Agenda item

(To receive a report from United Lincolnshire Hospitals NHS Trust, which provides an update to the papers presented to the Committee on 16 May, 13 June and 11 July 2018 in relation to the difficulties and challenges caused by a severe shortage of doctors and nurses within the children's and young person's services at Pilgrim Hospital Boston)

The Chairman welcomed to the meeting the following representatives from United Lincolnshire Hospitals NHS Trust:-

·         Jan Sobieraj, Chief Executive, United Lincolnshire Hospitals NHS Trust;

·         Michelle Rhodes, Director of Nursing, United Lincolnshire Hospitals NHS Trust;

·         Dr Neill Hepburn, Medical Director, United Lincolnshire Hospitals NHS Trust; and

·         Jeff Worrall, Delivery and Improvement Director, NHS Improvement.

The Chairman also welcomed Alison Marriott, (member of the public) to the Committee.  The Chairman invited Alison to speak for up to three minutes to the Committee. 

The Committee was advised that Alison Marriott represented SoS Pilgrim Hospital, a community group of approximately 10,000 people, which had been started in 2016 to help save services at Pilgrim Hospital, Boston.

It was highlighted that the SoS for Pilgrim Hospital's particular focus was maternity, neonatal and children's services.  The Committee was advised by the representative of SoS for Pilgrim Hospital that the current "interim model" for children's and neonatal services at Pilgrim Hospital was unacceptable and avoidable.  The Committee was advised further that the downgrades were a precursor to permanent removal or diminishing of services under the Sustainability and Transformation Partnership (STP).  It was highlighted that the STP in its current form had been rejected by Lincolnshire County Council in December 2016.  It was stated that the current downgrades to Pilgrim paediatrics and neonatal services all echoed the 2016 STP.

Concerns were also expressed to the lack of consultation undertaken; the impact the changes were having on children and families; and the potential safety impacts if services were to be removed. 

The Chairman invited the representatives from United Lincolnshire Hospitals NHS Trust to make their presentation to the Committee.

The Committee received an update report on the Trust's response to address the difficulties and challenging situations caused in the children's and young person's services at Pilgrim Hospital, Boston, as a result of the shortage of doctors and nurses.  Clarification was given that the report was not a Sustainable Transformation Partnership item.

It was highlighted that the model of care as described in the report presented to the Health Scrutiny Committee for Lincolnshire on 11 July 2018, had been implemented on 6 August 2018.  The Committee noted that the model of care comprised of:-

·         An enhanced paediatric presence in the Pilgrim Hospital Emergency Department, an acute assessment unit with a 12 hour length of stay; and confirmation was given that outpatient clinics and surgery were continuing at Pilgrim Hospital;

·         The commissioning of two private, paramedic crewed ambulances to transfer any patients who needed longer admission; and

·         The increased gestational age for delivery from 30 to 34 weeks. 

The Committee was advised that in the first five weeks 50 patients had been transferred; and that there had been no issues with transfers; and that the paramedics had also undertaken duties in the emergency department.  Overall, the Trust was confident that the model was working well; and that the risks were being monitored carefully.

It was highlighted that the recruitment position remained as it had been in previous months; and that the Clinical Directorate continued to work with medical agencies, irrespective of financial costs, to find agency and locum medical staff to support the rota at Pilgrim Hospital, Boston to keep services running safely.

It was reported that a full financial assessment for the project had been completed; and the total impact of the new service model until December 2018 was £1.75m, with loss in income accounting for 21%; pay accounting for 53%; and non-pay accounting for 26% of the projected costs.

It was reported further that contingency plans continued to be developed; as was the communications plan.

Attached to the report for the Committee's consideration were the following Appendices:-

Appendix A - Report to United Lincolnshire NHS Trust Board of Directors (30 August 2018), which comprised of the following:-

Appendix 1 – Financial Impact Assessment of the Interim Paediatric Service Model at Pilgrim Hospital;

Appendix 2 – Project Risk Register;

Appendix 3 - Contingency Plans;

Appendix 4 - Responses to Questions raised by Health Scrutiny Committee in July 2018; and

Appendix 5 – Rotas.

During discussion, the Committee raised the following points:-

·         Recruitment of middle grade doctors from overseas – The Committee was advised that recruitment was a national issue and confirmation was given that the Trust had worked with international agencies, but with limited success; and that the Trust was exploring other models to recruit to fill vacancies.  One member also raised the need to ensure that Lincoln Hospital remained a main hospital to support the university; which would then encourage doctors to work at Lincoln and help Lincoln Hospital become a centre of excellence.  The Committee was advised that all hospitals had to maintained to a standard; and that Lincolnshire had three significant hospitals, each having areas of expertise.  The Committee was also advised that staff leaving the Trust did receive exit interviews; and confirmation was given that some of the training for middle grade doctors was not available in Lincolnshire, and as a result doctors moved elsewhere to complete their professional training;  

·         Whether children were moved following a 12 hour period of stay.  The Committee was advised that 12 hours was only a guideline and the length of stay would be applied clinically and would be assessed dependent on the patient's needs;

·         One member asked for confirmation that there were two ambulances.  The Committee was advised that one ambulance was 24/7; the other ambulance worked 12 hours to cover busy periods.  A  question asked was of the 46 children who had gone to other hospitals, how long had the children had spent in other hospitals? A further question raised was out of the 50 patients transferred had there been any waiting time?   The Trust advised that this information would need to be gathered.  The Committee was reminded that two ambulances had been specially commissioned;

·         Some concern was expressed as to the effectiveness of the interim arrangements and to the recruitment issues.  Reassurance was given that the Trust would not compromise patient care; and that work continued in relation to other working models;

·         One member requested a revised list of acronyms;

·         One member also highlighted that communication was improving, particularly in GP surgeries and that sometimes there was an overload as to the number of notices put out.  The Trust confirmed that they had no responsibility for GP surgeries;

·         The need to communicate better with the Boston community.  The Trust confirmed that the event held at the Boston West Golf Club had not been a Trust event;

·         Project Risk Register – Why the two ambulances for children and pregnant women might be reduced.  It was reported that that the risk register at Appendix 2 was now out of date and circumstances over the last few weeks had identified that the ambulances had not been required as much as initially thought.  Confirmation was given that the private ambulances were additional and EMAS ambulances were still available if needed.  The Committee noted that the new ambulances were specifically equipped and were manned by paramedics; and if there was serious medical need, a consultant would travel with the patient in the ambulance.

Whether there had been an increase in the number of young people between the ages of 14 – 16 being cared for on adult wards.  The Committee was advised that this information was not available at the moment.

Whether the 111 service were signposting paediatric patients to Lincoln and Peterborough.   Confirmation was given that the 111 service had not been instructed to change their original brief.

Whether Lincoln and Peterborough had been full during the last few weeks, as this gave rise to concerns with winter approaching. Confirmation was given that the Rain Forest Ward had been full for a couple of hours only, which had not been caused any operational issues;

·         The role of NHS Improvement in the development of both the interim service model and the contingency plan;  It was noted that NHS Improvement had offered support and guidance to the development of the service model and the contingency plan;

·         Whether any risks were anticipated with the interim model over the coming months.  The Committee was advised that there were risks associated with workforce issues; and that these would be dealt with as and when they occurred;

·         What the mid to long term plan was to ensure that enough middle grade Doctors and Paediatric Nurses were recruited and whether any long term changes would be subject to full consultation with the Committee and the public.  The Committee was advised that as mentioned previously the Trust had been out to the international market; and if the applicants were committed then assessments would be made on their language skills and support would be given to help them upskill.  It was noted that the UK required a very high standard for clinicians;

·         Outcome of the engagement sessions in Boston; and whether any consideration had been given to holding such events in larger supermarkets in Boston.  It was noted that engagement events had taken place which had targeted children's groups, of which there was a long list along the east coast.  It was confirmed that events at supermarkets had not been very been positive. It was noted that the main issues of concern raised so far relating to chronic conditions over the winter period;

·         Concerns  were still expressed regarding the contingency plan in the following areas:- how children and expectant mothers would be transported to the next nearest hospital within a safe level of time; how such patients will be returned home after displacement; and what arrangements would be made for parents or partners to travel with patients and then get home.  It was confirmed that in situation when families were required to go out of Lincolnshire, the Trust was not able to find transport for families.  It was highlighted that work was on going with Carers UK to see if they were able to offer any support.  Confirmation was given that outpatient appointments were kept local.  A further request was made for further information regarding the length of stay of children in Boston hospital; and also the length of stay children stayed in other hospitals;

·         Reference to the closure of wards - Clarification was given that the wards were not closing, they were just being vacated to allow asbestos removal to be undertaken. 

The Chairman extended thanks to the ULHT representatives.

RESOLVED

1.    That the update report concerning the interim plan be noted.

2.    That an update report be received from United Lincolnshire Hospitals NHS Trust at the November meeting, which should include a developed contingency plan, to include solutions to the points raised by the Health Scrutiny Committee for Lincolnshire.