Agenda and minutes

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

Contact: Katrina Cope  Senior Democratic Services Officer

Items
No. Item

1.

Election of Chairman

Minutes:

RESOLVED

 

That Councillor C S Macey be elected as Chairman of the Health Scrutiny Committee for Lincolnshire for 2019/20.

 

COUNCILLOR C S MACEY IN THE CHAIR

2.

Election of Vice-Chairman

Minutes:

RESOLVED

 

That Councillor C J T H Brewis be elected as Vice-Chairman of the Health Scrutiny Committee for Lincolnshire for 2019/20.

3.

Apologies for Absence/Replacement Members

Minutes:

Apologies for absence were received from Councillors S Barker-Milan (North Kesteven District Council) and R Kayberry-Brown (South Kesteven District Council).

 

The Committee was advised that Councillors Lucille Hagues (North Kesteven District Council) and L Wootten (South Kesteven District Council) had replaced Councillors S Barker-Milan (North Kesteven District Council) and R Kaberry-Brown (South Kesteven District Council) respectively, for this meeting only.

 

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

4.

Declarations of Members' Interest

Minutes:

Councillor S Woodliffe (Boston Borough Council) wished it to be noted that he was currently a patient receiving treatment from United Lincolnshire Hospitals NHS Trust.

5.

Minutes of the Health Scrutiny Committee for Lincolnshire meeting held on 15 May 2019 pdf icon PDF 195 KB

Minutes:

RESOLVED

 

That the minutes of the Health Scrutiny Committee for Lincolnshire meeting held on 15 May 2019 be agreed and signed by the Chairman as a correct record.

6.

Chairman's Announcements pdf icon PDF 447 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:-

 

·         Healthy Conversation 2019 Workshops – Grantham and Boston;

·         Emergency and Urgent Care – Grantham and Louth; and

·         DAISY Awards for Nurses and Midwives – United Lincolnshire Hospitals NHS Trust.

 

During discussion, members highlighted the following:-

 

·         Some concern was expressed relating to proposals for urgent treatment centres appointments being made through NHS 111.  The Committee was advised that this method was the preferred direction of travel going forward;

·         Some concern was expressed that the proposed consultation would not be robust enough.  The Chairman agreed to highlight concerns raised to John Turner, Senior Responsible Officer, Lincolnshire STP; and

·         One member felt that more publicity of the Health Conversation 2019 needed to be undertaken to ensure that members of the public were aware of how important it was for them to express their views in shaping health services for Lincolnshire moving forward.

 

RESOLVED

 

1.    That the Chairman's announcements presented as part of the agenda on pages 13 to 20; and the supplementary announcements circulated at the meeting be noted.

 

2.    That a letter be written by the Chairman to John Turner, Senior Responsible Officer, Lincolnshire STP expressing the concerns raised.

7.

Women's and Children's Services - Case for Change and Emerging Options pdf icon PDF 784 KB

(To receive a report from the Lincolnshire Sustainability and Transformation Partnership, which sets out the Case for Change for Women's and Children's Services and the proposed options for future services as set out within the Acute Services Review and the feedback to date from Healthy Conversation 2019. Tracy Pilcher, Director of Nursing, Allied Health Professionals and Operations, Lincolnshire Community Health Services NHS Trust and Penny Snowden, Deputy Chief Nurse, United Lincolnshire Hospitals NHS Trust will be in attendance for this item)

Minutes:

Consideration was given to a report from the Lincolnshire Sustainability and Transformation Partnership, which set out the Case for Change for Women's and Children's Services and the proposed options for future services as set out within the Acute Services Review and the feedback to date from Healthy Conversation 2019.

 

The Chairman welcomed to the meeting:-

 

·         Tracy Pilcher, Director of Nursing, Allied Health Professionals and Operations. Lincolnshire Community Health Services NHS Trust; and

·         Simon Hallion, Managing Director Family Health, United Lincolnshire NHS Hospitals Trust.

 

The report presented provided the Committee with background information relating to the Healthy Conversation 2019 engagement exercise; the case for change for Women's and Children's Services; and the reasons why there needed to be changes.

 

The Committee was reminded of the significant hospital staffing issues, particularly at the Pilgrim Hospital, Boston, which had an on-going problem of not being able to recruit middle grade doctors and nursing staff.  It was highlighted that the shortage of medical and nursing staff had also meant there was reduced ability to support junior doctors; as the support and training required could not be provided.  However, since August 2018, as a result of safety concerns, the following temporary changes had been introduced:-

 

·         The closure of the paediatric in-patient beds; and the opening of a paediatric assessment ward at Pilgrim Hospital with any child requiring a non-elective admission needing to stay 23 hours, or have planned elective care being treated at Lincoln Hospital; and

·         Any babies' pre 24 weeks at Pilgrim Hospital being transferred to the Lincoln Hospital site, where staff were able to deal with their needs.

 

The Committee was advised of the two 'Emerging Options', details of which were shown on page 23 of the report.  The Committee was advised further that the NHS's preferred emerging option was number one as it would provide the following services at the two hospital sites:-

 

Pilgrim Site

·         To continue with a consultant led obstetric service with the addition of a co-located midwife-led unit;

·         The Boston special care baby unit currently cares for babies born from 34 weeks, this is the interim position.  Prior to August 2018, it cared for babies from 30 weeks;

·         To have short stay paediatric assessment ward for children needing up to 23 hours of care;

·         To have low acuity paediatric in-patient beds overnight; and

·         To have paediatric day case surgery.

 

Lincoln Hospital

·         To continue with a consultant led obstetric service with the addition of a co-located midwife-led unit;

·         To continue with a neonatal unit caring for babies born from 27 weeks;

·         To have a short stay paediatric assessment ward;

·         To have paediatric in-patient beds;

·         To have paediatric day case and planned surgery;

·         The wish to keep gynaecology services the same as now on both Lincoln and Pilgrim Hospital site with clinicians; and

·         Working as one team across the two sites.

 

The Committee noted that the second emerging option was to have a consultant obstetric, neonatal and paediatric services at Lincoln Hospital and a midwife-led unit and short stay  ...  view the full minutes text for item 7.

8.

Breast Services - Case for Change and Emerging Options pdf icon PDF 621 KB

(To receive a report from the Lincolnshire Sustainability and Transformation Partnership, which sets out the Case for Change for Breast Services and the proposed options for future services as set out within the Acute Services Review and the feedback to date from the Healthy Conversation 2019.  Mr Jibril Jibril, Consultant Surgeon and Head of Service, United Lincolnshire Hospitals NHS Trust and Sarah-Jane Mills, Chief Operating Officer, Lincolnshire West Clinical Commissioning Group will be in attendance for this item)

Minutes:

Consideration was given to a report from the Lincolnshire Sustainability and Transformation Partnership, which set out the Case for Change for Breast Services and the proposed options for future services as set out within the Acute Services Review and the feedback to date from the Health Conversation 2019.

 

The Chairman welcomed to the meeting Sarah-Jane Mills, Chief Operating Officer, Lincolnshire West Clinical Commissioning Group and Simon Hallion, Managing Director, Family Health, United Lincolnshire NHS Hospitals Trust.

 

The Committee was advised that United Lincolnshire NHS Hospital Trust (ULHT) was one of the largest breast services in the UK in terms of the total number of breast cancers treated by the service per year.  The Committee was advised that breast services were currently spread across ULHT sites with the majority of activity being serviced at Lincoln.  The Committee noted the performance as detailed on page 35 showed that for November 2018 to January 2019, performance against the two week wait standard had deteriorated.  It was noted further that patients diagnosed with breast cancer were being treated within the national 62 and 31 day waiting times standard, however, patients who were being referred into the service were having to wait too long to be seen; and receive their diagnosis. It was highlighted that the milestones in the NHS Long Term Plan would have an impact on breast cancers.  It was highlighted further that the strategy for Lincolnshire breast services had been developed using clinical guidelines for breast screening, diagnosing and treating breast cancer, together with the recommendations put forward in the NHS Long Term plan.

 

Page 38 of the report provided the Committee with details of the current service provision across the county.  The Committee was advised that there was a strong case for changing the way breast services were delivered in Lincolnshire, as a result of the number of patients being seen had increased; and that the model of care across ULHT hospital sites was inconsistent and did not always comply with clinical guidelines.  It was highlighted that the primary reason for this was because of the lack of breast radiologists and wider workforce issues.  It was highlighted further that there was a shortage of breast radiologist nationally.

 

Details of the two emerging options were shown on page 39 of the report.  As was details of the preferred NHS option, which was as follows:

 

·         Lincoln hospital to become a centre of excellence providing all first outpatient appointments (including the triple assessment appointment – consultation/imaging/biopsy) and day case and elective surgical procedures;

·         Screening mammography, follow-up outpatients and community support will stay the same and continue to be provided locally.  Mobile screening would also continue as it currently does; and

·         For those patients requiring a call back for further assessment, the assessment would take place at the centre of excellence at the Lincoln Hospital.

 

The Committee noted that oncological treatment for breast cancer i.e. chemotherapy and radiotherapy would continue as was currently provided.  The Committee noted further that the preferred option would establish  ...  view the full minutes text for item 8.

9.

Stroke Services - Case for Change and Emerging Options pdf icon PDF 789 KB

(To receive a report from the Lincolnshire Sustainability and Transformation Partnership, which sets out the Case for Change for Stroke Services and the proposed options for future services as set out within the Acute Services Review and the feedback to date from the Healthy Conversation 2019.  Dr Abdul Elmarimi, Consultant in Stroke Medicine, United Lincolnshire Hospitals NHS Trust and Dr Richard Andrew, Consultant Cardiologist, United Lincolnshire Hospitals NHS Trust will be in attendance for this item)

Minutes:

The Committee gave consideration to a report from the Lincolnshire Sustainability and Transformation Partnership, which set out the Case for Change for Stroke Services and the proposed options for future services as set out within the Acute Services Review and the feedback to date from the Healthy Conversation 2019.

 

The Chairman welcomed to the meeting Dr Abdul Elmarimi, Consultant in Stroke Medicine, United Lincolnshire Hospitals NHS Trust and Dr Richard Andrews, Consultant Cardiologist, United Lincolnshire Hospitals NHS Trust.

 

The Committee was provided with some background information, which made reference to the fact that there were over 100,000 people who suffered a stroke in the UK each year.  The Committee was advised of the long-term problems caused by strokes and the different types of strokes, details of which were shown on pages 44 and 45 of the report.

 

The report made reference to the milestones for stroke care as set out in the NHS Long Term Plan, details of which were shown on page 47 of the report.   It was noted that the national drive was to form larger Stroke Centres.

 

Details relating to the current model of Stroke Care in Lincolnshire; and the current position of the workforce were shown on pages 48 and 49 of the report.  The Committee was advised that clinical standards and performance standards were not consistently being met, and that there were significant workforce gaps against clinical guidelines for staffing levels, and that this had been the case for a number of years.

 

The Committee was advised that there were two emerging options, which were:

 

1.    Centre of Excellence – Stroke services at Lincoln Hospital;

2.    Strokes services continuing at both hospitals with a combined stroke rota.

 

The Committee was advised further that option one was the preferred option, as this option had been developed based on the national clinical guidelines for stroke published by the Royal College of Physicians.  This option also reflected the key messages and recommendations for stroke care as set out in the NHS Long Term Plan.

 

It was highlighted that the second option was less likely to be successful at delivering stroke services that met the national standards and guidelines for stroke services; and the delivery of seven day stroke services.

 

Reference was also made to the impact for patients of the preferred option.  Particular reference was made to concerns raised during the Healthy Conversation 2019 relating to the impact on travelling times to the Lincoln Hospital site for all patients across the county.  The Committee was advised that this had been considered and detailed information had been provided within the report presented regarding this matter.

 

The Committee was also advised of the new Stroke Service Framework and to the fact that by March 2020, it was expected that the average length of stay in hospital would have reduced from approximately 14 days to 10 days, with an aspiration that an average length of stay of seven days would be achieved in line with best practice.

 

A discussion ensued,  ...  view the full minutes text for item 9.

10.

Non-Emergency Patient Transport Service - Update pdf icon PDF 585 KB

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

Minutes:

The Committee gave consideration to a report from the NHS Lincolnshire West Clinical Commissioning Group, which provided the Committee with an update on the Non-Emergency Patient Transport Service.

 

The Chairman welcomed to the meeting Sarah-Jane Mills, Chief Operating Officer, Lincolnshire West Clinical Commissioning Group (LWCCG) and Wendy Martin, Executive Lead Nurse and Midwife – Quality and Governance, LWCCG.

 

The Committee was advised that since the previous update provided to the Committee at its March 2019 meeting; and following representations by Thames Ambulance Service Limited (TASL) to the Care Quality Commission (CQC) following the publication of their report in October 2018, the CQC had started a programme of further inspection visits to TASL, the results of which were expected to be published in the late summer of 2019.

 

It was reported that there had been some month on month improvement in the achievement of Key Performance Indicators (KPIs), however, performance remained below acceptable levels, as too many journeys had been subject to being unacceptably late; and some transport not arriving at all to collect patients for their appointments;

 

Detailed at Appendix A to the report was a summary of activity and KPI performance position for the period to April 2019.  It was highlighted that for April 2019, TASL had achieved the contracted level of performance for 1 out of 12 KPIs (call handling) and had delivered month on month improvement for 7 KPIs.  It was highlighted further that fast track journeys were much improved in April at 81.8%, following unacceptable performance in March of 50.0% against the target of 100%. 

 

The Committee noted that TASL had also used a number of third party providers who had been sub-contracted by TASL to supplement employed crew capacity for journeys, which including renal and out of county journeys. The report highlighted that third party resources were expected to continue to be engaged by TASL, as the additional capacity provided flexibility to respond to fluctuations in demand and in-house capacity. 

 

The Committee was also advised that the CCG continued to commission third party capacity outside of the TASL contract to support discharges at Lincoln and Boston hospitals.

 

In conclusion, the Committee was advised that the CCG would continue to closely monitor the delivery of the contract.  The Committee was advised further that the CCG was not intending to give notice to exit the contract at this time.

 

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

 

·         Confirmation was given that good working relationships were continuing with voluntary car drivers;

·         Some concern was expressed to the lack of improvement across the performance indicators, and how much longer the CCG was prepared to continue with the contract.  It was reported that the assessment of risk of termination of the contract remained as previously reported;

·         Cost of TASL to the service of missed appointments – The Committee was advised that modelling had been done to identify the cost to the patient and also to the cost of the service delivery.  Reassurance was given that all risks  ...  view the full minutes text for item 10.

11.

Health Scrutiny Committee for Lincolnshire - Work Programme pdf icon PDF 760 KB

(To receive a report from Simon Evans, Health Scrutiny Officer, which invites the Committee to consider and comment 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 64 to 66 of the report presented.

 

RESOLVED

 

That the work programme presented be agreed subject to the inclusion of the items highlighted in minutes number 10(3).

 

 
 
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