Agenda and minutes

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

Contact: Katrina Cope  Senior Democratic Services Officer

Items
No. Item

22.

Apologies for Absence/Replacement Members

Minutes:

Apologies from absence were received from Councillors Stephen Woodliffe (Boston Borough Council) and Councillor R Kaberry-Brown (South Kesteven District Council).   

 

The Committee was advised that Councillor L Wootten (South Kesteven District Council) had replaced Councillor R Kaberry-Brown (South Kesteven District Council), for this meeting only.

 

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

23.

Declarations of Members' Interest

Minutes:

No declarations of member's interest were received at this stage of the proceedings.

24.

Minutes of the Health Scrutiny Committee for Lincolnshire meeting held on 10 July 2019 pdf icon PDF 227 KB

Minutes:

RESOLVED

 

That the minutes of the Health Scrutiny Committee for Lincolnshire meeting held on 10 July 2019 be agreed and signed by the Chairman as a correct record.

25.

Chairman's Announcements pdf icon PDF 559 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:-

 

·         Orthodontic Provision in Lincolnshire;

·         Renal Dialysis Services;

·         Mental Health Services for Children and Young People;

·         Healthy Conversation Workshop Events; and

·         Training for New District Councillor Members of the Committee.

 

Members of the Committee who had attended Clinical Commissioning Group (CCG) meetings, or were planning to attend future meetings were invited to advise the Health Scrutiny Officer of their attendance.

 

RESOLVED

 

That the Chairman's announcements presented as part of the agenda on pages 21 to 28; and the supplementary announcements circulated at the meeting be noted.

26.

Update for Healthy Conversation 2019, the NHS Long Term Plan and NHS Estates pdf icon PDF 774 KB

(To receive a report from the Lincolnshire Sustainability and Transformation Partnership, which provides the Committee with feedback from Healthy Conversation 2019, an update on the national timetable and local plans to deliver a Long Term Plan for Lincolnshire; and the position of NHS estate. Senior representatives from the Lincolnshire Sustainability and Transformation Partnership will be in attendance for this item)

Minutes:

The Committee gave consideration to a report from the Lincolnshire Sustainability and Transformation Partnership (STP), which provided feedback from the Healthy Conversation 2019; advised of the national timetable and local plans to deliver a Long Term Plan for Lincolnshire and provided an update on the position of NHS estate.

 

The Chairman welcomed to the meeting Sarah Furley, Sustainability and Transformation Partnership Programme Director.

 

The Committee were reminded of the background behind Healthy Conversation 2019; the number engagement events held, details of which were shown on page 30 of the report. 

 

It was reported that the online survey for the Acute Services Review had closed on 31 August 2019, to enable all data received to be analysed; and that locality road shows were continuing, as were locality workshops.  It was reported further that the Healthy Conversation 2019 campaign would be ceasing at the end of October 2019, so that all the information gathered could be used to develop the Long Term Plan for Lincolnshire.  Detailed at Appendix A to the report was a copy of Engagement Event Poster Distribution list; and Appendix B provided the Committee with information relating to engagement for Wave 2 and 3 of the Healthy Conversation 2019.

 

The Committee noted that there were other activities taking place, which comprised of the recruitment of a Citizen's Panel to help with virtual engagement with a representative sample of Lincolnshire's population; that work was continuing with Lincolnshire County Council to collectively address some of the public's concerns regarding transport; and that a local awareness campaign to promote NHS 111 would be starting in October 2019 to support winter resilience.

 

The Committee were reminded that the NHS Long Term Plan Implementation Framework, published in June had set out the requirements on sustainability and transformation partnerships and integrated care systems to create their five-year strategic plans.  It was noted that the framework expected local systems to meet the end goals set out in the Long Term Plan, but also allowed the substantial freedom to respond to local needs and priorities.  The expected principles of the system five-year plans were shown on page 32 of the report.  

 

It was highlighted that NHS England had asked each local Healthwatch to support public engagement on the long term plan; and to contribute to the development of a local plan in each area.  The report highlighted that Healthwatch Lincolnshire had asked people 'What Would You Do?' to improve local services in Lincolnshire.  The Committee noted that 400 people had responded and the common messages received were shown at the bottom of page 32 of the report.

 

It was reported that Lincolnshire's Long Term Plan would be underpinned by the feedback from Healthwatch and from the public and stakeholders.  The plan would also include the work that had been undertaken on integrated community care and the recent development of Primary Care Networks, as well as plans for Mental Health Services; and prevention and reducing inequalities; and the work of the STP.  It was highlighted Lincolnshire's Long  ...  view the full minutes text for item 26.

27.

Medical Services at Grantham and District Hospital - Case for Change and Emerging Options (Healthy Conversation 2019) pdf icon PDF 418 KB

(To receive a report from the Lincolnshire Sustainability and Transformation Partnership (STP), which sets out the case for change for medical services at Grantham Hospital and the proposed options for future services as set out in the Acute Services Review; and feedback from the Healthy Conversation 2019.  Dave Baker, Chair, South West Lincolnshire Clinical Commissioning Group, Dr Yvonne Owen, Medical Director, Lincolnshire Community Health Services NHS Trust, and Sarah Furley, Programme Director, Lincolnshire  STP will be in attendance for this item)

Additional documents:

Minutes:

Consideration was given to a report from the Lincolnshire Sustainability and Transformation Partnership, which set out the case for change for medical services at Grantham and District Hospital; 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 Sarah Furley, Programme Director Lincolnshire Sustainability and Transformation Partnership, Dr Yvonne Owen, Medical Director, Lincolnshire Community Health Services, Dr Dave Baker, GP Chair, South West Lincolnshire Clinical Commissioning Group, and Dr Neill Hepburn, Medical Director, United Lincolnshire Hospitals NHS Trust.

 

The GP Chair, South West LincoInshire Clinical Commissioning Group presented the report and highlighted to the Committee that the report presented only considered the medical services at Grantham and District Hospital. 

 

Page 46 of the report provided information relating to the background of the Acute Service Review.  It was noted that the case for change had been established at a Clinical Summit held in February 2018.  It was noted further that the case for change had arisen as a result of significant workforce challenges being experienced by United Lincolnshire Hospitals NHS Trust (ULHT), which had impacted the Trust's ability to deliver safe, quality services.  It was highlighted that a conclusion had been reached that ULHT was operationally unsustainable in its current form and that a current review of healthcare provision for the Lincolnshire population going forward was required.  It was highlighted further that in Grantham there were two primary concerns; the first was the future for the A & E department; and the second, the stability of acute medical services.

 

Details of the case for change were shown on page 46 of the report.  It was reported that at present there were six substantively employed acute care physicians; and that the remaining ten posts were filled by locum consultants.  The Committee noted that the service was heavily reliant on locum medical staff.

 

Paragraph 1.3 of the report provided details of the number of non-planned admissions to the three hospital sites for the first four months of 2019; and a chart on page 47 provided the Committee with activity for the Grantham and District Hospital 'front door' for the period from 1 April 2018 to 31 March 2019.

 

Details of the two emerging options for Medical Services at Grantham Hospital were shown on page 48 of the report. 

 

It was highlighted that the aim was to have integrated care delivered by the community services, hospital services alongside the recent development of Primary Care Networks.  The Vision for 2021 was shown on page 49 of the report.

 

The Committee was advised that the response to Healthy Conversation 2019 had been significant; and that a review of the feedback provided by stakeholders had been undertaken which was informing the further refinement of the preferred NHS option for the future of not only Medical Services but also A & E services at Grantham.  It was highlighted that the resounding feedback with regards to a preferred emerging  ...  view the full minutes text for item 27.

28.

Trauma and Orthopaedic Services - Case for Change and Emerging Option (Healthy Conversation 2019) pdf icon PDF 1 MB

(To receive a report from the Lincolnshire Sustainability and Transformation Partnership with provides the Committee with an update on the national and local context regarding the vision and strategy that will deliver an effective and accessible Trauma & Orthopaedic Service for patients in Lincolnshire, Senior representatives from the Lincolnshire Sustainability and Transformation Partnership will be in attendance for this item)

Minutes:

The Committee gave consideration to a report from the Lincolnshire Sustainability and Transformation Partnership, which provided the national and local context regarding the vision and strategy to deliver an effective and accessible trauma and orthopaedic service for patients in Lincolnshire.

 

The Chairman welcomed to the meeting Dr Neill Hepburn, Medical Director, United Lincolnshire Hospitals NHS Trust, Mr Kalundaivel Sakthivel, Consultant and Clinical Lead Trauma and Orthopaedic Surgery, United Lincolnshire Hospitals NHS Trust; and Catherine O'Dwyer, Consultant Anaesthetist and Clinical Director for Surgery, United Lincolnshire Hospitals NHS Trust.

 

The Committee were reminded that the Lincolnshire Acute Services Review had been undertaken to ensure that clinical services at the acute hospitals would be sustainable going forward.

 

The Committee was advised about a national pilot for trauma and orthopaedics entitled 'Getting it Right First Time' (GIRFT) which was a programme led by a consultant orthopaedic surgeon.  It was highlighted that the programme aimed to improve quality of medical and clinical care within the NHS through deeper insight of performance.  It was noted that ULHT had volunteered to be involved with the GRIFT pilot due to the high level of patient benefits that could be achieved.  The Committee noted further that ULHT had been part of Phase 2, which had included three other hospital trusts (King's College London, East Kent and Cornwall).  Details of the orthopaedic pilot arrangements commenced on 20 August 2018 were shown on page 56 of the report.  Appendix A to the report provided the Committee with a report of the Getting it Right First Time Pilot trial as at February 2019.

 

Page 57 of the report provided the Committee with details of elective admissions to the hospital sites for the first four months of 2018, prior to the start of the trauma and orthopaedic pilot.  It was highlighted that before the trial, ULHT had experienced extremely high cancellation rates, with up to 43 patients cancelling each month.  It was highlighted further that since the orthopaedic project commenced in August 2018, the Trust wide cancellation rate for non-clinical reasons had reduced to 19 cases for the month of February 2019.  The Committee was advised that the performance against the 18 week combined Referral to Treatment standard for all providers, for August 2019, the figure was 88.5%, compared to June 2018 when the performance was 85.8%.  It was also highlighted that the inpatient waiting list had also reduced to 2,758 at the end of July 2019, compared to 3,197 in June 2018.

 

The Committee noted that evidence so far had identified a strong case for change to the way in which Trauma and Orthopaedic services were delivered in Lincolnshire.  Paragraph eight of the report provided more details to this effect. 

 

It was highlighted to the Committee that there was one emerging option for sustaining general surgery services in Lincolnshire, details of which were shown at paragraph 9 of the report.  It was highlighted further that investment was not required to support the proposed option as theatre capacity was sufficient to  ...  view the full minutes text for item 28.

29.

General Surgery Services - Case for Change and Emerging Option (Healthy Conversation 2019) pdf icon PDF 542 KB

(To receive a report from the Lincolnshire Sustainability and Transformation Partnership, which provides the Committee with an update on the national and local context regarding the vision and strategy for delivering an effective and accessible general surgery service for patients in Lincolnshire.  Senior representatives from the Lincolnshire Sustainability and Transformation Partnership will be in attendance for this item)

Minutes:

Consideration was given by the Committee to a report from the Lincolnshire Sustainability and Transformation Partnership, which explained the national and local context regarding the vision and strategy to deliver an effective and accessible general surgery service for the patients of Lincolnshire.

 

The Chairman welcomed to the Committee Dr Neill Hepburn, Medical Director, United Lincolnshire Hospitals NHS Trust and Catherine O'Dwyer, Consultant Anaesthetist and Clinical Director for Surgery, United Lincolnshire Hospitals NHS Trust.

 

The report presented provided the Committee with background information relating to the clinical speciality for general surgery and what conditions/treatments that encompassed.

 

It was highlighted that for general surgery the main concern had been the impact of workforce challenges, which had limited the ability to provide adequate cover across the County; it was felt that ULHT was operationally unsustainable in its current form; and as a result a review of healthcare provision was required.

 

Details of the elective admissions, non-elective admissions and day cases for the hospital sites were shown on page 80 of the report.  It was highlighted that performance against the 18 week Referral to Treatment (RTT) standard for all providers across the region for the month of June 2019 had shown that performance for general surgery was only being achieved by three private providers.  This information was presented in a chart on page 81 of the report.  Page 82 of the report detailed by provider the median waiting times for patients to access the general surgery outpatient clinics as at June 2019.

 

The Committee were also provided with details of Incidence and Prevalence of Bowel Cancer, this information was contained on pages 83 to 84 of the report.  It was noted that ULHT currently provided general surgery theatre lists on three sites Lincoln County, Boston Pilgrim and Grantham and District (Non-elective surgical provision being much smaller at Grantham than at Lincoln or Boston).  It was noted further that outpatient appointments were offered at the three main sites plus peripheral sites.

 

It was highlighted that there was a strong case for changing the way in which general surgery services were delivered in Lincolnshire, as 15% of elective and day case surgical procedure were cancelled per annum due to bed pressures brought about by medical emergencies each year and the 18 week RTT and national cancer standards were not being met.  It was also reported that the service had made a £15.67m loss in 2017/18.  It was reported further that the reasons for the loss also covered the losses made for trauma and orthopaedics. The reasons for the loss being as a result of the high level of cancelled elective procedures.

 

It was highlighted further that there would need to be financial investment at the Grantham Hospital site as the emerging option had indicated that five theatres would be required; and Grantham currently only had four theatres.

 

The Committee was advised that there had not been any Healthy Conversation 2019 feedback relating to general surgery.

 

During discussion, the Committee raised the following comments:-

 

·         Performance information  ...  view the full minutes text for item 29.

30.

Health Scrutiny Committee for Lincolnshire - Work Programme pdf icon PDF 836 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 as detailed on pages 98 to 100 of the report presented, and whether specific items as shown on page 97 of the report warranted inclusion on an agenda for a future meeting.

 

The Committee gave consideration to the merits of including the items listed below on to a future agenda:-

 

·         Grantham A & E Overnight Closure – Impact on Peterborough City Hospital – The Committee agreed to consider this item at the 16 October 2019 meeting;

·         Community Pharmacy Contractual Framework (2019/20 – 2023/24) – The Committee agreed that this item was not a matter for the consideration at this time; but would be included in the work programme for a future meeting; and

·         Orthodontic Provision in Lincolnshire – That this item should be added to the list of items to be planned for inclusion for future meetings.

 

The Committee were also invited to consider whether they needed to be involved in discussion relating to the location of renal dialysis services in Boston.  The Committee agreed that this was not an item for the Committee to consider at this stage and a suggestion was made that the Committee be advised of the progress with the location for renal services in Boston, with local councillors involved if there continued to be an issue.

 

The Committee was also advised that the Annual Report of the Director of Public Health was now planned for the November meeting.

 

RESOLVED

 

1.    That the work programme presented be agreed subject to the inclusion of the item on Grantham A & E – Impact on Peterborough City Hospital at the meeting on 16 October 2019.

 

2.    That items on Orthodontic Provision and Community Pharmacy be provisionally listed in the work programme for future meetings.

 

The Committee adjourned at 1.05pm and re-convened at 2.00pm.

 

Additional apologies for absence for the afternoon part of the meeting were received from Councillors M T Fido, B Bilton (City of Lincoln Council) and Dr B Wookey (Healthwatch Lincolnshire).

31.

Winter Resilience pdf icon PDF 428 KB

(To receive a report from the Lincolnshire East Clinical Commissioning Group, which updates the Committee on Winter Planning across the Health and Care Economy in Lincolnshire.  Ruth Cumbers, Urgent Care Programme Director, Lincolnshire Sustainability and Transformation Partnership will be in attendance for this item)

Minutes:

The Committee gave consideration to a report from the Lincolnshire East Clinical Commissioning Group, which provided an update on Winter Planning across the Health and Care Economy in Lincolnshire.

 

The Chairman welcomed to the meeting Ruth Cumbers, Urgent Care Programme Director and Simon Evans, Director of Operations, United Lincolnshire Hospitals NHS Trust.

 

The Committee was made aware of the background to winter pressures, the national context, and the local picture for Lincolnshire.  It was highlighted that in Lincolnshire there was continued progress to integrate services, with a number of projects being set up under the new care models programme that were starting to deliver prevention and improved care for patients closer to home.  It was highlighted further that the development of integrated urgent care services was maintaining and building on this momentum.

 

Details of the six areas of winter planning were shown on pages 89 and 90 of the report.  It was highlighted that despite early preparations, trusts were always concerned about winter pressures.

 

It was reported that for the winter of 2018/19, the demand for services had increased significantly through December, with the ambulance service having a particularly challenging time attempting to cope with the high level of demands from patients.  The Committee noted that as the national situation deteriorated regulators had sought assurance from local systems as to how they were responding.  It was reported that Lincolnshire teams were able to demonstrate that a more joined up approach by system leaders had translated into a more joined up system management and resilience.

 

However, despite the pressures the system had received praise from the regulators for its resilience, grip and management of issues and the ability to recover from periods of unprecedented demand.

 

The Committee were made aware of who was responsible for the plan; the purpose of a winter plan, how the system aimed to manage the pressures; and who implemented and monitored the winter plan. The plan for Lincolnshire was for Health and Care colleagues from across the system to continue working together with a particular focus on learning and understanding reasons at a system level of what needed to be done to reduce avoidable attendances and admissions to hospital and ambulance conveyances.

 

Details of the Surge and Escalation Plan, Cold Weather Plan were shown on pages 92 to 93 of the report for the Committee to consider.

 

Other areas referenced were the Stay Well This Winter Campaign, Flu Prevention, Maximising Capacity some reference was made to the Christmas and New Year; Planned Care Activity over the Winter, Transitional Care; Local Authority Plans; Mental Health and Acute Services.

 

In conclusion, the Committee was advised that the system had learnt from 2018/19 and there was belief that the winter planning for 2019/20 was robust.

 

During discussion, the Committee raised the following issues:-

 

·         The percentage of staff who had received a flu jab.  The Committee was advised that all organisations had been above target at around 72% and that ULHT had been 83%;

·         Black Alert – Clarification was given  ...  view the full minutes text for item 31.

 

 
 
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