Agenda and minutes

Apologies for absence were received from Councillors M A Whittington, Mrs P F Watson (East Lindsey District Council), Mrs R Kaberry-Brown (South Kesteven District Council), P Howitt-Cowan (West Lindsey Council) and Dr B Wookey (Healthwatch Lincolnshire).

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.

It was noted further that Councillors W Gray (East Lindsey District Council), L Wootten (South Kesteven District Council) and Dr M Prior (Healthwatch Lincolnshire) had attended the meeting as replacement members for Councillors Mrs P F Watson (East Lindsey District Council), Mrs R Kaberry-Brown and Dr B Wookey (Healthwatch Lincolnshire) respectively, for this meeting only.

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

Dr M Prior wished it to be noted that she represented Healthwatch Lincolnshire at meetings of the Lincolnshire West Clinical Commissioning Group Governing Body.

Councillor Mrs K Cook advised the Committee that in respect of agenda item 7, she was a Lincolnshire Partnership NHS Foundation Trust Stakeholder Governor.

RESOLVED

That the minutes of the Health Scrutiny Committee for Lincolnshire meeting held on 13 June 2018 be agreed and signed as a correct record, subject to the following two bullet points being included on page 12.

·         Concern was expressed that not enough was being done to encourage a healthy diet.  A suggestion was made for schools to include a meat free day once a week.  The Committee was advised that the school diet issue was complicated, as there were nutritional standards set by the  Government;

·         A further concern was raised regarding the fact that some immunisations were not suitable for vegans, as they had been tested on animals, or contained animal products.  A question was asked as to what could be done to reduce testing on animals; and to promote those immunisations not tested on animals.  The Committee was advised that more manufacturers were now producing products with no animal content.

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 announcements included:-

·         That on 9 July 2018, the Rt Hon Matt Hancock MP had been appointed as the Secretary of State for Health and Social Care.  It was also highlighted that the Committee was still awaiting a letter of determination from the Secretary of State for Health and Social Care in relation to the overnight closure of Grantham Accident and Emergency Department;

·         That on 6 July 2018, Caroline Walker had been made the Chief Executive of North West Anglia NHS Foundation Trust;

·         That on 22 June 2018, the Local Government Association had published Healthy Weight, Healthy Futures – Local Government Action to Tackle Childhood Obesity.  The Committee was advised that an item had been included in the Committee's future work programme; and

·         That the Lincolnshire Sustainability and Transformation Partnership had published a series of engagement events throughout the county.  The said dates were detailed in the supplementary announcements circulated.

RESOLVED

That the Chairman's Announcements presented as part of the agenda on pages 17 – 22; and the supplementary announcements circulated at the meeting be noted.

(To receive a report from United Lincolnshire Hospitals NHS Trust, which provides the Committee with an update on the Children and Young Persons Services at United Lincolnshire Hospitals NHS Trust)

The Chairman welcomed to the meeting Jan Sobieraj, Chief Executive, United Lincolnshire Hospitals NHS Trust, Michelle Rhodes, Director of Nursing, United Lincolnshire Hospitals NHS Trust, and Mark Brassington, Chief Operating, United Lincolnshire Hospitals NHS Trust.

Pursuant to minute number 15 from the Health Scrutiny for Lincolnshire meeting held on 13 June 2018, the Committee received an update concerning children and young person's services at United Lincolnshire Hospitals NHS Trust. 

The Committee was advised that a proposed workable model of care had been worked up and presented to the ULHT Trust Board on 29 June 2018.  Details of the proposed model were shown in Appendix 1 on pages 34 and 35 of the report presented. 

The Committee was advised further that the service at Pilgrim Hospital, Boston, was still very fragile, but actions were being taken to help mitigate the situation and a proposed model of care was being developed for the future.

It was reported that Health Education East Midlands was continuing to place trainee junior doctors in ULHT and that they would be based at Lincoln County Hospital, however, agreement had been reached that the junior doctors could undertake some duties at Pilgrim Hospital, Boston when a consultant was present for support and teaching. 

The Committee noted that a new Trust wide rota was being developed and discussed with the consultant body; and that work was continuing with medical agencies, irrespective of financial cost, to find agency and locum medical staff to support the rota at Pilgrim Hospital, Boston, in order to keep children's services running safely.

During consideration of the proposed model of care, it was reported that there would be an eight-bed paediatric assessment unit open 24 hrs, which would be co-located with the neonatal unit; paediatric outpatients provision; the re-instatement of four day surgery beds; neonatal services would be managed from 34 weeks gestation; consultant led maternity unit provision; and a 24 hour In Patient Gynaecology Ward. 

The Committee was advised that the proposed model of care would mean that 98% of children who were seen and managed at Pilgrim Hospital, Boston on a daily basis would continue to receive care there.  The Committee was advised further that the modelling indicated that two children each day might require transferring for an inpatient stay in Lincoln; and that two additional expectant mothers would need transferring to Lincoln each week to deliver a premature baby.  Representatives from ULHT appreciated the concerns raised in respect of travelling.  It was highlighted that with existing provision, mothers, young babies and children were currently being transferred to Lincoln and out of county.  The Committee noted that transport options were being examined.

During discussion, the Committee raised the following points:-

·         Paediatric Assessment Unit - Whether the nursing team would be 24/7 and multi-skilled; when the service would be introduced and whether the service would be made countywide.  The Committee was advised that at the moment the focus was on Pilgrim Hospital, Boston, and that some work was already being done to  ...  view the full minutes text for item 24.

(To receive a report from the Richard Childs, Chairman of Lincolnshire West Clinical Commissioning Group and the Lincolnshire (Shadow) Joint Commissioning Committee, which advises the Committee of the Clinical Commissioning Groups arrangements to support the Lincolnshire Sustainability and Transformation Partnership)

The Chairman welcomed to the meeting Richard Childs, Chair, Lincolnshire West Clinical Commissioning Group and Sarah-Jane Mills, Chief Operating Officer, Lincolnshire West Clinical Commissioning.

Consideration was given to a report which updated the Committee on the Clinical Commissioning Group arrangements to support the Lincolnshire Sustainability and Transformation Partnership.

The Committee received an overview of why there was need to look at current Clinical Commissioning Group arrangements.  It was noted that the way the four Lincolnshire Clinical Commissioning Groups interacted with themselves and other stakeholders was not as streamlined, or as quick as the changing health environment required.  As a consequence, the view was that changes were necessary.

It was highlighted that the Legislative Reform (Clinical Commissioning Groups) Order 2014 allowed for CCGs to form joint committees for the purpose of exercising their commissioning functions.  It was reported that since their establishment the Lincolnshire CCGs had worked together to support the commissioning of health care provision for people in Lincolnshire.  The Committee noted that since May 2017 South Lincolnshire and South West Lincolnshire CCGs had shared an Accountable Officer, but were still constituted as two CCGs.  Overall, arrangements had worked well, but the statutory responsibility of each organisation required that decisions had to be considered by each organisation, which had resulted in a slowing down of decision making; and resulted in delays in delivering improvements.

Looking forward, the four CCGs were looking to develop a framework that would support strategic commissioning for Lincolnshire, whilst protecting and retaining local clinical engagement and a focus on the needs of the different localities across the county.  Page 73 of the report identified the framework for discussion.

The Committee was advised that the current priority was to establish a joint executive function to lead and manage the strategic commissioning issues across the county; and to have one Accountable Officer, and to retain Lead Officers in each of the four CCGs.  The purpose of the one Accountable Officer was to streamline activity to ensure that there was effective patient care. 

During discussion, the Committee raised the following issues:-

·         The benefits of one Accountable Officer - The Committee was advised that a single Accountable Officer would be able to deal with strategic issues; and would have oversight of the whole system.  This would then ensure better equity of services across the county.  The Committee also noted that the appointment of such an officer would help accelerate the STP and help ensure that national initiatives were workable for Lincolnshire;

·         Some members expressed their support for the report and its proposals; and for the frankness of the two presenters.  The Committee was advised that the purpose of the changes was not to create an additional layer, but to ensure that processes were more effective to ensure that patients received a better service in a timely fashion;

·         The need for working closely with district councils, the County Council and MPs was stressed to build up relationships and trust; and to ensure that lobbying continued to ensure that Lincolnshire's voice was  ...  view the full minutes text for item 25.

(To receive a report from Jane Marshall, Director of Strategy for Lincolnshire Partnership NHS Foundation Trust, which updates the Committee on the full feedback received from the targeted engagement events held with the public and patients concerning the proposals for changes in the Learning Disability (specialist health) services run by Lincolnshire Partnership NHS Foundation Trust (LPFT))

The Chairman welcomed to the meeting Jane Marshall, Director of Strategy, Lincolnshire Partnership NHS Foundation Trust and Richard Eccles, Chief Commissioning Manager Mental Health, Learning Disabilities and Autistic Spectrum Disorder, South West Lincolnshire Clinical Commissioning Group.

Consideration was given to a report on behalf of Lincolnshire Partnership NHS Foundation Trust, which provided the Committee with full feedback from targeted engagement events that had been held with the public and patients to discuss the proposals for changes in the Learning Disability (Specialised Health) Services.

Appended to the report for the Committee's consideration were the following documents:-

·         Appendix A – Feedback from the notes taken at the Learning Disability Engagement Events held in February and March 2018; and

·         Appendix B – Transforming Care in Learning Disability Services – Staff Survey January 2018.

The Director of Strategy, Lincolnshire Partnership NHS Foundation Trust highlighted that at the 11 October 2017 meeting, the Health Scrutiny Committee for Lincolnshire had recommended to Lincolnshire Partnership NHS Foundation Trust that it commence a period of targeted engagement with the public, patients and staff concerning the model of service provision of specialist health services to people with a learning disability in Lincolnshire.  It was noted that this decision had followed the temporary closure of the learning disability in-patient service at Long Leys Court in Lincoln in July 2015.

The report provided details of the targeted engagement response from five events to which a total of 72 people had attended.  Appendix A provided the Committee with patient feedback from each event.  In addition to the planned events, an online survey had also been issued to all staff based in Lincolnshire Partnership NHS Foundation Trust to capture their views on the proposed service change.  Appendix B provided the Committee with the feedback from the on-line staff survey.

It was reported that the main themes from the feedback received from the events and the on-line survey were as follows:-

·         There was support to move to community based services and there was no objection to the moving to a community based model of service;

·         There was support for the Community Home Assessment and Treatment Team, a 24/7 service dedicated to rapid response and preventing the need for admission;

·         A comment was raised to the lack of beds for people with learning disabilities, if they needed an inpatient bed;

·         There had been concern about the gaps in services for people with Autism and their carers' and families;

·         Concern had also been expressed that services needed to be more integrated and seamless; and that more needed to be done to sign post people to services;

·         There was concern about transitions of care between services and agencies; as people were having to tell their stories over and over again to different providers; and concern was also expressed to the lack of carer support and carer breaks;

·         The main themes from staff were that the majority of respondents were supportive of the new model; there was concern about gaps in services for people with Autism; and some  ...  view the full minutes text for item 26.

(To receive a report from South West Lincolnshire Clinical Commissioning Group, which provides the Committee with information on the review of the Minor Injury Nurse Pilot incorporated into the Grantham Out of Hours base. John Turner, Chief Officer, South West Lincolnshire CCG and Dave Baker, Chairman of the South West Lincolnshire CCG will be in attendance at the meeting)

Pursuant to minute number 19 (1) (2) of the meeting held on 13 June 2018, the Committee had requested that an update be received concerning the Minor Injury Nursing Service Trial at Grantham Hospital.

The Committee welcomed to the meeting:-

·         John Turner, Chief Officer, South West Lincolnshire Clinical Commissioning Group (SWLCCG);

·         Dr Dave Baker, GP Chair, South West Lincolnshire Clinical Commissioning Group (SWLCCG); and

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

The Chairman advised that the Chief Officer SWLCCG, and GP Chair SWLCCG were only able to attend the meeting for 30 minutes, as they had to return to a Clinical Senate meeting.  Due to the time constraints, the Committee had been asked to submit questions in advance and the said questions and responses were tabled at the meeting.

The Chairman requested that the Committee proceed directly to questions,

During discussion, the Committee raised the following questions:-

·         The back ground to the trial - The Committee was advised that the trial had started in September 2016, and was operated by Lincolnshire Community Health Services NHS Trust as part of the Out of Hours Services based on the Kingfisher Unit at Grantham Hospital.  The Committee noted that for 2017 the service had operated for 1,875 hours and had seen 65 patients.  One member asked whether there was any evidence of people going elsewhere.  The Committee was advised that the numbers were low and that a further piece of work needed to be done to see where people were going;

·         Consultation – The Committee was advised that the CCG was not conducting a formal consultation exercise in relation to the Minor Injury Nurse Trial as it was only a trial service, but the trial had undergone a well-publicised four week survey to gain patient feedback; and the CCG had also written to a number of stakeholders requesting their feedback.  The Committee was advised that 304 responses had been received to the CCG survey.  One member highlighted that a local survey by a pressure group had found that over 370 people had not been aware of the service.  The Committee noted that the responses to the CCG's survey were currently being analysed, the results of which would then be reported back to the Governing Body.  The Committee noted that the key themes emerging were that the respondents did not know about the existence of the service, and that it was available as a walk in service; and respondents were also claiming that NHS 111 did not offer the service as an option.  Confirmation was given to the Committee that the availability of the service was cited on the NHS 111;

·         Continuation of the service at Grantham Hospital – One member highlighted that as the cost for the service was minimal (£130,000.00), would the Trust consider extending the service until the Sustainability Transformation Plan was introduced.  The Committee was advised that the Governing Body at the end of the month would take into consideration the letter  ...  view the full minutes text for item 27.

(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 could be of greatest benefit.

The Committee gave consideration to the work programme as detailed on pages 118 to 120 of the report presented.

During consideration, of the work programme the Committee raised the following items:-

·         The inclusion of the Pain Management Service as an item on a future agenda;

·         A report from United Lincolnshire Hospitals NHS Trust for the 12 September 2018 meeting; and

·         Autism Strategy.

The Committee was also advised that the Lincolnshire Sustainability and Transformation Partnership – Mental Health Update would be moving to a future date.

RESOLVED

That the work programme presented be agreed subject to the addition/movement of items as detailed above.