Agenda and minutes

Apologies for absence were received from Councillors R H Woolley (Lincolnshire County Council) and P Howitt-Cowan (West Lindsey District Council).

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

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

Councillor Mrs K Cook also advised the Committee that she was currently a patient of Lincolnshire Partnership NHS Foundation Trust.

RESOLVED

That the minutes of the Health Scrutiny Committee for Lincolnshire meeting held on 14 June 2017 be approved and signed by the Chairman as a correct record.

The Chairman welcomed to the Committee, advisors Gary James, Accountable Lincolnshire East Clinical Commissioning Officer and Chris Weston, Consultant in Public Health (Wider Health Determinants).

The Chairman advised the Committee that there were no further updates to those already circulated.  The Committee was however invited to consider whether they wished to respond to any of the proposed GP mergers (Items 2, 3 and 4 of the Chairman's Announcements documents circulated as part of the agenda).

Following a short discussion, it was agreed that a response should be made to Item 2 - The Proposed Merger of GP Surgeries in Coningsby, Louth and Tetford; and that a working group should be established to formulate a response.

Some reference was also made to the additional A & E funding for United Lincolnshire Hospitals NHS Trust.  Confirmation was received that the funding was capital funding for buildings to NHS providers for the provision of Primary Care Streaming Services.  The Committee was also advised that as Grantham Hospital already had primary care provision, they were not eligible for the funding. 

RESOLVED

1.    That the Chairman's Announcements presented be noted.

2.    That a small working group be established to formulate a response to the formal consultation of the proposed merger of GP Surgeries in Coningsby, Louth and Tetford.

(To receive a report from Jan Sobieraj (Chief Executive, United Lincolnshire Hospitals NHS Trust), which advises the Committee of the progress made since the Care Quality Commission (CQC) published its findings on 11 April 2017 following its inspection of United Lincolnshire Hospitals NHS Trust (ULHT) in October 2016.  Jan Sobieraj and Michelle Rhodes (Director of Nursing) will be in attendance for this item)

The Committee gave consideration to a report from Jan Sobieraj, Chief Executive, United Lincolnshire Hospitals NHS Trust, which advised on the progress made since the Care Quality Commission (CQC) had published their findings on 11 April 2017; following a partial inspection at Lincoln County Hospital, Pilgrim Hospital Boston and Grantham Hospital in October 2016; and an unannounced inspection in December 2016 at Pilgrim Hospital Boston.

Details of the CQC ratings for each site were detailed in Appendix A to the report.

The key concerns highlighted by the CQC had related to:-

·         governance, which included serious incident management;

·         medicines management;

·         failure to meet national access standards for A & E; cancer and referral for treatment;

·         identifying vulnerable adults and responding to their care needs;

·         staff morale and managerial supervision; and

·         board level oversight.

It was noted that the Trust had been asked to respond to a number of concerns in a prompt manner.  It was noted further that substantial progress had been made against these issues; and as a result the issues had been incorporated into the Trust's forward plan.  Details of the issues raised and progress made against each issue was contained within the report presented.

Trust representatives expressed their disappointment to the outcomes of the CQC report; but also recognised that the Trust could do better.  It was highlighted that staff shortages within the Trust had resulted in some issues taking longer to resolve.  Despite operational issues, the Trust was making good progress and reassurance was given that if CQC inspectors conducted an inspection now, they would be looking at a different organisation.  Working with partners, the Trust would continue to make progress to improve quality and safety.

During discussion, members of the Committee raised the following points:-

·         Some members felt that the Trust should promote its good working achievements more.  Particular reference was made to 'Surgery', which had achieved good CQC ratings in each category.  Good news stories reflected on Lincolnshire as a whole; and better promotion might help with recruitment going forward.  One member stressed that there was a need to communicate in Plain English to the residents of Lincolnshire.

It was also highlighted that the Trust needed to keep residents aware of what was going on to improve the Trust's CQC ratings; and that this should be conveyed in Plain English also, this would then ensure community buy in.  It was highlighted further that awareness of the CQC's rating evaluation method needed to be defined and communicated better.  Clarification was given that the CQC's 'N/A' in this context meant 'Not Available';

·         The non-inclusion of Delayed Transfers of Care (DTOC).  It was reported that the CQC inspection did not focus on DTOCs; in any event, overall DTOCs were not an issue at the moment.  The percentage was at 4.1%, but had been as low as 3.6%;

·         An explanation of the CQC rating pertaining to 'Maternity and Gynaecology' in relation to Pilgrim Hospital Boston, when the Sustainability & Transformation Plan (STP) had included  ...  view the full minutes text for item 15.

(To receive a report from Simon Evans (Health Scrutiny Officer), which asks the Committee to consider the outcomes of the Working Group held on 14 July 2017; and to finalise the Committee's response to the Lincoln Walk In Centre Consultation. Dr Sunil Hindocha (Chief Clinical Officer from Lincolnshire West CCG) and Wendy Martin (Executive Lead Nurse and Midwife – Quality and Governance) will be in attendance for this item)

The Chairman on behalf of the Committee welcome to the meeting Dr Sunil Hindocha, Chief Clinical Officer, Lincolnshire West Clinical Commissioning (LWCCG) Group and Wendy Martin, Executive Lead Nurse and Midwife Quality and Governance, LWCCG.

The Committee received a short joint presentation from the Chief Clinical Officer LWCCG and the Executive Lead Nurse and Midwife Quality and Governance LWCCG, which provided some background information to the Walk-in-Centre; the alternative services available for urgent and routine primary care requirements; provided information of user groups of the Walk-in-Centre; and provided confirmation concerning the communications campaign.

During discussion, the Committee raised the following comments:-

·         Contract expiry date – The Committee was advised that the contract had already been extended several times previously.  The current contract was due to expire on 30 September 2017.  From the feedback received so far, it had become apparent that very few people were aware of the alternative provision available.  The Committee was advised that urgent access to health services was already available through GP surgeries and NHS 111.  For less urgent health issues, these could be addressed by a routine appointment with a GP, or health advice from a Pharmacy.  If assistance was needed 'Out of Hours' patients would be able to access urgent GP services through calling 111; it was also highlighted that many GP surgeries also ran minor illness clinics which were run by Advanced Nurse Practitioners.  For parents with children, GPs would be providing a separate phone line for them to use. 

It was also reported that 25 GPs had been recruited to Lincolnshire from GP International Recruitment Scheme; seven of whom were now based in practices in the Lincoln area;

·         The financial viability of the proposal and the impact on A & E – Some concern was expressed as to the financial viability of the proposal, as it was suggested that the financial appraisal would follow the consultation.  The Committee was advised if the Walk-in-Centre were to close, national survey data indicated that 20% - 30% of patients stated that in such circumstances they would present themselves to A & E; however evidence from elsewhere, where walk-in-centres had closed, suggested that the actual number presenting to A & E was much lower.  It was highlighted that the LWCCG had realised that there was more to do to educate people not to attend to A & E unless it was an emergency.  The Committee was advised further that actual figures of patients diverting to A & E were estimated as being between 2% – 3%.  It was confirmed that a modelling exercise had been conducted;

·         What happened following the consultation – It was reported that the consultation would now conclude on 18 August 2017.  All comments received would be reviewed and taken in to account for a final recommendation to the Governing Body.  A final decision would be made in September 2017;

·        What alternative provisions would be made if a decision was made to close the Walk-in-Centre – It was highlighted that promotional work of alternative  ...  view the full minutes text for item 16.

(To receive a report from John Brewin (Chief Executive of Lincolnshire Partnership NHS Foundation Trust), which provides the Committee with an overview of the current issues within the Trust, and an update on recent feedback from the CQC re-inspection, current service developments and end of year 2016/17 performance)

Consideration was given to a report from John Brewin, Chief Executive of Lincolnshire Partnership NHS Foundation Trust, which provided the Committee with an overview of the current issues within the Trust, and an update on recent feedback from the Care Quality Commission (CQC) re-inspection.  Ian Jerams, Director of Operations Lincolnshire Partnership NHS Foundation Trust and Jane Marshall, Director of Strategy & Performance Lincolnshire Partnership NHS Foundation Trust were also in attendance at the meeting.

The Committee was advised that the Trust had undergone a full CQC re-inspection in April 2017; and had been rated overall as 'good'.  Details of the particular areas of progress since the initial inspection in 2015 were that:-

·         Services in the 'safe' domain had improved from inadequate;

·         The 'well led' domain had improved to good;

·         The Community Children and Adolescent Services (CAMHS) had continued to be rated as outstanding; and

·         The CQC had noted the transformation across the Trust in a short period of time; resulting in a positively engaged workforce; and good staff morale.

Further information relating to the achievements of the Trust and the measures that contributed to the Trust's improvement were contained in Appendix A to the report.

It was reported that the Service Developments going forward included:-

·         Proposals to address the out of area bed use.  The Committee noted that approximately 300 patients were receiving treatment out of county in 2015/16;

·         That a Psychiatric Intensive Care Unit (PICU) unit had opened earlier in July.  The facility provided ten beds for men with acute and severe illness.  It was highlighted that an equivalent women's unit was proposed to be opened by the end of 2018; and

·         Other developments included a Clinical Decisions Unit, investment in more intensive crisis and home treatment services; and the creation of a community based rehabilitation service.

The report also provided the Committee with details of the Five Year Forward View for Mental Health and Learning Disability, which was a national document that contained key objectives that needed to be in place by 2020/21.  Particular reference was made to the expansion of psychological services, improving access to psychological therapies for both people with long term conditions and children and young people.

It was highlighted that for 2016/17 the Trust had met all its financial targets and the majority of the other performance and quality indicators.  It was highlighted further that as the Trust had recorded a small surplus above the Control Total set by NHS Improvement of c£700k on a budget of £100m, the Trust would receive an additional bonus from the national Sustainability and Transformation Fund, and that this could be used to support on-going capital programmes.

The Committee was advised the most significant target that had not been met related to Delayed Transfers of Care.  It was noted that these had reduced, but remain challenging in older adult services, due to a lack of appropriate placements.

The Chairman on behalf of the Committee congratulated the Trust on its   achievements. 

During discussion,  ...  view the full minutes text for item 17.

(To receive a report from Simon Evans (Health Scrutiny Officer), which invites the Committee to consider and approve a draft statement prepared by the Working Group in relation to which themes in the Lincolnshire Joint Strategic Needs Assessment should be prioritised for inclusion in the Joint Health and Wellbeing Strategy)

Consideration was given to a report from Simon Evans (Health Scrutiny Officer), which provided the Committee with a draft statement from the Working Group established at the 14 June 2017 meeting to select which themes merited prioritisation for the purposes of drafting the revised Joint Health and Wellbeing Strategy.

Attached at Appendix A to the report was a copy of the Working Groups Draft Statement of Prioritisation of the Themes in the Joint Strategic Needs Assessment for Inclusion in the Joint Health and Wellbeing Strategy for the Committee's consideration.

During a short discussion, the Committee agreed to a minor change being made to Appendix A under the heading of Road Traffic Collisions, last sentence being amended to read "They also highlighted the importance of maintenance of road signs to ensure all signage is clearly visible on rural roads in the County"

A request was also made from the Committee for the Joint Health and Wellbeing Strategy to be included in the Committee's future work programme.

RESOLVED

1.      That the statement attached at Appendix A be approved subject to the last sentence under the heading Road Traffic Collisions being amended to read "They also highlighted the importance of maintenance of road signs to ensure all signage is clearly visible on rural roads in the county."

2.    That the Joint Health and Wellbeing Strategy be included as a future item in the Committee's work programme.

(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 that scrutiny activity was focussed where it could be of greatest benefit.

Appendix A to the report provided the work programme from July 2017 to April 2018 for the Committee's consideration.

The Committee was invited to highlight any additional scrutiny activity which could be included for consideration in the work programme.

Items suggested for inclusion by members of the Committee were as follows:-

·         Grantham A & E Department – Overnight Closure – Outcome of Referral to the Secretary of State for Health;

·         North West Anglia NHS Foundation Trust – Update on Peterborough City Hospital and Stamford & Rutland Hospital;

·         Immunisation and Screening;

·         Joint Strategic Needs Assessment;

·         Lincoln Walk-in-Centre – Report on decision made by Lincolnshire West Clinical Commissioning Group;

·         Update on the progress from Lincolnshire Hospitals NHS Trust to be presented to the Committee twice a year (Minute number 15(3) refers); and

·         Update on the Joint Health and Wellbeing Strategy (Minute number 18(2) refers).

RESOLVED

1.    That the items as detailed above be included as future items for consideration in the work programme.