Agenda and minutes

Apologies for absence were received from Councillors M A Whittington, S Barker-Milan (North Kesteven District Council) and Councillor R Kaberry-Brown (South Kesteven District Council).

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 L Wootten to replace Councillor M A Whittington for this meeting only.

It was noted further that Councillor L Hagues (North Kesteven District Council) had replaced Councillor S Barker-Milan (North Kesteven District Council) for this meeting only.

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

Councillor S Harrison (East Lindsey District Council) wished it to be noted that she was a patient of Connect Health.

RESOLVED

That the minutes of the Health Scrutiny Committee for Lincolnshire meeting held on 16 October 2019 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.

The Supplementary Chairman's announcements made reference to:-

·         Lincolnshire Partnership NHS Foundation Trust: Child Adolescent Mental Health Services.  In relation to item 6 on the agenda, a letter dated 8 January 2020 from Brendan Hayes, Chief Executive of LPFT, to Debbie Barnes, Chief Executive of Lincolnshire County Council, was attached at Appendix A to the supplementary announcements for the Committee's consideration;

·         Contribution from LIVES to emergency responses in Lincolnshire – Additional information requested by the Committee at their October meeting;

·         NHS Access Standards Review – Urgent and Emergency Care – An update on the NHS Access Standards Review; and

·         Lincolnshire Sustainability and Transformation Partnership (STP) Long Term Plan – An update on the Lincolnshire STP Long Term Plan.  It was noted that NHS England/NHS Improvement was expected to allow local STPs to publish their plans sometime in March 2020.

RESOLVED

That the Chairman's announcements presented as part of the agenda on pages 19 to 26; 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 Care Quality Commission Inspection at United Lincolnshire Hospitals NHS Trust. Senior representatives from United Lincolnshire Hospitals NHS Trust will be in attendance for this item)

The Chairman welcomed to the meeting Mark Brassington, Chief Operating Officer, United Lincolnshire Hospitals NHS Trust and Victoria Bagshaw, Director of Nursing, United Lincolnshire Hospitals NHS Trust.

The Committee was advised that the Care Quality Commission (CQC) had inspected the Trust during June 2019; and that a separate 'well-led' assessment had taken place during July 2019.  The Committee noted that the final inspection report had been published in October 2019.

It was reported that not all services and sites had been inspected. The services that had been inspected included:-

·         Urgent and emergency care at Lincoln and Pilgrim hospitals;

·         Medical care at Lincoln and Pilgrim hospitals;

·         Critical care at Lincoln and Pilgrim hospitals;

·         Maternity services at Lincoln and Pilgrim hospitals; and

·         Children and young people's services at Lincoln and Pilgrim hospitals.

Details of the 2019 Care Quality Commission ratings were shown on pages 28 and 29 of the report.  It was noted that the Trust remained with an overall rating of 'requires improvement'.  It was highlighted that the CQC report detailed a mix of positive improvements and current challenges for the Trust, many of which had been identified within the Trust prior to the inspection and formed part of the on-going Quality and Safety Improvement Plan.

It was reported that the individual ratings for each hospital was that Lincoln County Hospital and Pilgrim Hospital, Boston 'required improvement'. Grantham and District Hospital and County Hospital, Louth, which had not been inspected continued to be rated as 'good'.

The Committee noted that the Trust was in the process of developing an Integrated Improvement Plan and was reviewing the process and structure through which the plan was owned, delivered and assured.

The Committee noted further that the CQC had identified examples of outstanding practice and exemplary care across services, and that this was particularly recognised at Pilgrim Hospital, Boston, where the overall rating had moved from 'Inadequate' to 'Requires Improvement'.

Details of identified challenges for the Trust were shown on pages 30 and 31 of the report and Appendix A provided the United Lincolnshire Hospitals NHS Trust Response to CQC Must Do's and Should Do's for the Committee to consider.

In conclusion, the Committee was advised that the Trust was finalising an Integrated Improvement Plan following the inspection, which was a new structure through which the Trust described, delivered and monitored improvements.  The Committee noted that once the plan had been agreed, the document would be shared more widely.

It was also highlighted that the Trust had a programme of work to support the development of leaders and to further embed the new Trust Operating Model.  It was highlighted further that to improve the staffing position, the Trust was currently undertaking an extensive domestic and international recruitment programme for both medical and nursing posts, as well as working with universities to support further recruitment into nursing posts and supporting the development of the Lincoln Medical School.  The Committee was advised that since the inspection in July 2019, measurable progress had already been  ...  view the full minutes text for item 46.

(To receive a report from Lincolnshire Partnership NHS Foundation Trust, which invites the Committee to comment on the pilot Intensive Home Treatment Service which commenced operating on 4 November 2019.  Senior representatives from the Lincolnshire Partnership NHS Foundation Trust will be in attendance for this item)

The Committee gave consideration to a report from Lincolnshire Partnership NHS Foundation Trust (LPFT), which invited comments on the Intensive Home Treatment Service Pilot, which had commenced operation on 4 November 2019.

The Chairman welcomed to the meeting Jane Marshall, Director of Strategy, Lincolnshire Partnership NHS Foundation Trust, Rachel Redgrave, Head of Commissioning for Mental Health, South West Lincolnshire Clinical Commissioning Group and Anita Lewin, Director of Nursing, Allied Health Professionals and Quality.

The Committee was advised that the pilot provided a community Intensive Home Treatment service for young people (aged up to 18).  It was noted that investment for the new model of care pilot (including the clinical team running it) had come from an existing inpatient service (based at Ash Villa in Sleaford), which was temporarily closed.  It was noted further that if the pilot was successful, following evaluation there was an option to continue with it. The Committee was advised that as the proposal would be a significant service change, it would be subject to public engagement and public consultation in line with statutory duties.

Background details and an explanation of the service was shown on pages 58 and 59 of the report.

The Committee noted that the reason for the pilot was to improve the quality of care provided for young people closer to home. The Committee noted further that the quality treatment and care would be delivered in less restrictive settings as a safe and effective alternative treatment model to in-patient care for young people who would otherwise require admission.

It was highlighted that the aim of the new model was to intervene earlier in the deterioration of a young person's mental health and provide a rapid response with treatment at home in order to prevent admission to hospital.

The Committee noted that whilst staff always provided excellent clinical care, Ash Villa had been identified as a "fragile service" and reasons for that were shown on page 60 of the report, but they included patient safety, the high risk building environment and the financial costs.  The Committee was advised that a decision had been taken in September 2019, to temporarily close the unit on grounds of patient safety.  Approval was given from NHS England to bring forward the pilot, which began on 4 November 2019, with the experienced staff from Ash Villa running the Intensive Home Treatment service.

A timetable for the new model of care was shown on page 61 of the report presented.

In conclusion, the Committee noted that the Lincolnshire Partnership NHS Foundation Trust was committed to a vision of providing care as close as possible to people's homes; and exploring new ways of working to build up capacity in community teams to provide 24/7 community services for young people with mental health problems.  The Committee noted further that improvements were also needed to be made to improve the quality of care provided to young people, which included improving the physical environment of wards that LPFT operated in order to protect  ...  view the full minutes text for item 47.

(To receive a report from the Lincolnshire Partnership NHS Foundation Trust, which invites the Committee to comment on the proposal to continue the Older Adult Home Treatment Team service as well a re-opening the refurbished Brant Ward in Lincoln.  Senior representatives from the Lincolnshire Partnership NHS Foundation Trust will be in attendance for this item)  

The Chairman welcomed to the meeting Jane Marshall, Director of Strategy, Lincolnshire Partnership NHS Foundation Trust, Rachel Redgrave, Head of Commissioning for Mental Health, South West Lincolnshire Clinical Commissioning Group and Anita Lewin, Director of Nursing, Allied Health Professionals and Quality.

The Committee was advised that the need for older mental health services was increasing; and that there were some gaps in services.  The ambition of the pilot was to increase community support; offer care closer to home; to deliver seven day a week services; and have hospital care available to the best standard when needed.

The Committee was reminded that the Trust had set up the Adult Home Treatment Team (HTT) as a pilot service whilst estates work had been undertaken to upgrade Brant Ward, Lincoln to meet modern NHS privacy and dignity standards.  The HTT provided services to adults with functional mental health conditions for example someone living with anxiety or depression.  The service was focussed on admission avoidance, and supporting early discharge from hospital.

At the Health Scrutiny Committee for Lincolnshire meeting held in April 2019, a report had been received relating to the first five months of operation of the Home Treatment Team, which had demonstrated significant positive outcomes, details of which were shown on page 64 of the report.

The Committee was advised that the upgrade to Brant Ward at Witham Court, Lincoln to create single en-suite bedrooms and improve ward living spaces was now complete and ready to re-open.

It was highlighted that LPFT were proposing to continue the current service model with one functional older adult mental health ward (Brant Ward, Lincoln) and a county-wide HTT.  The Committee was advised as a result the Trust was proposing to transfer the in-patient ward from Rochford Ward in Boston to the newly refurbished Brant Ward in Lincoln.  It was highlighted that the reason for the change was that the Rochford Ward was not fit for purpose and it did not meet the Care Quality Commission standard for care environments.

It was reported that the Rochford Ward would be temporarily closed with staff working into the HTT model or in other services.  The Committee noted that a further HTT hub would be created in Boston to accommodate the HTT team.

In conclusion, the Committee was advised that LPFT were committed to a vision of providing care as close as possible to people's homes.  There was recognition that there were still some challenging decisions to be made on the balance of inpatient and community facing services.

The Committee were invited to provide feedback to LPFT on the proposal to continue Older Adult Home Treatment service as well as re-opening of the refurbished Brant Ward, Lincoln.

During consideration of this item, the Committee raised the following points:-

·         Support overall was given to the HTT service, and the Committee welcomed further details concerning the outcomes of the evaluation of the HTT service;

·         Some concern was expressed to the temporary loss of the Rochford Ward. Reassurance was given that  ...  view the full minutes text for item 48.

(To receive a report from Lincolnshire West Clinical Commissioning Group (LWCCG), which provides the Committee with an update regarding the mobilisation of the new Community Pain Management service and the actions taken to address feedback from patients and colleagues. Sarah-Jane Mills, Chief Operating Officer LWCCG and other senior representatives from the LWCCG will be in attendance for this item) 

The Chairman welcomed to the Committee Sarah-Jane Mills, Chief Operating Officer, Lincolnshire West Clinical Commissioning Group.

The report circulated provided the Committee with an update on the mobilisation of the new service and the actions that had been taken to address feedback from patients and colleagues.

The Committee was advised that Lincolnshire CCGs closely monitored the performance of the Community Pain Management Service run by Connect Health in both terms of both access and quality.

It was reported that accessibility for patients had improved, Connect Health had mobilised 14 clinic locations across the county, details of which were shown on pages 70 and 71 of the report.  It was noted that the average waiting time from referral to first appointment offered was 22 working days with 100% of all patients initiating their second phase of treatment within 40 working days. Information relating to the skill mix of multi-disciplinary pain management clinicians was shown on page 71 of the report.  It was noted that the greatest number of referrals into CPMS had been from the Lincolnshire East region. The Committee was advised that currently the longest waiting times causing concern was for patients who had transitioned to the CPMS who required a Consultant appointment, but it was anticipated that demand on consultant appointments would reduce.   

It was reported that Connect Health were working with the CCG's Medicines Management Optimisation Service and local prescribing forums to help address the issues in Lincolnshire in relation to the high prescribing of pain management medications, particularly, opioid based medication.

The Committee noted that new service users were very complimentary about the CPMS.  It was noted further that complaints were reducing; and that the main theme from recent complaints had been with regard to the expectations of patients transitioning to the CPMS; and the provision of repeated PLCV injections.  Page 75 of the report provided some patient feedback comments for the Committee to consider.  Comments from friends and family between October and December 2019 were shown on page 81 of the report.

In conclusion, the Committee was advised that Connect Health were working very hard to mobilise a complex multi-faceted service based on 'Best Practice' and recognised by the British Pain Society and NICE.  Recognition was given that the mobilisation of the new service had been challenging and had not provided a positive experience for some patients.  Reassurance was given that the CCG and Connect Health would continue to work together to address issues highlighted by patients who had transitioned from previous services.

During discussion, the Committee raised the following issues:-

·         That office staff needed better information to be able to provide help and guidance; and that there needed to be more follow up from office staff;

·         That the transitioning stage could have been better managed if there had been better communication;

·         Long travelling distance of some patients to access the service.  Confirmation was given that capacity match was being looked into particularly in the east of the county;

·         Consultant capacity – Reassurance was given that  ...  view the full minutes text for item 49.

(To receive a report from NHS England and NHS Improvement – Midlands, which provides an overview of the NHS dental services commissioned in Lincolnshire and an update on the current challenges and commissioning intentions to improve NHS dental services and oral health across Lincolnshire.  Carole Pitcher, Primary Care Senior Contract Manager, NHS England and NHS Improvement – Midlands, Jane Green, Primary Care Senior Contract Manager, NHS England and NHS Improvement – Midlands and Jason Wong, Chair of the Lincolnshire Local Dental Network will be in attendance for this item)

The Chairman welcomed to the meeting Carole Pitcher, Primary Care Senior Contract Manager, NHS England/NHS Improvement, Jane Green, Primary Care Senior Contract Manager, NHS England/NHS Improvement, and Jason Wong, MBE, Chair of Lincolnshire Local Dental Network.

The Chairman on behalf of the Committee extended congratulations to Jason Wong on receiving his MBE in the recent New Year's Honours List.

The Committee was advised that NHS England and NHS Improvement had aligned to form seven new regional footprints.  It was noted that the regional office covering Lincolnshire was the Midlands Region.  It was noted further that the new Midlands region had two localities which were West and East Midlands; and that Lincolnshire was part of the East Midlands locality along with Nottinghamshire, Derbyshire, Leicester City, Leicestershire, Rutland and Northamptonshire.

Details of the 70 contracts in Lincolnshire providing NHS dental service were shown in the report.  Details of the procurement process outcomes were shown on page 87 of the report.  Disappointment was expressed to the fact that no preferred bidders had been identified for three lots in Lincolnshire, those being Mablethorpe, Spalding A (Johnson Community Hospital) and Skegness/Spilsby.  It was highlighted that the Midlands local dental team were working with the preferred bidders identified for the five awarded lots.

It was reported that since the withdrawal of Bupa Dental Care from the NHS provision of dental services in Mablethorpe, a review of interim options were being considered.  It was noted that expressions of interest had been received from existing providers to deliver urgent dental care sessions from the dental practice based in Marisco Centre, Mablethorpe for a twelve month period; and that discussions were on-going.

The Committee was advised that in-line with Department of Health guidance, orthodontic contracts had been nationally extended to 31 March 2019, or beyond, depending on the Regional timeline for procurement.  It was highlighted that in Lincolnshire the current PDS contracts were due to expire on 1 May 2020; and that the new regional teams in the Midlands and East were currently considering the options to re-procure the services.

It was reported that it had been identified that there was a significant issue with recruiting dentists to work within the NHS across Lincolnshire and it was acknowledged that this was becoming an increasing pressure nationally.  It was reported further that the Local Dental Network Chair for NHS England and NHS Improvement – Midlands had established a working group to review the recruitment and retention issues being experienced; and to developing a strategy to improve the dental workforce in Lincolnshire.  The Committee was also advised that to support dentist recruitment, NHS England and NHS Improvement – Midlands were developing a business case to establish an international recruitment pilot for Lincolnshire based on the successful GP international recruitment programme. The Committee was also advised that a career event had been held in Lincoln to promote the dental pathways and that a copy of the presentation would be circulated to schools in Lincolnshire.   A link to the  ...  view the full minutes text for item 50.

(To receive a report from Simon Evans, Health Scrutiny Officer, which provides the Committee with a summary of the main elements of the workshop held on 18 December 2019 and for consideration to be given to whether any topics should be included in the Committee's work programme)

The Committee gave consideration to a report from the Health Scrutiny Officer, which provided an update from the Workshop held on 18 December 2019 concerning the Annual Report of the Director of Public Health 2019: The burden of Disease in Lincolnshire.

The Committee was asked to consider whether it wished to look any aspects from the Director's Annual Report which could be included as part of the work programme.

RESOLVED

1.    That the report on the Committee's informal workshop meeting held on 18 December 2019 on the Director of Public Health's Annual report on the Burden of Disease in Lincolnshire be noted.

2.    That the local implementation plan of the NHS Long Term Plan which is due to be considered by the Committee, following its publication, be noted.

3.    That the following topics from the Annual Report be included as part of the Committee's work programme:

·         Undiagnosed High Blood Pressure and High Cholesterol;

·         Musculoskeletal Problems; and

·         Cardiovascular Disease.

(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 as detailed on pages 98 and 99 of the report presented.

The Committee was asked to consider a request from the Adults and Community Wellbeing Scrutiny Committee to participate in two workshop sessions on rural and coastal health inequalities.

Suggestions put forward included 111 Service the number of calls per area and the number of patients helped/not helped; and the use of opioids. The Committee was advised that these matters could be included respectively in the out of hours update in March and the further update on the Community Pain Management Service.

RESOLVED

1.    That the work programme presented be agreed subject to the potential inclusion of the items referred to above and those requested at minute numbers 46(1) (2) (3); 47(1) (2); 48(1) (2) (3); 49(2); 50 (1) (2);51(3); and52(2).

2.    That support be given to the request from the Adults and Community Wellbeing Scrutiny Committee for members of the Health Scrutiny Committee for Lincolnshire to participate in two workshop sessions on rural and coastal health inequalities.