Agenda and minutes

An apology for absence was received from Councillor H Matthews (East Lindsey District Council).

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

RESOLVED

That the minutes of the Health Scrutiny Committee for Lincolnshire meeting held on 18 September 2019 be agreed and signed by the Chairman as a correct record, subject to the word 'Health' at the bottom of page 6 and bottom of page 7 being amended to read 'Healthy'.

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:-

·         Trauma and Orthopaedics; and General Surgery – Information requested by the Committee at the 18 September 2019 meeting;

·         Cancer Performance – Information requested by the Committee at the 18 September 2019 meeting; and

·         Urgent Treatment Centres – Louth and Skegness. 

The Executive Support Councillor for NHS Liaison and Community Engagement updated the Committee with regard to transport arrangements for patients in Skellingthorpe to the Glebe Medical Practice in Saxilby.  The Committee was advised that unless provision was subsidised by the County Council, a bus service between Skellingthorpe and Saxilby was not a viable option.  The Chairman advised the Committee that discussions would need to take place with the County Council's Transport Manager.

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 the East Midlands Ambulance Service NHS Trust Lincolnshire Division, which update the Committee on progress made within the Lincolnshire Division of the East Midlands Ambulance Service.  Mike Naylor, Director of Finance, East Midlands Ambulance Service NHS Trust and Sue Cousland, General Manager – Lincolnshire Division – East Midlands Ambulance Service NHS Trust will be in attendance for this item)

Consideration was given to a report from the East Midlands Ambulance Service (EMAS) NHS Trust Lincolnshire Division, which provided the Committee with an update on the progress made within the Lincolnshire Division of the East Midlands Ambulance Service.

The Chairman welcomed to the meeting Sue Cousland, Lincolnshire Division Manager, EMAS NHS Trust.

The presentation to the Committee made reference to key improvement elements that were being focussed on, which included culture change, leadership, workforce and recruitment, performance, collaborative working and the Divisional Work Plan.  It was highlighted that the Care Quality Commission Inspection - Final Report had indicated a rating for the whole service of 'Good' and a rating of 'Outstanding' for caring.  It was highlighted further that a new Executive Lead Officer had been appointed for Lincolnshire.  The Committee was advised that the Clinical Senior Leadership Team were all working within the area; and that all Senior Leaders had been encouraged to attend a Leadership Programme.  It was highlighted that the area operation management role was being undertaken in the locality, with conversations with staff, for example, taking place in hospital café's.  The Committee noted further that the appraisal process had been reviewed; and that staff were being promoted based on a full assessment of their abilities.

The Committee was advised that the Strategy and Clinical Model had been approved and it was highlighted that a system approach to pre-hospital care was being developed to ensure that alternative pathways were available. 

The presentation indicated that for 2018/19, 116 staff had been recruited.  It was noted that staff turnover rate was between 8% and 10%.  The Committee was advised that for 2019/20 the forecast was for 124 staff being recruited; and that more emphasis was being made on the east of the county.  It was highlighted that there was funding for 2 additional Resource Managers.  The Committee noted that there was also 6 Military Paramedics operating on an honorary contract basis providing more flexibility along the east of the county.

Some reference was made to the Ambulance Response Programme; and the Lincolnshire Trajectories for 2019/20.  It was highlighted that there had been a 12% increase in activity so far during the year.  The presentation also made reference to conveyance information to Emergency Departments by CCG.  The Committee noted that the Lincolnshire West CCG had a number of robust pathways in place, and that work was on-going with the other CCG areas to increase the number of pathways available.  Details of the hospital handover impact on performance were shared with the Committee; and it was highlighted that there had been a loss of 700 hours per week during the July peak, details of which were shown on the slide presented.

The Committee was advised that collaborative working with the Acute Hospitals was on-going; and it was highlighted that a Rapid Handover Protocol had been agreed, which was due to start from 4 November 2019.  Reference was also made to a further co-responder team operating from Wainfleet; and that joint working  ...  view the full minutes text for item 36.

(To receive a report from the Lincolnshire Sustainability and Transformation Partnership, which provides the national and local context regarding Lincolnshire's strategy for cancer; and details of the emerging option for oncology and haematology as part of the Lincolnshire Acute Services Review.  Senior representatives from the Lincolnshire Sustainability and Transformation Partnership will be in attendance for this item)

The Chairman welcomed to the meeting Sarah-Jane Mills, Chief Operating Officer, Lincolnshire West Clinical Commissioning Group, Louise Jeanes, Cancer Care Programme Manager, Lincolnshire West Clinical Commissioning Group, Dr Carl Deaney, Marsh Medical Practice, North Somercotes, and Dr Aurura Sanz-Torres, Consultant Clinical Oncologist and Clinical Director (Oncology and Haematology), United Lincolnshire Hospitals NHS Trust.

The report provided the Committee with an update on Cancer Lincolnshire's Long Term Plan 2019/24, and the vision and strategy for delivering effective and accessible haematology and oncology services for patients in Lincolnshire; it also provided details of the emerging option for oncology and haematology as part of the Lincolnshire Acute Services Review.

It was highlighted in Lincolnshire there were currently 27,500 people living with cancer and that this figure was expected to rise to 45,400 by 2030.  It was highlighted further that cancer prevalence was across the four locality areas and ranged from 2.7% to 3.2% (national average being 2.6%).  The Committee was advised that the most common cancers were Breast, Lung, Colorectal & Prostate and of these, colorectal was the most common cancer in Lincolnshire.  It was highlighted that although survival rate had improved for most cancers, the difference between survival rates for the most survivable cancers and the less survival cancers was significant at 55%.  It was highlighted that the strategy aimed to improve survival rates, and improve early diagnosis and prevention.

The Committee noted that over the next five years the Lincolnshire Sustainability and Transformation Partnership would be working with the East Midland Cancer Alliance provider trusts and McMillan towards building on progress and improvements already made on the Cancer Programme.  Details of the ambitions for survival, screening, early diagnosis, treatment, personalised care and workforce were detailed within the report. 

Reference was also made to interventions to be implemented from 2021 onwards, which included the Lung Health Check Programme, and Rapid Diagnostic Pathways.

The key areas of focus for transformation were detailed on pages 45 and 46 of the report and included improvements to screening, diagnosing cancers earlier and faster, and ensuring that there was universal access to optimal treatment and adopting faster, safer and more precise treatments; and offering personalised care for all patients. 

During discussion, the Committee raised the following issues:-

·         One member enquired why there was a predicted rise in the number of patients with cancer to 45,000 by 2030.  The Committee was advised that this figure was influenced by three factors: the ageing population; earlier diagnosis; and lifestyle choices which included obesity, smoking and alcohol consumption.  Confirmation was given that work was on-going with the public to tackle a number of these long term issues.  It was noted that all the measures to help improve the service would also increase the number of patients.  Details of the benefits of the Case for Change were shown in Section 3 of the report.  An example given to the Committee of smarter working was prostate triage, which involved looking at everyone connected to the process, to ensure that all  ...  view the full minutes text for item 37.

(To receive a report from the Lincolnshire Sustainability and Transformation Partnership, which provides the Committee with an overview of the new service model; and a progress update with regard to the implementation of the mobilisation plan.  Senior representatives from the Lincolnshire Sustainability and Transformation Partnership will be in attendance for this item)

The Chairman advised that Mrs Sandra Harrison, an East Lindsey District Councillor had made a written request to address the Committee concerning the community pain management service.  The Chairman advised further that in accordance with usual practice he had invited Mrs Harrison to speak for a period of 3 minutes to address the issues set out in the report.

In her short statement to the meeting, Mrs Harrison expressed concerns relating to the fact that patients and stakeholders had been misled about the service contracted by the Lincolnshire West CCG to Connect Health.  The Committee was advised there had been poor communication with patients; and some spinal injections were no longer available from the Community Pain Management Service.

The Chairman welcomed to the meeting Sarah-Jane Mills. Chief Operating Officer, Lincolnshire West Clinical Commissioning Group and Dr John Parkin, Executive GP, Lincolnshire West Clinical Commissioning Group to respond to the issues raised.

The Committee was advised that best practice as defined by the National Institute for Health and Care Excellence (NICE) and the British Pain Society had reduced the number of recommended interventions; this included the withdrawal of facet joint injections and acupuncture.  It was highlighted that some epidural type injections were still available for painful conditions such as sciatica.  It was highlighted that the most appropriate care would be informed by clinical need, national guidelines, and shared decision making.  It was highlighted further that the new service brought many additional options for people living with pain, in addition to those treatment currently available.

The report presented provided details of the procurement process, the transition of patients; new referrals; locations; activity; and the challenges of introducing the new service.

The Committee noted that there had been some problems during the transition period, details of which were shown at paragraph 4 of the report.

The Committee was advised that Connect Health had established a Community Pain Management hub in Lincoln and were running 13 clinics across Lincolnshire.  It was highlighted that Connect Health had made repeated attempts to establish premises for a pain service in Stamford, but to no avail.  This had caused some problems with appointments, as staff in the Referral Management Centre were unaware of the geography and infrastructure of Lincolnshire and the challenges the local population faced with regard to transport.

The Committee noted that feedback on the service provided by Connect Health had been variable, details of complaints and compliments were shown on pages 62 and 63 of the report presented.

Reassurance was given that the new service was being proactively managed, with fortnightly operational and monthly contract meetings taking place with Connect Health; support was being provided to patients who were having difficulties with transition to the new provider; and regular contact was being made with Connect Health, to ensure that individual patient concerns are being managed or resolved.

During discussion, the Committee raised the following issues:-

·         One member enquired as to when appointments would be available in Louth.  The Committee was advised that appointments would  ...  view the full minutes text for item 38.

(To receive a report from the Lincolnshire Sustainability and Transformation Partnership, which provides the Committee with an update on the implementation of the Integrated Community Care portfolio.  Senior representatives from the Lincolnshire Sustainability and Transformation Partnership will be in attendance for this item)

The Chairman welcomed to the meeting Sarah-Jane Mills, Chief Operating Officer, Lincolnshire West Clinical Commissioning Group and Dr John Parkin, Executive GP, Lincolnshire West Clinical Commissioning Group. 

The Committee gave consideration to a report from the Lincolnshire Sustainability and Transformation Partnership, which provided an update on the implementation of the Integrated Community Care portfolio; and the progress made in four of the key programme areas, details of which were shown on pages 66 to 69 of the report presented. 

Attached at Appendix A to the report was a copy of a Briefing Document: Understanding Primary Care Networks for the Committee to consider:-

·         Neighbourhood Working;

·         Introduction of Primary Care Networks;

·         Use of Technology; and

·         Development of Specialist Community Services.

The Committee noted that feedback received from Healthy Conversation 2019 had confirmed that local people were asking for care closer to home; for access to services to be a simpler process; and to be able to receive a high standard of care from compassionate professionals.

The Committee was advised that an Integrated Community Care programme was the key enabler to delivering sustainable modern health care.  That alongside the development of Primary Care Networks, neighbourhood working and the upgrading of service models, work was on-going to explore how technology could help enhance local service provision that would enable clinicians to better identify patients who would benefit from proactive interventions.  

In conclusion, the Committee was invited to submit comments to the Lincolnshire Sustainability and Transformation Partnership as part of the Healthy Conversation 2019 engagement exercise.

During discussion, the Committee raised the following comments:-

·         Reference was made to the boundaries for Primary Care Networks (a national initiative) and locally-developed Neighbourhood Teams.  The Committee was advised that there was much similarity, but also some variation, but it was hoped that Primary Care Networks would create greater integration and joint working both across General Practice and other agencies.  Clarification was given that Primary Care Networks were a grouping of local general practices that were able to collaboratively work, sharing staff and expertise, whilst maintaining the independence of individual practices.  Further information relating to Primary Care Networks was contained in Appendix A to the report;

·         Explanation as to the role of a new Clinical Pharmacist with a Primary Care Network, details of which were shown on page 68 of the report;

·         Dates applicable for the phasing in of neighbourhood working.  The Committee was advised that the establishment of neighbourhood teams had started in 2017 (Phase 1) and that Phase 2 had started at the end of 2018 start of 2019.  It was highlighted that Primary Care Networks had been established in July 2019, and that their development was still a work in progress;

·         Clarification was given that communities and clinicians were working together to design services; and

·         The timescale for all neighbourhood teams to be fully functional.  The Committee noted that neighbourhood teams were not all operational and that the phasing in of services was on-going.  It was noted that over the last two years the teams had  ...  view the full minutes text for item 39.

(To receive a joint report from United Lincolnshire Hospitals NHS Trust and the Sustainability and Transformation Partnership, which provides more information for the Committee on the impact of the overnight closure of Grantham A & E.  Senior representatives from United Lincolnshire Hospitals NHS Trust and the Lincolnshire Sustainability and Transformation Partnership will be in attendance for this item)

Pursuant to minute number 30(1) from the meeting held on the 18 September 2019, the Committee gave consideration to a joint report from United Lincolnshire Hospitals NHS Trust and the Lincolnshire Sustainability and Transformation Partnership, which provided the Committee with information on the impact of the overnight closure of Grantham A & E, in the first instance, on Peterborough City Hospital.

Additional information from North West Anglia NHS Foundation Trust had been circulated to members of the Committee for consideration, prior to meeting.  The information circulated provided the Committee with answers to the four questions detailed on pages 94 and 95 of the report.

The Chairman welcomed to the meeting Mark Brassington, Chief Operating Officer, United Lincolnshire Hospitals NHS Trust.

The Committee noted that there was still some ambiguity regarding the figures presented, as a result of differing data collection regimes.

The Chief Operating Officer responded to questions raised, which included the following issues:-

·         The effect of proposed housing development in Grantham on Grantham & District Hospital.  Some members contended that the potential growth of Grantham warranted the need for Grantham A & E to be open 24 hours.  The Committee was reminded that as Grantham Hospital formed part of the Acute Services Review, no changes would happen until after the outcome of the public consultation on Grantham A & E was implemented.  Reassurance was given that housing growth area was considered when looking at sustaining Grantham Hospital; and the Committee noted that work was on-going with the district council concerning future options ;

·         One member reminded the Committee that the reason the Grantham A & E had been closed overnight was on the grounds of patient safety.  The Committee was advised that some doctors had been recruited from overseas; however, as most did not have the required skill set, they were required to undertake a period of training for the General Medical Council as part of the CESR (Certificate of Eligibility for Specialist Registration) programme;

·         A question was asked where patients would be taken if a major trauma incident happened on the A1.  The Committee was advised that patients would be taken to the Queen's Medical Centre, Nottingham, which had been the region's major trauma centre since 2012;

·         Developer contributions under planning legislation – There was some discussion on how the NHS submitted its responses to consultations on local authority planning applications; and

·         A question was asked as to whether consideration would be given to making Grantham an A & E rather than an Urgent Treatment Centre.  The Committee was advised that at present, there were no plans for Grantham to become an A & E.  The Lincolnshire NHS's preferred option was for an Urgent Treatment Centre in Grantham.

On behalf of the Committee the Chairman extended thanks to the Chief Operating Officer for his update; and advised that the information presented would be noted; including the assurance that the impact of the overnight closure would be managed until such time as the outcome of the public consultation was implemented.  A request was also made  ...  view the full minutes text for item 40.

(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 103 to 106 of the report presented.

The Committee put forward the following suggestions:-

·         Out of Hours Services, including 111 (Integrated Urgent Care); and

·         Louth Hospital Inpatient Services.

RESOLVED

That the work programme presented be agreed subject to the potential inclusion of the items referred to above and those requested at minute numbers 36 (1)(2), 38, 39(2), and 40(3).