Agenda and minutes

Apologies for absence were received from Councillors C Matthews, P Gleeson (Boston Borough Council), C J T H Brewis (South Holland District Council) and Dr B Wookey (Healthwatch).

The Committee was advised that Dr Maria Prior (Healthwatch) was the replacement member for Dr B Wookey (Healthwatch) for this meeting only.

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

Dr M Prior advised the Committee that she was on the governing body at Lincolnshire West CCG.

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

Councillor Mrs R Kaberry-Brown advised 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 12 September 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 to the Committee's attention the Supplementary Chairman's announcements circulated at the meeting.

Some members of the Committee expressed their support to the action taken by the Chairman relating to the Grantham and District Hospital – Overnight Closure of Accident and Emergency Department.  The Committee was advised that the Chairman had sought clarification from the Minister of Stare on the status of the referral made by the Committee on 31 January 2018; and whether the Minister's letter represented a determination of the January 2018 referral.  The Chairman advised that he would update members of the Committee as soon as a response was received.

RESOLVED

That the Chairman's Announcements presented as part of the agenda on pages 19 – 26; and the supplementary announcements circulated at the meeting be noted.

(To receive a report from Ruth Cumbers, Urgent Care Programme Director, which updates the Committee on Winter Planning across the Health and Care economy in Lincolnshire)

The Chairman welcomed to the meeting Ruth Cumbers, Urgent Care Programme Director, Lincolnshire East Clinical Commissioning Group and Simon Evans, Director of Operations, United Lincolnshire Hospitals NHS Trust, which updated the Committee on Winter Planning across the Health and Care Economy in Lincolnshire. 

The Urgent Care Programme Director, Lincolnshire East Clinical Commissioning Group advised the Committee that winter planning had started even earlier this year to work out the best way of responding to winter pressures as a county. 

The Committee noted that for several years' winter pressures for the health and social care system in Lincolnshire had continued throughout the whole of the year; and that it was no longer just through the winter period.  It was highlighted that it was known that there was increased need for urgent care and emergency departments across Lincolnshire during the winter months.  To help with the pressure points, part of the solution was to encourage patients to access alternatives to emergency care where appropriate. 

The Committee was advised that in September 2018, the Urgent Care Team had launched the ASAPLincs app and website.  It was highlighted that ASAP had been designed to support individuals to make the right choice and signpost citizens to the most appropriate service for their condition.  The report highlighted that the most common referral method to ED in Lincolnshire during 2017/18 was self-referral.  It was noted that in Lincolnshire 58% of the self-referrals could have been dealt with elsewhere.  The Committee was advised that following the introduction of a similar app in Gloucestershire, 15,000 people had downloaded the app in its first year and that A & E attendances had dropped by 16,000 across two acute sites, as had GP appointments involving minor ailments.  It was highlighted that the public needed reassurance to look at other options and the ASAP was one way of helping with that reassurance.

The Committee was advised that the Winter Plan had been produced by the Urgent Care Team with contributions from partners across the health and care community.  The plan confirmed organisational resilience and business continuity mitigations.  Page 4 of the report provided the Committee with details on how the system aimed to manage pressures.  It was highlighted that to support winter planning the Delivery Board had agreed to set-up a "winter room", which would be staffed seven days per week with representatives from across the urgent care system to support day to day operational resilience to manage demand, capacity and flow.  It was highlighted further that the system had also put plans in place to improve ambulance conveyance to the acute hospital sites.  The Committee was advised that "Home First Prioritisation" would run throughout the winter period. 

It was reported that week commencing 15 October 2018, a piece of work with the East Midlands Ambulance Service had commenced to review the qualitative reasons behind conveyances.  This would help crews understand the way they worked.  The auditing of the work would focus on frail and older people (over 75).  It was noted  ...  view the full minutes text for item 44.

(To receive a report from the Lincolnshire Sustainability and Transformation Partnership (STP) and Lincolnshire Partnership NHS Foundation Trust (LPFT), which updates the Committee on progress and strategic activity in relation to the NHS direction for delivery of Mental Health Services in Lincolnshire.  Jane Marshall, Director of Strategy, Lincolnshire NHS Foundation Trust will be in attendance for this item)

The Chairman welcomed to the meeting the following representatives:-

Jane Marshall, Director of Strategy, Lincolnshire Partnership NHS Foundation Trust, Rachel Redgrave, Head of Commissioning, Mental Health, South West Lincolnshire Clinical Commissioning Group and Christopher Higgins, Deputy Director of Operations, Lincolnshire Partnership NHS Foundation Trust.

The Chairman also advised that a member of the public, Mrs Penny West had requested to address the Committee with regard to the report.  The Chairman invited Mrs West to speak for a period of 3 minutes to address the issues set out in the report.

In her short address to the meeting Mrs West raised the following questions:-

·         Page 30 of the report - The provision of community mental health services for working age adults (People aged 18 to 65).  Whether people aged 66 and over would be disadvantaged; and whether this was an example of age discrimination.  Reassurance was given that there was no discrimination on the basis of age, but traditionally mental health services had been organised into 0 – 18, 18 – 65, and 65+.  Confirmation was given that people would be able to access services regardless of age;

·         Page 34 of the report – Older Adult Services.  Whether the beds provided were short term and whether issues of patient isolation were being addressed.  Clarification was given that works were about to commence to upgrade patient environment at Brant Ward, Lincoln to create single rooms to protect patient dignity.  Confirmation was given that day room facilities would also be available; and

·         Page 32 of the report – Workforce Development – whether there would be 'deskilling' of staff.  The Committee was advised that the workforce plan was to support the service transformation.  To ensure successful delivery it was critical there was a skilled and well-supported workforce, who was trained to deliver evidence based interventions at the right level.  It was highlighted that nurses would always be supported by a doctor.  It was highlighted further that the changes to roles were to help meet the recruitment difficulties Lincolnshire was facing.

In guiding the Committee through the report presented there was an acknowledgement of the Health Scrutiny Committee for Lincolnshire and the Lincolnshire Health and Wellbeing Board's support to mental health work stream.

It was highlighted that the content of the report focussed on what was in the Lincolnshire Sustainability and Transformation Partnership (LSP).  It was highlighted further that the priorities for the Lincolnshire Partnership NHS Foundation Trust (LPFT) were the repatriation of mental health patients back to Lincolnshire, and the transformation of the community mental health teams.  Page 29 of the report detailed that the LPFT was currently looking at bringing back both male and female patients who currently went out of county for bed based psychiatric intensive care and acute mental health placements.  The report highlighted that since the start of the programme the number of male patients going out of area for psychiatric intensive care had been reduced to zero and the total number of patients who went  ...  view the full minutes text for item 45.

(To receive a report for Sarah-Jane Mills, Chief Operating Officer, Lincolnshire West Clinical Commissioning Group, which enables the Committee to give consideration to the Annual Report for 2017/18 for Lincolnshire West Clinical Commissioning Group)

The Chairman welcomed to the meeting Sarah-Jane Mills, Chief Operating Officer, Lincolnshire West Clinical Commissioning Group (LWCCG).

The Committee was asked to give consideration to the Annual Report for 2017/18 for LWCCG (pages 1 to 54 only), a copy of which was detailed at Appendix A to the report.

The Committee were invited to ask questions from which the following points were raised:-

·         Page 74 Involving Patients and the Public – The Committee was advised that the CCG had well established communication and feedback mechanisms in place to keep patients and the public well informed, which were used to promote local and national campaigns, and services provided;

·         Page 5 – some concern was expressed concerning the diseases that impacted most upon life expectancy in Lincolnshire West, particular reference was made to deaths under 1 years of age;

·         Page 92 – Women and Children, particular reference was made to maternity choices.  The report highlighted that it was essential that women and children had safe, high quality care, at the right time and at the right place; and as close to home as possible; with a choice of place of care wherever possible; and that the care delivered was by the most appropriate levels of staff with the skills and expertise required.  It was highlighted that the Local Maternity Systems Group continued to work across the system; and that the transformation team were hosted by Lincolnshire East CCG;

·         Page 58 – Better Care – Some concern was raised at the CCG's performance for Maternal smoking at delivery; choices in maternity services.  A question was asked what was being done to improve performance.  The Committee was advised that the Lincolnshire approach was being driven through the Better Births Lincolnshire Programme, whose work included supporting smoking cessation during pregnancy; encouraging breast feeding; and reducing neonatal mortality and still births.  It was highlighted that smoking prevalence during pregnancy was a Lincolnshire wide issue and that work was being undertaken by the four CCGs and Public Health regarding this matter.  It was highlighted that every still birth was a tragedy and that 20% of mums had been smoking throughout their pregnancy;

·         It was highlighted that the report made reference to the stopping of services that did not deliver good results; as there appeared to be no detail as to what these areas might be.  It was highlighted that any substantial changes to a service would lead to a full consultation; where a specific treatment had no clinical or minimal benefit to the patient, it was unlikely there would be a consultation.  It was highlighted that even before any consultation, a full equality impact assessment would be carried out as many changes would be countywide not just in LWCCG area;

·         The likely location of the two primary hubs.  The Committee was advised that the likely location of the two primary hubs would be south of Lincoln and in the Gainsborough area;

·         Actions that were being taken to improve areas not meeting the minimum criteria, such  ...  view the full minutes text for item 46.

(To receive a report from Simon Evans, Health Scrutiny Officer, which invites the Committee to respond to the survey being undertaken by Lincolnshire East Clinical Commissioning Group on Inpatient Services at Louth County Hospital)

Consideration was given to a report from Simon Evans, Health Scrutiny Officer, which asked the Committee to finalise its response to the survey being undertaken by Lincolnshire East Clinical Commissioning Group on Inpatient Services at Louth County Hospital.

The Health Scrutiny Officer confirmed that a copy of the draft response had been circulated by email, a copy of which was circulated at the meeting.  It was highlighted that the response had been based on the views of the working group who were in support of Option 2.

During consideration of the draft response document, the following comments were raised:-

·         Reference was made to the East Lindsey District Council Resolution from their 10 October 2018 meeting; which urged the Lincolnshire East Clinical Commissioning Group (LECCG) to maintain the level of excellence at Louth County Hospital and for LECCG to engage in full and proper consultation with the community before any decision was made.  Reference was also made to the Louth Town Council Resolution from their 9 October 2018 meeting which recognised the reduction in hospital bed provision that should only be introduced when there was adequate neighbourhood working and social care and that support for Louth Hospital was extended for continued services in both outpatient and inpatient departments and that this should be built on.  (Copies of which were circulated at the meeting);

·         Page 1 of the response letter to Dr Stephen Baird – A suggestion was made that the second sentence in the last paragraph should be amended to include social care.  The Committee following a short discussion agreed that reference to social services should not be included in the response as LECCG was not responsible for social services and a suggestion was made that East Lindsey District Council should write to the Leader of the Council Councillor M J Hill OBE if it wished to raise any issues regarding social care; and

·         Page 2 of the response letter to Dr Stephen Baird – That the heading Arrangements for the Survey Period should be amended to read 'Arrangements for the Engagement Period' and that other references throughout the response should be amended accordingly.

RESOLVED

1.    That the attendance of Councillors Mrs P F Watson and C Matthews at the engagement events held in Louth on 2 October 2018 be noted.

2.    That the Health Scrutiny Committee for Lincolnshire approves its final response to Louth Hospital In-patient Engagement exercise, based on the draft response of the working group, subject to the above amendments being made.

(To receive a report from Simon Evans, Health Scrutiny Officer, which invites the Committee to finalise its response to the Integrated Care Providers Contract Arrangements – Consultation)

The Committee gave consideration to a draft response document concerning the Integrated Care Provider Contract, which had been emailed out to members of the Committee, a copy of which was tabled at the meeting.

The Health Scrutiny Officer presented the draft response of the working group.

The Committee noted that a separate response was also being prepared on behalf of the Lincolnshire Health and Wellbeing Board.

RESOLVED

That the working group's response to the Integrated Care Providers Contract Arrangements be approved.

(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 106 to 107 of the report presented.  The Committee noted that the Dental Services in Lincolnshire item was to be deferred to a future meeting.

RESOLVED

That the work programme presented be agreed subject to the change as detailed above.