons Services at United Lincolnshire Hospitals (ULHT) NHS Trust. Jan Sobieraj, Chief Executive, Kevin Turner, Deputy Chief Executive, Michelle Rhodes, Director of Nursing, and Dr Neill Hepburn, Medical Director from United Lincolnshire Hospitals NHS Trust will be in attendance for this item)

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

·         Kevin Turner, Deputy Chief Executive, United Lincolnshire Hospitals NHS Trust;

·         Dr Neill Hepburn, Medical Director, United Lincolnshire Hospitals NHS Trust; and

·         Michelle Rhodes, Director of Nursing, United Lincolnshire Hospitals NHS Trust

Pursuant to minute number 7(2) from the 16 May 2018 meeting, the Committee had requested a monthly update from representatives from the United Lincolnshire Hospitals NHS Trust concerning Children and Young Persons Services at Pilgrim Hospital Boston.

Attached to the report were the following appendices for the Committees consideration:-

·         Appendix A – A copy of the United Lincolnshire Hospitals NHS Trust (ULHT) Board papers from the 25 May 2018;

·         Appendix A1 – Appendix 5 – to the United Lincolnshire Hospitals NHS Trust Board paper for 25 May 2018; and

·         Appendix A2 – Appendix 6 – to the United Lincolnshire Hospitals NHS Trust Board paper for 25 May 2018.

The Committee was advised that on 25 May 2018, the Trust Board had directed that work was to continue to maintain current services at Pilgrim Hospital, Boston; and that work should continue on a contingency plan for the implementation of co-location of paediatric and obstetric services to Lincoln, in the event of the current service model at Pilgrim Hospital, Boston not being sustainable.

It was reported that since the last meeting the Trust had been successful in attracting some agency locum middle grade doctors to the posts.  As a result of concerns raised by the medical team around safety relating to a potential medical rota where 7 wte out of the establishment of 8 wte were going to be locum/agency doctors.  To address the issues raised the Trust had appointed two additional locum consultants to support the middle grade doctors; and work was ongoing to explore alternative ways of working to mitigate the concerns raised.

The Committee was also advised that Health Education England were now planning to remove Tier 1 (junior doctor) trainees from paediatrics at Pilgrim Hospital, Boston.  This move would make staffing the paediatric unit very difficult as the unit was run on an eight doctor rota of which six posts would normally be filled by such doctors.

It was reported that nursing staff numbers had also improved, which had allowed an increase to inpatients beds from eight to twelve at Pilgrim; and had also allowed paediatric surgery to be restarted.

The Committee was also advised that the proposed Clinical Senate Review, which had been commissioned by NHS England and NHS Improvement, had been stood down.  The Committee was advised further that ULHT had asked the Royal College of Paediatrics and Child Health to undertake a review of children's and young persons' services, which would be commencing on 14 June 2018; and that the Trust Board would be reviewing the matter at their meeting on 29 June 2018; that the task and finish group in consultation with health partners would continue to develop contingency plans; and that a detailed communications and engagement plan  ...  view the full minutes text for item 15.

(To receive a report from the Lincolnshire Sustainability and Transformation Partnership, which provides the Committee with an update on the progress of the Lincolnshire Sustainability and Transformation Partnership (STP).  Sarah Furley, STP Programme Director, John Turner, Senior Responsible Officer STP and Andrew Morgan, Chief Executive Lincolnshire Community Health Services NHS Trust will be in attendance for this item)

The Chairman welcomed to the meeting:-

·         John Turner, Senior Responsible Officer, Lincolnshire Sustainability and Transformation Partnership (STP);

·         Andrew Morgan, Chief Executive, Lincolnshire Community Health Services NHS Trust; and

·         Sarah Furley, STP Programme Director.

The Committee gave consideration to a report from the Lincolnshire Sustainability and Transformation Partnership, which provided information on the progress of the Lincolnshire Sustainability and Transformation Partnership.

Appended to the report the Committee's considerations were the following Appendices:-

·         Appendix A – Joint Letter from NHS England and NHS Improvement concerning 'working closer together'; and

·         Appendix B – Joint Letter from NHS England and NHS Improvement concerning NHS Regional Geographies.

The Senior Responsible Officer, Lincolnshire Sustainability and Transformation Partnership advised that the Committee had received regular updates in relation to the development of the Lincolnshire STP, which had included quarterly updates relating to the overall progress of the STP as a whole, and then monthly examinations of specific work programmes within the STP. 

It was reported that the Lincolnshire STP was one of 44 "footprints" established in England; and that during 2017/18 the STPs had evolved from plans to partnerships; and that current national thinking described STPs as working at a system level, with a co-ordinating function.  It was highlighted that as local STPs were systems working closely together to develop collaborative relationships, so were NHS England and NHS Improvement.

The Committee noted that over the last 12 months Lincolnshire had been developing in line with the emphasis being placed on a system approach.

The report provided the Committee with updates on some key outcomes for 2018/19, which included Mental Health; Integrated Neighbourhood Working; implementation of GP Forward View; Urgent and Emergency Care Transformation; Operational Efficiencies; Planned Care and Other Enabling Programme.  It was highlighted that the Committee, over the last five months, had already received detailed reports relating to Mental Health Services, Urgent and Emergency Care Services, Operational Efficiency Programme, The GP Forward View Programme and Integrated Neighbourhood Team Working.

The Committee was advised that paragraph 5.6 of the report highlighted the key successes that had been completed in respect of the Planned Care Programme (100 day programme).  As a result there had been rapid improvement across Dermatology, Ophthalmology and Diabetes.  It was noted the 100 day methodology had demonstrated some excellent results and had been evaluated well by all those involved.

It was reported that since December 2017, work on the Acute Service Review was continuing at pace.  Paragraph 6 of the report provided the Committee with more detailed information concerning the review.

The Committee was advised the NHS would put detailed options into the public domain, once they had been fully assessed for clinical viability and financial sustainability; and had passed through the NHS England assurance process.  It was highlighted that as many of the elements of this process were national, it was not possible to say when the public consultation would commence.  It was anticipated that it would not take place in the current calendar year.

Reassurance was given  ...  view the full minutes text for item 16.

(To receive a report from the Thames Ambulance Service Limited (TASL), which provides the Committee with an update on the latest position in terms of service delivery performance and organisational changes.  Mike Casey, General Manager, Thames Ambulance Service Limited (TASL) will be in attendance for this item)

Consideration was given to a report from the Thames Ambulance Service Ltd (TASL), which provided the Committee with an update on the latest position in terms of service delivery performance and organisational changes.

The Chairman welcomed to the meeting Mike Casey, General Manager, Thames Ambulance Service Ltd.

In guiding the Committee through the report, the General Manager of Thames Ambulance Service Ltd advised that since the last meeting a new operational structure had been agreed, and was currently being implemented.  The Committee was advised that TASL had confirmed its commitment to Lincolnshire by relocating its Head Office to the Pelham Centre in Lincoln.

The Committee was also advised that the performance improvement plan had included:-

·         A new process had been implemented for call handling, which had resulted in some significant improvements in call answering times.  It was highlighted that call answering had unfortunately seen a drop as a result of TASL losing six call centre staff, these staff had now been replaced and 'pipeline' recruitment was now in place, so it was hoped that performance would now start to improve;

·         That since the revised offer had be sent to the voluntary car service drivers, 64 of the existing drivers had returned.  The Committee noted that TASL had recognised the importance of the service and as such a further revised offer was to be going out to the drivers to encourage a greater number back into the organisation;

·         That a series of staff meetings had been held at Boston, Lincoln and Grantham stations.  It was noted that from the feedback received, an action plan had been created;

·         A dedicated local secondment manager had been seconded to deliver the performance improvement plan; and

·         That weekly performance reporting had been introduced across contract areas, including Lincolnshire; and that daily performance reporting had been introduced.

The Committee was advised that TASL continued to work with the CQC and commissioners.  Confirmation was received that a full CQC action plan had been implemented.  The Committee noted that TASL had until November 2018 to meet the agreed trajectory.

Attached at Appendix A to the report was a copy of the Recovery Action Plan for the Committees consideration. 

A discussion ensued, from which the Committee raised the following points:-

·         Whether TASL still had contracts with the North and North East Lincolnshire.  The Committee was advised that TASL was disappointed that notice had been received of the termination of the contract in North Lincolnshire, however, TASL would continue to provide a service until the termination date and would re-tender for the service;

·         One member enquired as to whether the April/May figures presented were actual figures.  Confirmation was given that the presented figures were  forecasted;

·         Page 111 – The amber status for voluntary car service recruitment.  One member highlighted that to recruit volunteers, more needed to be done other than advertising and putting leaflets up.  The Committee was advised that TASL had been active in trying to recruit more voluntary car service drivers, which had included: advertising through  ...  view the full minutes text for item 17.

(To receive a report from the Professor Derek Ward, Director of Public Health, which requests the Committee to receive and consider the 2017 Annual Report on the Health of the People of Lincolnshire. Tony McGinty, Consultant in Public Health – Health Protection will be in attendance for this item)

Consideration was given to a report from Derek Ward, Director of Public Health, which invited the Committee to consider and comment on the Annual Report of the People of Lincolnshire 2017, which had been produced by Tony McGinty, in his capacity of Interim Director of Public Health.  

Attached at Appendix A to the report was a copy of the Annual Report of the Director of Public Health on the people of Lincolnshire 2017.

The Committee received a short presentation from Tony McGinty, Consultant in Health Protection, which advised that the Annual Report focussed on the two topics that were high on the agenda for local organisations locally.  The two chapters were:

·         A chapter on the case for investing in prevention in support of the Lincolnshire Health and Care System's need to shift investment into proven prevention interventions; and

·         A chapter renewing the focus on the biological and environmental threats to people's health and the systems in place to track these hazards and protect Lincolnshire people from harm.

The Committee was advised that the report would be published electronically, and was connected to the Joint Strategic Needs Assessment evidence, as well as being presented to a range of NHS and local government bodies for consideration.

Also, page 124 of the report presented highlighted the five recommendations to the system of health and care organisations.

The Committee was advised that in the last 40 years there had been continuous growth in life expectancy in Lincolnshire; and not all the extra years were always spent in good health.  It was highlighted that in Lincolnshire in recent years, the gap between healthy life expectancy and life expectancy had widened.

During discussion, the Committee raised the following issues:-

·         The effect in key conditions Stroke, Hypertension, Type 2 Diabetes, Dementia and Arthritis in the over 65s; if nothing was done; and following prevention e.g. people remaining active.  Examples were given by some members of the Committee who had commenced exercise regimes and the positives effects they had received as a result, weight loss, sense of wellbeing and better physical fitness;

·         The need for more preventative measures at the primary care stage.  The Committee noted that there were a number of cancer screening programmes for example that were very important, which could ultimately prevent illness and death;

·         A question was asked as to how CCGs and NHS providers respond to the report and its recommendations.  The Committee noted that the NHS was motivated to give out messages to patients concerning their health and wellbeing; and that a significiant programme was planned for front line staff to help them encourage patients to improve their wellbeing.  One member also suggested that  the NHS and Public Health could do more awareness raising to patients of the organisations, clubs and activities going on within their locality.  The Committee was also advised that public health had some programmes it was running, one example given was 'Vitality', which was an armchair activity; and

·         The need for healthy wellbeing to be promoted more especially  ...  view the full minutes text for item 18.

(To receive a report from Simon Evans, Health Scrutiny Officer, which invites the Committee to consider and comment on 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.

It was agreed by the Committee that the Chairman should send a letter to John Turner, Accountable Officer, South West Lincolnshire CCG expressing the views of the Committee in response to the consultation relating to the proposal to close the Grantham Minor Injuries Unit, which has been operating between 6.30pm and 11.30pm.  The Committee also felt that representatives from the South West Lincolnshire CCG should be invited to attend the 11 July 2018 meeting to provide clarity to the concerns raised.

RESOLVED

1.    That the work programme presented be agreed subject to the addition of an update on the Minor Injuries Unit, Grantham Hospital be added to the agenda for the 11 July 2018 meeting.

2.    That a letter be sent on behalf of the Committee to John Turner, Accountable Officer South West Lincolnshire CCG, expressing the views of the Committee in response to South West Lincolnshire Clinical Commissioning Group's proposal to close the Grantham Hospital Minor Injuries Unit.