Agenda and minutes

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

Contact: Katrina Cope  Senior Democratic Services Officer

Items
No. Item

12.

Apologies for Absence/Replacement Members

Minutes:

Apologies for absence were received from Councillors M T Fido, C Matthews M A Whittington and Dr B Wookey.

 

It was noted that the Head of Paid Service, having received notice under Regulation 13 of the Local Government (Committee and Political Groups) Regulations 1990, had appointed Councillor L Wootten to replace Councillor M A Whittington for this meeting only.

 

It was noted further that Dr M Prior (Healthwatch Lincolnshire) had replaced Dr B Wookey (Healthwatch Lincolnshire) and Councillor L McWilliams (City of Lincoln) had replaced Councillor Bill Bilton (City of Lincoln) for this meeting only.

 

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

13.

Declarations of Members' Interest

Minutes:

Dr M Prior wished it to be noted that in respect of Agenda Item 9 – Glebe Medical Practice Consultation on Proposal to Close Skellingthorpe Health Centre she represented Healthwatch Lincolnshire on the Lincolnshire West Clinical Commissioning Group Governing Body; and that Healthwatch Lincolnshire had been involved with the consultation process.

14.

Chairman's Announcements pdf icon PDF 238 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:-

 

·         Care Quality Commission Letters – United Lincolnshire Hospitals NHS Trust (These letters, dated 14 June and 24 June 2019, were relevant to the consideration of the item in Minute 16 below);

·         NHS Long Term Plan Implementation Framework;

·         Healthy Conversation 2019 Update and Acute Services Review Consultation; and

·         Retirement of Deputy Chief Executive – United Lincolnshire Hospitals NHS Trust.

 

RESOLVED

 

That the Chairman's announcements presented as part of the agenda on pages 17 and 18; and the supplementary announcements circulated at the meeting be noted.

15.

Minutes of the Health Scrutiny Committee for Lincolnshire meeting held on 12 June 2019 pdf icon PDF 219 KB

Minutes:

RESOLVED

 

That the minutes of the Health Scrutiny Committee for Lincolnshire meeting held on 12 June 2019 be agreed and signed by the Chairman as a correct record, subject to Councillor C S Macey being added to the list of Councillors in attendance.

16.

United Lincolnshire Hospitals NHS Trust - Update on Care Quality Commission Inspection pdf icon PDF 225 KB

(To receive a report from United Lincolnshire Hospitals NHS Trust (ULHT), which provides the Committee with an update on the Quality and Safety Improvement Programme.  Michelle Rhodes, Director of Nursing ULHT will be in attendance for this item)

Additional documents:

Minutes:

Consideration was given to a report from United Lincolnshire Hospitals NHS Trust, which provided the Committee with an update on progress made with the Quality & Safety Improvement Programme.

 

The Chairman welcomed to the meeting Dr Neill Hepburn, Medical Director, United Lincolnshire Hospitals NHS Trust and Michelle Rhodes, Director of Nursing, United Lincolnshire Hospitals NHS Trust.

 

The Committee was advised that following the Care Quality Commission (CQC) inspections made during 2018, the Trust had developed and submitted an improvement plan to the CQC at the end of July 2018 containing 12 work programmes.  It was noted that the Trust's process for delivering and monitoring progress against the Quality and Safety Improvement Plan remained the same as 2017/18.  It was noted further that the Director of Nursing was the Senior Responsible Officer for Quality with individual Executive Directors being held responsible for each of the work programmes.  The Committee was advised that the Improvement Plan was scrutinised on a weekly basis and then presented to the Quality Safety Improvement Board every two weeks; and to the Quality Governance Committee monthly.

 

Attached to the report were the following Appendices:-

 

·         Appendix A – Highlight report: Improving Quality & Safety (May 2019);

·         Appendix B – Quality Safety Progress Overview Report (May 2019);

·         Appendix C – Quality and Safety Improvement Plan; and

·         Appendix D – Details relating to Divisional Leads and Trust Board members July 2019.

 

The Committee noted that since the February inspection in 2018, measurable progress had been made in response to the CQC's immediate concerns. Details of the progress made against the work programmes were shown in Appendix B to the report.  Page 20 of the report highlighted some identified challenges relating to Safety Culture; the Deteriorating Patient and the Emergency Department at Pilgrim Hospital.

 

It was highlighted that a further core visit had taken place during June 2019, when five pathways had been inspected at the Pilgrim and Lincoln Hospital sites.  The Committee was advised that feedback had been received for the Lincoln County Hospital site in relation to: Urgent and Emergency Care, Maternity, and Children and Young People Services; and for Pilgrim Hospital Boston for Urgent and Emergency Care, Maternity and Children and Young People Services.  (Copies of the Care Quality Commission letters concerning the inspection of the Lincoln County Hospital and Pilgrim Hospital sites had been circulated to members of the Committee as part of the Supplementary Chairman's Announcements, as referred to in Minute 14 above).

 

The Committee was advised that the Trust was having a well led CQC inspection of core services in the week beginning 15 July 2019; and that the Trust was hoping that it would be moved out of special measures.  It was noted that once the report was released (anticipated in September) the Trust would share the findings with the Committee.

 

During discussion, the Committee raised the following issues:-

 

·         Some concern was expressed to the CQC findings of bullying of staff taking place at the Lincoln County Hospital site.  The Committee was advised that the Trust  ...  view the full minutes text for item 16.

17.

United Lincolnshire Hospitals NHS Trust - Children and Young Persons' Services Update pdf icon PDF 634 KB

(To receive a report from United Lincolnshire Hospitals NHS Trust (ULHT), which provides the Committee with an update on Children and Young Persons' Services.  Dr Neill Hepburn, Medical Director ULHT will be in attendance for this item)

Additional documents:

Minutes:

Consideration was given to a report from United Lincolnshire Hospitals NHS Trust, which provided the Committee with an update on Children and Young Persons' Services.

 

The Chairman welcomed to the meeting Dr Neill Hepburn, Medical Director ULHT, Suganthi Joachim, Clinical Director, Family Health Division and Simon Hallion, Managing Director, Family Health Division.

 

The Committee were reminded that the inpatient service for children and young people at Pilgrim Hospital, Boston had been suspended from August 2018 and replaced by an interim service model, which included a Paediatric Assessment Unit (PAU).

 

The Committee noted that the interim model had been introduced as a result of concerns raised by senior medical staff; and the inability of the Trust to recruit middle grade doctors at Pilgrim Hospital.  It was reported that the new model had seen the average paediatric stay reduced from 43 hours to 8 hours.  It was noted that the Trust actively monitored the number of children staying over 12 hours.  It was noted further that a consultant could keep any child at Pilgrim Hospital beyond 12 hours when it was clinically required, or deemed in the best interest of the child.  The Committee were advised that the on-site ambulance was available 24/7 and for the period up to 30 April 2019, of the 2,790 children who had attended Pilgrim Hospital, 272 had been transferred to other hospitals.  The Committee was advised further that the Lincolnshire Sustainability and Transformation Partnership (STP) had proposed that the PAU model at Pilgrim Hospital should be continued, subject to engagement and consultation, and that a PAU should also be created at Lincoln County Hospital; and that this would be a key element of the 'Healthy Conversation 2019' process.

 

The Committee was advised that positive feedback had been received on the introduction of the Paediatric Observation Priority Score Assessment model to the Trust's Emergency Department (ED).  This tool had enabled clinicians to carry out a structured assessment of children in the ED environment and provide a clinical priority rating as the assessment output.  It was noted that plans were being finalised to recruit to specific rotational children's nursing roles between ED and paediatric areas, as experience elsewhere had suggested that such roles could attract candidates.

 

It was reported that the service was delivering a level 2 neonatal service at Lincoln County Hospital (from 29 week gestation) and a special baby unit at Pilgrim Hospital (from 34 week gestation).

 

The Committee was advised that nursing vacancies across Rainforest Ward, Safari Unit (Lincoln) and Ward 4A (Boston) were running at around 50% of establishment.  It was highlighted that this was being mitigated by the use of additional hours and by using long-term agency nursing appointments.  The Committee was advised further that the Trust was continuing with a recruitment campaign to attract registered children's nurses to Lincolnshire.  The Trust was also looking at introducing more flexible working opportunities to help retain staff and attract new staff.

 

The Committee was advised that the service was still fragile. Details of paediatric  ...  view the full minutes text for item 17.

18.

Mental Health, Learning Disability and Autism Services - Case for Change and Emerging Options pdf icon PDF 513 KB

(To receive a report from the Lincolnshire Sustainability and Transformation Partnership, which presents the Case for Change in mental health, learning disability and autism community services and provides feedback from the Lincolnshire Healthy Conversation 2019.  Jane Marshall, Director of Strategy, Lincolnshire Partnership NHS Foundation Trust will be in attendance for this item) 

Minutes:

The Committee gave consideration to a report from the Lincolnshire Sustainability and Transformation Partnership (LPFT), which presented the drivers for change in mental health, learning disability and autism community services and linked into the feedback received from the first round of the Lincolnshire Healthy Conversation 2019 with the public. 

 

The Chairman welcomed to the meeting Jane Marshall, Director of Strategy, Lincolnshire Partnership NHS Foundation Trust and Rachel Redgrave, Head of Commissioning for Mental Health, Autism & Learning Disability.

 

The Committee was advised of the four dimensions to LPFT services, which were:-

 

·         Prevention and support in neighbourhoods/communities;

·         Early intervention and responding quickly;

·         Care and treatment for people with serious mental health problems; and

·         Highly specialist services for the most complex mental health problems.

 

The Committee was advised further that the focus of the report was on the first two dimensions 'Prevention and support in neighbourhoods and communities' and 'Early intervention and responding quickly'.

 

It was highlighted that in order to transform services, more needed to be done as an integrated care system. 

 

The Committee was advised that feedback received had been generally positive.  Page 96 of the report provided the Committee with suggestions from the Healthy Conversation 2019 feedback which were receiving further attention.

 

Pages 91 and 93 of the report highlighted the types of services LPFT wanted to partner with others to develop and deliver.  These included an integrated, place-based mental health workforce; building community capacity and resources, which included improving digital provision; and enhancing social prescribing opportunities and networks.

 

Attached at Appendix A to the report was a copy of the 'You Said We Did' responses on mental health, which had been posted on the website; and Appendix B provided the Committee with Healthy Conversation 2019 feedback.

 

The Committee welcomed the report and raised the following issues:-

 

·         The importance of ensuring that information was made widely available relating to the services provided, so that patients knew where to seek help and how to access it.  The Committee was advised of the development of a helpline Mental Health Hub App which would be available 24/7 in 2020.  The Committee was advised further that work was on-going with Lincolnshire County Council to create a directory of services.  One member also highlighted the need for groups within the community for all people with low-level mental health conditions to attend.  The Committee was advised that February 2019 had seen the launch of the county wide Dementia Strategy.  The Committee was advised that the hub was situated near Lincoln County Hospital with spokes within the community;

·         The need to focus on reducing waiting times; as this was essential in helping to prevent the further deterioration of an individual's mental wellbeing before being able to access support;

·         That community support provided through the Managed Care Network and other independent local schemes was invaluable;

·         The need to expand perinatal mental health services was supported by the Committee.  The Committee noted that the size of the perinatal mental health service had tripled over the last year to  ...  view the full minutes text for item 18.

19.

General Practice Access and Demand pdf icon PDF 232 KB

(To receive a report from the Lincolnshire Local Medical Committee, which provides the Committee with information relating to GP access and demand.  Dr Kieran Sharrock, Medical Director will be in attendance for this item)

Additional documents:

Minutes:

The Committee gave consideration to a report from the Lincolnshire Local Medical Committee, which provided an update on General Practice (GP) access and demand.            

 

The Chairman welcomed to the meeting Dr Kieran Sharrock, the Medical Director of the Lincolnshire Medical Committee.

 

It was reported that all health services were seeing increasing demand; and a change in the complexity of medical needs.  It was highlighted that there was now an increasingly frail and older population; and more patients with multiple long term medical conditions.

 

The report highlighted that nationally there had been a drop of 600 GPs from January to December 2018, with 230 less GP partners.  Despite shortages, GPs were trying to provide appointments for patients on basis of need; and that each practice had a different method for doing this, some having 'sit and wait' clinics; and others using a duty-doctor system.  The report provided a list of possible solutions to help with demand and access issues.

 

It was highlighted further that Lincolnshire was adopting all of the solutions over time, as it was felt that these approaches would provide better health outcomes for patients.  Details of workforce initiatives in progress and their results were shown on page 105 of the report.  The Committee was advised that the workforce modelling and planning had utilised Whole System Partnership's Strategic Workforce Integrated Planning and Evaluation Framework, which provided a strategic approach to transformation, incorporating population needs, the future vision for meeting these needs and workforce requirements.  Detailed at Appendix A to the report was information relating to the Strategic Workforce Integrated Planning & Evaluation (SWiPe) Framework.

 

It was highlighted that care navigation was in place across the county, which directed patients at first point of contact to the most appropriate professional for their care.  It was highlighted further that the professional seen might not always be a GP, but could be a pharmacist or advanced nurse practitioner.

 

In summary, the Committee was advised that general practice in Lincolnshire was under pressure, due to workload shortages. To help ease this pressure a number of solutions were being implemented by the Lincolnshire system, but as mentioned earlier this would take some time to come into effect.

 

 During discussion, the Committee raised the following issues:-

 

·         Charging patients for missed appointments – The Committee was advised that this was not something GPs could introduce, as there was no basis in existing NHS law to make charges for missed appointments; and furthermore, there would have to be a change to the national policy for such a suggestion to be implemented.  The Committee was advised further that such a scheme would probably cost too much to administer;

·         Up skilling of practice staff. It was reported that this was already being done across the county, patients were being directed to the most appropriate professional;

·         The need to encourage people to take more responsibility for their health; and for more focus to be placed on prevention, particular reference was made to obesity, health and wellbeing, and diabetes;  ...  view the full minutes text for item 19.

20.

Glebe Medical Practice Consultation on Proposal to Close Skellingthorpe Health Centre pdf icon PDF 295 KB

(To receive a report from the Lincolnshire West Clinical Commissioning Group, which provides the Committee with information on the consultation currently being undertaken regarding the proposed closure of the Skellingthorpe branch surgery of The Glebe Medical Practice.  Sarah-Jane Mills, Chief Operating Officer, Lincolnshire West Clinical Commissioning Group will be in attendance for this item)  

Additional documents:

Minutes:

Consideration was given to a report from Lincolnshire West Clinical Commissioning Group, which provided the Committee with an update on the consultation currently being undertaken in regard to the proposed closure of the Skellingthorpe branch of The Glebe Medical Practice.

 

The Chairman welcomed to the meeting Sarah-Jane Mills, Chief Operating Officer, Lincolnshire West Clinical Commissioning Group.  It was reported that Dr Catherine Ash, a partner at the Glebe Practice, had intended to be at the meeting, but had submitted her apologies.

 

In guiding the Committee through the report, the Chief Operating Officer advised the Committee of the background behind the proposal.  The Committee was advised that the Glebe Medical Practice was a rural practice, which operated from two sites, with the main surgery being situated in Saxilby, the branch site then operated from Skellingthorpe, which was located some 4.6 miles away.  It was highlighted that there was no separate patient list attached to the branch site, as all patients were registered at The Glebe Medical Practice.  Details relating to the services provided at the Skellingthorpe branch were shown on page 112 of the report.  The Committee was advised that the practice believed that having all the clinical teams working from one site would improve access overall for patients to both the GP's and the nursing team. 

 

It was reported that the consultation had commenced on the 3 June 2019 and would be finishing on 2 August 2019.  The feedback from the process would then be analysed, following which the Clinical Commissioning Group's Primary Care Commissioning Committee would then make their decision.

 

Detailed at Appendix A to the report was a copy of the consultation letter, frequently asked questions and a copy of the questionnaire for the Committee to consider?

 

The Committee noted that from the responses received so far, it had been identified that more patients used the Saxilby site; that 74% had specified that they would travel to appointments by car and in the event of Skellingthorpe closing, 72% confirmed they would travel to Saxilby; and 60% of patients stated they understood the practices reasons for the proposed closure.

 

The Committee noted further that the issue of transport and travel was being looked into further, as there was no direct public transport route between the two villages.  It was reported that the practice was working with Skellingthorpe Parish Council and Healthwatch to look at all options to address transport concerns.

 

Confirmation was also given that The Glebe Medical Practice would make provision for appointments to be available for patients from the Skellingthorpe site.

 

The Committee noted that three practices, whose borders included Skellingthorpe were all rated as 'good' by the Care Quality Commission and all had open lists.

 

During discussion, the Committee raised the following points:-

 

·         The need to ensure that full consideration was given to transport arrangements from Skellingthorpe to The Glebe Medical Practice, as no direct public transport route existed.  The Committee was advised that it was not the Clinical Commissioning Groups responsibility to provide  ...  view the full minutes text for item 20.

21.

Health Scrutiny Committee for Lincolnshire - Work Programme pdf icon PDF 762 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 125 to 126 of the report presented.

 

RESOLVED

 

That the work programme presented be agreed subject to the inclusion of the items highlighted in minute numbers 16(2) (3); and 17(2).

 

 
 
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